This review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patients and analyzes the reliability and validity of clinical evaluation and the effectiveness of different treatment approaches. GHS, a common complication of stroke, can be considered an important risk factor for shoulder pain and other problems. GHS is a complex phenomenon, and its pathomechanics are not yet fully understood. Radiographic measurements are considered the best method of quantifying GHS. Clinical evaluation can be useful as screening assessment. Functional electrical stimulation and strapping are effective in an acute stage of hemiplegia; some types of slings have been shown to be effective and may be used together with other strategies. Abbreviations: FES = functional electrical stimulation, GHJ = glenohumeral joint, GHS = glenohumeral subluxation, SP = shoulder pain. This material is the result of work supported with resources and the use of facilities at the University of Florence. * References are listed in "References" section of main body text. † Paci M, Nannetti L, Baccini M, Pasquini J, Rinaldi LA, Taiti PG. Shoulder subluxation after a stroke: relationships with pain and motor recovery. Physiother Res Int. Unpublished observations. Note: Numbers in parentheses indicate range. NA = not available (mean, range, or both), AP = anteroposterior view. * Paci M, Nannetti L, Baccini M, Pasquini J, Rinaldi LA, Taiti PG. Shoulder subluxation after a stroke: relationships with pain and motor recovery. Physiother Res Int. Unpublished observations.

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GHS is a factor associated with shoulder pain development and with arm motor recovery and should be treated in the acute stage of hemiplegia.

Objective. Physiotherapy is usually provided only in the first few months after stroke, while its effectiveness and appropriateness in the chronic phase are uncertain. We conducted a systematic review and meta-analysis of randomized clinical trials (RCT) to evaluate the efficacy of physiotherapy interventions on motor and functional outcomes late after stroke. Methods. We searched published studies where participants were randomized to an active physiotherapy intervention, compared to placebo or no intervention, at least 6 months after stroke. Outcome was change in mobility and activities of daily living (ADL) independence. Quality of trials was evaluated using the PEDro scale. Findings were summarized across studies as effect size (ES) or, whenever possible, weighted mean difference (WMD) with 95% confidence interval (CI) in random effects models. Results. Fifteen RCT were included, enrolling 700 participants with follow-up data. The meta-analysis of primary outcomes from the original studies showed a significant effect of the intervention (ES 0.29, 95% CI 0.14-0.45). Efficacy of the intervention was particularly evident when short-and long-distance walking (SDW, LDW) were considered as separate outcomes, with WMD of 0.05 m/sec (95% CI 0.008-0.088) and 20 m (95% CI 3.6-36.0), respectively. Also ADL improvement was greater, though non-significantly, in the intervention group. No significant heterogeneity was found. Interpretation. A variety of physiotherapy interventions improve functional outcomes even when applied late after stroke. These findings challenge the concept of a plateau in functional recovery of patients that had experienced stroke and should be valued in planning community rehabilitation services.