Incidence, Time Course and Predictors of Impairments Relating to Caring for the Profoundly Affected arm After Stroke: A Systematic Review.
Rhoda Allison, Laura Shenton, Kathryn Bamforth and 2 others
PMID 26015292WHAT IT FOUND
No included study predicted difficulty caring for the arm after stroke.
Spasticity and pain appeared as early as 1 week, and contracture by 2 weeks. Weakness and reduced motor control predicted spasticity and contracture; reduced sensation, shoulder subluxation, weakness, and stroke severity predicted pain.
Key findings
01No included study evaluated the natural course or predictors of difficulty caring for the arm after stroke in a systematic way.
02In people with hemiplegia, arm spasticity ranged from 33% to 78%, shoulder pain affected 22% to 90%, and arm contracture was present in at least 50%.
03Weakness and reduced motor control were the most consistent predictors of spasticity and contracture; reduced sensation, shoulder subluxation, weakness, and stroke severity were the most common predictors of pain.
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
No included study measured difficulty caring for the arm as a separate outcome, so the review cannot say which patients will have trouble with arm care. The included studies varied widely in population, time since stroke, and outcome measures, so the authors could not combine the results statistically. Many studies used pain and spasticity measures with limited reliability or validity, and some pain tools may not work well for people with stroke. None of the studies specifically targeted people with a profoundly affected arm, so the findings apply more broadly to people with arm weakness after stroke. The search excluded non-English studies, children, case reports, case series, and laboratory or imaging predictors, which may have left relevant evidence out. Predictors such as sensation were not measured in a consistent way, so confidence in some risk factors is limited.
Declared interests
The authors report no declarations of interest.
The easy way to misread this
Do not read the reported incidence ranges or risk factors as proof that these impairments cause difficulty caring for the arm. No included study measured difficulty caring for the arm in a systematic way, and many predictor measures had limited reliability.