title: Incidence and associations of hemiplegic shoulder pain poststroke: prospective population-based study.
abstract: OBJECTIVE
  To provide an epidemiological perspective of the clinical profile, frequency, and determinants of poststroke hemiplegic shoulder pain.
  
  
  METHODS
  A prospective population-based study of an inception cohort of participants with a 12-month follow-up period.
  
  
  METHODS
  General community and hospital within a geographically defined metropolitan region.
  
  
  METHODS
  Multiple ascertainment techniques were used to identify 318 confirmed stroke events in 301 individuals. Among adults with stroke, data on shoulder pain were available for 198 (83% of the survivors) at baseline and for 156 and 148 at 4 and 12 months, respectively.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Subjective reports of onset, severity, and aggravating factors for pain and 3 passive range-of-motion measures were collected at baseline and at 4- and 12-month follow-up.
  
  
  RESULTS
  A total of 10% of the participants reported shoulder pain at baseline, whereas 21% reported pain at each follow-up assessment. Overall, 29% of all assessed participants reported shoulder pain during 12-month follow-up, with the median pain score (visual analog scale score=40) highest at 4 months and more often associated with movement at later time points. Objective passive range-of-motion tests elicited higher frequencies of pain than did self-report and predicted later subjective shoulder pain (crude relative risk of 3.22 [95% confidence interval, 1.01-10.27]).
  
  
  CONCLUSIONS
  The frequency of poststroke shoulder pain is almost 30%. Peak onset and severity of hemiplegic shoulder pain in this study was at 4 months, outside of rehabilitation admission time frames. Systematic use of objective assessment tools may aid in early identification and management of stroke survivors at risk of this common complication of stroke.
authors.affiliation: Department of Rehabilitation and Aged Care, Flinders University of South Australia, Adelaide, South Australia, Australia. Electronic address: zoe.adey-wakeling@health.sa.gov.au.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Adey-Wakeling
authors.affiliation: Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: Department of Rehabilitation and Aged Care, Flinders University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
authors.affiliation: Lyell McEwin Health Service and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Leyden
authors.affiliation: Lyell McEwin Health Service and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kleinig
authors.affiliation: Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
authors.affiliation: Faculty of Health Sciences, Discipline of Rural Health, School of Population Health, University of Adelaide, Adelaide, Australia.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Newbury
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain; D005260:Female; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology; D020069:Shoulder Pain / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D020521:Stroke / Q000150:complications*; D013997:Time Factors
keywords: Epidemiology; Hemiplegia; Pain; Rehabilitation; Shoulder; Stroke