A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients.
Ruihuan Pan, Mingchao Zhou, Hao Cai and 7 others
PMID 28629270WHAT IT FOUND
Stroke patients who used a modified wheelchair arm-support in addition to positioning, passive therapy, Western and Chinese medicine and ordinary wheelchair care had lower pain scores at 12 weeks, but not at 4 weeks.
The support was not tested alone.
Key findings
01Pain scores did not differ significantly at 4 weeks, but at 12 weeks the support group had a median score of 0.00 versus 3.00 in controls (P = 0.000).
02Among patients without prior shoulder pain, new pain occurred in 4.00% of the support group and 30.00% of the control group (P = 0.034).
03Daily living independence scores were significantly higher in the support group at 4 weeks (55.00 vs 43.00) and 12 weeks (78.50 vs 54.00).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The device was too large to conceal, so participants and therapists knew who received it; this can bias pain reporting. Both groups received multiple routine treatments, including positioning, passive rehabilitation, Western and Chinese medicine and ordinary wheelchair care, so the arm-support alone cannot be isolated. Follow-up assessment was by telephone rather than face-to-face, and upper limb movement scores were excluded at 12 weeks because of possible bias. The study did not test earlier or later intervention timing, or different shoulder pain causes, so the best patient and time point are unknown. Pain was measured with two different scales, which may introduce measurement bias. The sample excluded spasticity-related shoulder pain, so results apply mainly to flaccid hemiplegia. The report gives different numbers for analysis: 114 completed (58 treatment, 56 control), while tables show 60 per group. Quality of Life Index is described as a 0 to 5 scale, but 12-week medians are 7.00 and 6.00.
Declared interests
The authors declared no potential conflicts of interest. The study was supported by the Guangdong Science and Technology Department.
The easy way to misread this
Do not conclude the arm-support alone reduced pain or prevented shoulder pain. It was added to routine positioning, passive rehabilitation, Western and Chinese medicine, and ordinary wheelchair care, and the trial was single-blind.