title: Evidence for therapeutic interventions for hemiplegic shoulder pain during the chronic stage of stroke: a review.
abstract: OBJECTIVE
  To determine the effectiveness of therapeutic interventions targeting hemiplegic shoulder pain (HSP) more than 6 months post stroke.
  
  
  METHODS
  A literature search of multiple databases (PubMed, CINAHL, Ovid, and EMBASE) was conducted to identify articles published in the English language from 1980 to April 2012. Studies were included if (1) all participants were adults who had sustained a stroke; (2) research design was a randomized controlled trial (RCT) that examined the effectiveness of any treatment for HSP; (3) all participants had experienced stroke at least 6 months previously; and (4) an assessment of pain had been conducted before and after treatment using a standardized method. The following data were extracted: patient characteristics (ie, age, gender, time since stroke), sample size, study design, measurement of pain pre and post treatment, and adverse events.
  
  
  RESULTS
  Ten RCTs (PEDro scores 4-9) met inclusion criteria and included a total sample size of 388 individuals with a mean age of 53.2 years (range, 43.6-73.2). Mean time post stroke was 18.4 months. Three studies addressed the use of botulinum toxin type A (BTx-A); 2 studies examined electrical stimulation; 3 studies focused on intraarticular glenohumeral corticosteroid injections; 1 studied subacromial corticosteroid injections; and 1 study looked at massage therapy.
  
  
  CONCLUSIONS
  Positive outcomes were noted with the use of corticosteroid injections and electrical stimulation and conflicting results were seen regarding the use of BTx-A. Overall, these targeted therapies provide benefit in the treatment of HSP in individuals who are more than 6 months post stroke.
authors.affiliation: St. Joseph's Health Care, Parkwood Hospital, London, Ontario, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Viana
authors.forename: Shelialah
authors.initials: S
authors.lastname: Pereira
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.forename: Thomas
authors.initials: T
authors.lastname: Miller
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002908:Chronic Disease; D016208:Databases, Factual / Q000706:statistics & numerical data; D004599:Electric Stimulation Therapy; D005260:Female; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000150:complications / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008405:Massage / Q000379:methods; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000150:complications / Q000209:etiology / Q000628:therapy; D020521:Stroke / Q000150:complications*
chemical_list: D000305:Adrenal Cortex Hormones; D019274:Botulinum Toxins, Type A