title: Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review.
abstract: OBJECTIVE
  To determine whether shoulder orthoses prevent or reduce gleno-humeral subluxation and hemiplegic shoulder pain.
  
  
  METHODS
  OVID SP, MEDLINE, AMED, CINAHL, PEDro and the Cochrane Central Register of Controlled Trials.
  
  
  METHODS
  We included: randomised or quasi-randomised controlled trials, controlled before and after studies and observational studies. Two reviewers independently screened, critically appraised papers using the PEDro tool, and extracted data. A descriptive synthesis was performed as there were insufficient data for meta-analysis.
  
  
  RESULTS
  Eight studies were included, totalling 186 participants: One randomised controlled trial with 41 participants, one quasi-randomised with 14 participants, one before and after controlled study with 40 participants and five observational studies with 91 participants met the inclusion criteria. Findings suggest that applying an orthosis to an already subluxed shoulder immediately reduced vertical subluxation on X-ray but improvements were not maintained when orthosis was removed. Orthoses with both proximal and distal attachments improved shoulder pain in the majority of stroke patients when worn for four weeks (starting several days or weeks post-stroke). There was no increase in adverse effects of contracture, spasticity or hand oedema when compared to no orthosis. Orthoses were generally well-tolerated and most patients rated the orthosis as comfortable to wear.
  
  
  CONCLUSIONS
  Observational studies suggest that orthoses reduce vertical subluxation whilst in-situ. Available evidence from heterogeneous studies after stroke suggests that orthoses may reduce pain and are well-tolerated with prolonged use. No studies have tested whether subluxation and pain can be prevented by immediate post-stroke application of orthoses.
authors.affiliation: 1 St George's University Hospitals NHS Foundation Trust, Neurosciences/Therapies, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Nadler
authors.affiliation: 2 St George's University of London, Neurosciences, UK.
authors.forename: Mmh
authors.initials: M
authors.lastname: Pauls
mesh_terms: D006429:Hemiplegia / Q000150:complications / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D009989:Orthotic Devices; D017063:Outcome Assessment, Health Care; D012783:Shoulder Dislocation / Q000209:etiology / Q000517:prevention & control* / Q000534:rehabilitation; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control* / Q000534:rehabilitation; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation / Q000295:instrumentation / Q000379:methods*
keywords: Stroke; orthoses; rehabilitation; shoulder pain; subluxation