Efficacy of Physical Modalities for Hemiplegic Shoulder Pain After Stroke: A Systematic Review.

The review could not combine trials into one overall estimate because the modalities, doses, patient groups and outcome measures differed too much. The trials were small, with 12 studies and 567 participants total. All trials were judged at high risk of bias for outcome measurement because assessors were likely aware of group allocation. Allocation concealment and blinding of participants and personnel were major concerns. Seven of 12 trials gave the physical modality together with physiotherapy, so the effect of the modality alone cannot be separated. Harms were reported in only 5 of 12 trials, so safety cannot be assumed from the trials that did not mention them. Only 5 of 12 studies had follow-up assessments, limiting long-term conclusions. English-language trials only, so relevant evidence may have been missed.

The work was funded by the University of Foggia under the Research Project of Ateneo program, 2024. The authors declared no conflict of interest.

Do not conclude that physical modalities are proven treatments for hemiplegic shoulder pain after stroke. The review found some pain reductions, but the evidence was very low certainty, many trials gave the modality together with physiotherapy, and outcome assessors were likely aware of group allocation.