A Multicenter Cross- Sectional Survey on Physiotherapy Treatment Practices in Hemiplegic Shoulder Pain and Subluxation in Stroke Patients

Abstract

Globally, hemiplegic shoulder pain (HSP) and sometimes subluxation are the most common and disabling impairments seen in post stroke survivors. The Frequency of hemiplegic shoulder pain ranges 70% or more in individuals suffering from stroke [1]. In United Kingdom, there is incidence of Hemiplegic Shoulder Pain of 200 per 100,000 population per year [2]. In Thailand, the occurrence of glenohumeral subluxation is reported to be 37% and is linked with hemorrhagic type of stroke, loss of proprioception sensation and Brunnstorm 'stage of arm recovery [3]. Objectives: To identify the current physiotherapy treatment practices in hemiplegic shoulder pain and subluxation in stroke patients. Material and Methods: A cross sectional survey was conducted on 151 Neuro musculoskeletal Physical Therapists, who fulfilled study inclusion criteria and working in different public and private Physiotherapy departments in Karachi, Pakistan by using Non probability purposive sampling Technique. The objective of the study was explained and informed consent was taken from all the Physical therapists taking part in this study. This study used a self-designed structured questionnaire that was pretested through a pilot survey on 25 subjects prior to assess their attitudes and treatment practices. The questionnaire had two sections, in the first section informations related to the participant's demographic, educational details and clinical experiences were asked. Whereas, in section two, informations related to their clinical practices were inquired. Statistical analysis was done through SPSS Version 21. The frequencies and percentages for all categorical variables were computed. Mean and standard deviation were calculated approximately for all continuous variables. P-value <0.05 will be considered statistically significant. Results: The results of this survey show that majority of physical therapists having DPT as a graduation degree, in which females are significant higher than males from private clinical sectors working in musculoskeletal speciality, treat more than two patients of HSP and subluxation in a week. They are certified in Bobath and PNF techniques and use stabilization exercises, shoulder supports, electrical stimulation for treatment purposes. The subjects consider poor handling of patient as a limiting factor in therapy and suggest that HSP or subluxation affect quality of life of a patient. Conclusion: It is suggested that majority of physical therapists in Karachi, Pakistan use shoulder supports, stabilization exercises, electrical stimulation, and are trained in PNF and Bobath therapies in management of HSP and subluxation in stroke survivors. According to a systematic review in UK, there is no clear evidence that will report any connection between subluxation of glenohumeral joint and shoulder pain in stroke population [4]. The hemiplegic shoulder pain (HSP) delays rehabilitation and increases the financial expenses of management in people with stroke. Unfortunately, a very little is known about the incidence of hemiple...