title: Persistent shoulder pain in the first 6 months after stroke: results of a prospective cohort study.
abstract: OBJECTIVE
  To identify factors associated with persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke.
  
  
  METHODS
  Prospective inception cohort study.
  
  
  METHODS
  Stroke units of 2 teaching hospitals.
  
  
  METHODS
  Patients (N=31) with a clinical diagnosis of stroke.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  The development of pPSSP within the first 6 months after stroke. Clinical assessment of motor, somatosensory, cognitive, emotional, and autonomic functions, undertaken within 2 weeks (t0), at 3 months (t1), and at 6 months (t2) after stroke.
  
  
  RESULTS
  Patients with pPSSP (n=9) were compared with patients without pPSSP (n=22). Bivariate logistic regression analyses showed that pPSSP was significantly associated with impaired voluntary motor control (t0, t1, t2), diminished proprioception (t0, t1), tactile extinction (t0), abnormal sensation (t1, t2), spasticity of the elbow flexor muscles (t1, t2), restricted range of motion (ROM) for both shoulder abduction (t2) and shoulder external rotation (t1, t2), trophic changes (t1), and type 2 diabetes mellitus (t0).
  
  
  CONCLUSIONS
  These findings suggest a multifactorial etiology of pPSSP. The association of pPSSP with restricted, passive, pain-free ROM and signs indicative of somatosensory sensitization may implicate a vicious cycle of repetitive (micro)trauma that can establish itself rapidly after stroke. Intervention should therefore be focused on maintaining and restoring joint ROM as well as preventing injury and somatosensory sensitization. In this perspective, strategies that aim to intervene simultaneously at various levels of function can be expected to be more effective than treatment directed at merely 1 level.
authors.affiliation: Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands. meyke.roosink@gmail.com
authors.forename: Meyke
authors.initials: M
authors.lastname: Roosink
authors.forename: Gerbert J
authors.initials: GJ
authors.lastname: Renzenbrink
authors.forename: Jan R
authors.initials: JR
authors.lastname: Buitenweg
authors.forename: Robert T
authors.initials: RT
authors.lastname: Van Dongen
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Geurts
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: IJzerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity; D010148:Intractable Pain / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012307:Risk Factors; D020069:Shoulder Pain / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D020886:Somatosensory Disorders; D020521:Stroke / Q000150:complications*