title: Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life.
abstract: OBJECTIVE
  To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia.
  
  
  METHODS
  Prospective, open label design.
  
  
  METHODS
  The outpatient services of a large teaching rehabilitation hospital in The Netherlands.
  
  
  METHODS
  Fifteen stroke survivors with chronic (> six months) hemiplegia and a therapy-resistant painful shoulder with subluxation. All patients suffered from clinically relevant shoulder pain, as assessed by a score of at least 4 out of 10 on a numerical rating scale. Shoulder subluxation was indicated by at least 1/2 fingerbreadth of glenohumeral separation on palpation.
  
  
  METHODS
  Six hours of P-NMES per day for a total of six weeks.
  
  
  METHODS
  Shoulder pain (Brief Pain Inventory), shoulder subluxation (clinical and radiographic), shoulder pain-free external rotation (hand-held goniometer), motor impairment (Fugl-Meyer Motor test) and quality of life (SF-36) were assessed before treatment, after six weeks of intramuscular stimulation, at three months and six months follow-up.
  
  
  RESULTS
  A significant reduction in pain was found on the Brief Pain Inventory. Pain reduction was still present at six months follow-up. All domains, in particular bodily pain, of the SF-36 showed improvement in the short term. After six months of follow-up, bodily pain was still strongly and significantly reduced, whereas social functioning and role physical demonstrated a nonsignificant improvement of more than 10% compared with baseline.
  
  
  CONCLUSIONS
  This pilot suggests that P-NMES potentially reduces shoulder pain in chronic hemiplegia. To establish the clinical value of P-NMES in treating hemiplegic shoulder pain a randomized controlled trial is needed.
authors.affiliation: Roessingh Research and Development and Rehabilitation centre Het Roessingh, Enschede, The Netherlands. g.renzenbrink@roessingh.nl
authors.forename: Gerbert J
authors.initials: GJ
authors.lastname: Renzenbrink
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: IJzerman
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D012783:Shoulder Dislocation / Q000150:complications; D020069:Shoulder Pain / Q000209:etiology / Q000534:rehabilitation*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*