title: Incidence, Time Course and Predictors of Impairments Relating to Caring for the Profoundly Affected arm After Stroke: A Systematic Review.
abstract: OBJECTIVE
  A significant number of stroke survivors will not recover the use of their affected arm. A proportion will experience pain, stiffness and difficulty with basic care activities. The purpose of the review was to identify predictors of difficulty caring for the profoundly affected arm and establish the incidence and time-course of the related impairments of pain, spasticity and contracture.
  
  
  METHODS
  Data sources: Databases (PubMED, MEDLINE, AMED, EMBASE, CINAHL and the Cochrane Controlled Trials Register) were searched from inception to December 2013. Additional studies were identified from citation tracking.
  
  
  METHODS
  Independent reviewers used pre-defined criteria to identify eligible studies. Quality assessment and risk of bias were assessed using the McMasters Assessment Tool. A narrative evidence synthesis was performed.
  
  
  RESULTS
  Thirty-nine articles reporting 34 studies were included. No studies formally measured difficulty caring for the arm, but related impairments were common. Incidence of spasticity in those with weakness ranged from 33% to 78%, shoulder pain affected 22% to 90% and contracture was present in at least 50%. Spasticity and pain appear within 1 week of stroke, and contracture within two weeks. Impairments continued to develop over at least 3-6 months. The most frequent predictors of spasticity and contracture were weakness and reduced motor control, and the risk of pain is most commonly predicted by reduced sensation, shoulder subluxation, weakness and stroke severity.
  
  
  CONCLUSIONS
  There is no published evidence on predicting the likelihood of difficulty caring for the arm following stroke. However, the related impairments of spasticity, pain and contracture are common. Given the time-course of development, clinicians may need not only to intervene early but also be prepared to act over a longer time period. Further research is needed to examine difficulty caring for the arm and the relationship with associated impairments to enable researchers and clinicians to develop targeted interventions. © 2015 The Authors. Physiotheraphy Research International Published by John Wiley & Sons Ltd.
authors.affiliation: Stroke Service, Newton Abbot Hospital, Torbay and Southern Devon Health and Care Trust, Newton Abbot, UK.
authors.forename: Rhoda
authors.initials: R
authors.lastname: Allison
authors.affiliation: Stroke Service, Newton Abbot Hospital, Torbay and Southern Devon Health and Care Trust, Newton Abbot, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Shenton
authors.affiliation: Stroke Service, Newton Abbot Hospital, Torbay and Southern Devon Health and Care Trust, Newton Abbot, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Bamforth
authors.affiliation: Brunel University London, Centre for Research in Rehabilitation, London, UK.
authors.forename: Cherry
authors.initials: C
authors.lastname: Kilbride
authors.affiliation: Mood Disorders Centre, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
authors.forename: David
authors.initials: D
authors.lastname: Richards
mesh_terms: D004185:Disability Evaluation; D019468:Disease Management; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009128:Muscle Spasticity / Q000534:rehabilitation; D009788:Occupational Therapy / Q000379:methods; D010291:Paresis / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D020069:Shoulder Pain / Q000503:physiopathology / Q000534:rehabilitation; D000071939:Stroke Rehabilitation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity
keywords: disability; pain; spasticity; stroke