Supportive devices for preventing and treating subluxation of the shoulder after stroke

Abstract

Background: Supportive devices such as slings, wheelchair attachments and orthoses have been used to treat subluxation of the shoulder after stroke.

Objectives: To investigate the effect of supportive devices in preventing subluxation, re-positioning the head of humerus in the glenoid fossa, decreasing pain, increasing function and adversely increasing contracture in the shoulder after stroke.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched on 22 March 2004). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2004), MEDLINE (1966 to March 2004), CINAHL (1982 to March 2004), EMBASE (1974 to March 2004), AMED (1985 to March 2004) and the Physiotherapy Evidence Database (PEDro, March 2004). We also handsearched conference proceedings and contacted authors for additional information.

Selection criteria: Studies were included if they were: randomised, quasi-randomised or controlled trials; participants had a stroke; intervention was supportive devices; and subluxation, pain, function or contracture were measured.

Data collection and analysis: Two independent reviewers examined the identified studies which were assessed for methodological quality and analysed as (1) supportive devices versus no supportive devices or (2) two supportive devices.

Main results: Four trials (one on slings, three on strapping - 142 participants) met the inclusion criteria. One trial testing a hemisling versus no device reported that no participants had subluxation greater than 10 mm, the same number had lost more than 30 degrees of shoulder external rotation (Peto odds ratio (OR) = 1.00, 95% confidence interval (CI) 0.1 to 9.3), and more participants in the hemisling group had pain (Peto OR = 8.7, 95% CI 1.1 to 67.1). The other three showed that strapping was effective in delaying the onset of pain (weighted mean difference (WMD) = 14 days, 95% CI 9.7 to 17.8), but was ineffective in reducing pain severity (WMD = -0.7 cm on a visual analogue scale, 95% CI -2.0 to 0.7), increasing upper limb function (WMD = 0.8, 95% CI -1.5 to 3.1) or affecting the degree of contracture (WMD = -1.4 degrees, 95% CI -10.9 to 8.1) at the shoulder.

Authors' conclusions: There is insufficient evidence to conclude whether slings and wheelchair attachments prevent subluxation, decrease pain, increase function or adversely increase contracture in the shoulder after stroke. There is some evidence that strapping the shoulder delays the onset of pain but does not decrease it, nor does it increase function or adversely increase contracture.

Conflict of interest statement

None known

Figures

1

Means and 95% CIs for the immediate reduction in subluxation (mm) with the use of supportive devices in an already subluxed shoulder. The vertical dotted line represents the average subluxation before applying supportive devices (calculated across the 4 studies)

1.1. Analysis

Comparison 1 Supportive devices versus no supportive devices, Outcome 1 Pain (number of participants with pain).

1.2. Analysis

Comparison 1 Supportive devices versus no supportive devices, Outcome 2 Pain (number of pain free days after admission to study).

1.3. Analysis

Comparison 1 Supportive devices versus no supportive devices, Outcome 3 Pain (over previous 24 hours on a 10 cm visual analogue scale post intervention).

1.4. Analysis

Comparison 1 Supportive devices versus no supportive devices, Outcome 4 Function (summation of Items 6, 7, 8 of the Motor Assessment Scale (score 0‐18) post intervention).

1.5. Analysis

Comparison 1 Supportive devices versus no supportive devices, Outcome 5 Contracture (number of participants with > 30° loss of shoulder external rotation).

1.6. Analysis

Comparison 1 Supportive devices versus no supportive devices, Outcome 6 Contracture (degrees of shoulder external rotation post intervention).