Is lycra sleeve effective for the management of glenohumeral subluxation in people with stroke – A feasibility study?

Kumar, Praveen; Gibson, Rebecca; Greet, Jennifer; Mills, McKenna; Rossall, Faye; Whales, Rhiannon

Abstract

Introduction: Glenohumeral subluxation (GHS) is reported to occur in 81% of patients post stroke. Current management approaches for GHS are varied and unsatisfactory. Functional Electrical Stimulation (FES) has been recommended in the National Clinical Guidelines for Stroke. However, due to cost and training involved, FES is not routinely used in the clinical practice. Clinically, a cost-effective and patient-friendly approach for GHS is required. Lycra sleeve has been used in the past, but the evidence to support its use on people with stroke suffering from GHS is limited. The primary aim of this feasibility study was to assess 1) the effectiveness of Lycra sleeves on GHS, 2) to explore patients’ perceptions and experiences of using the lycra sleeve. A secondary aim was to assess the effectiveness on shoulder pain and upper limb function.

Method: Mixed-method design was used. Patients with chronic post-stroke hemiplegia, able to consent and with a clinical palpable gap (1 or more fingerbreadths) were recruited from the community. Primary outcome (GHS) was assessed by ultrasound method (acromion-greater tuberosity distance measured in cm), secondary outcomes (pain, upper limb function) were assessed by the numerical rating scale and the Modified motor assessment (MMAS) scale respectively. A questionnaire was completed by patients to gather their perceptions and experiences. Timeframes for the assessments were as follows: pre-application of sleeve, immediately after application on day 1 and day 8. Patients were instructed to wear the Lycra sleeve for 7 consecutive days, 7 hours a day and to record any observations.

Results: Five patients (mean age/SD 51±8 years) participated in this study. GHS reduced immediately after wearing the Lycra sleeve on both day 1 and day 8 with the mean AGT distance showing a reduction of 0.21 cm and 0.28 cm respectively. The mean time the Lycra sleeve was worn each day was 6.7 hours. Three patients experienced decreased pain, 1 patient showed improvement in MMAS score. Three patients found donning and doffing the sleeve easy. Four patients found the sleeve beneficial as they were more aware of the affected limb and were able to incorporate upper limb more in ADL.
Discussion: Reduction in AGT distance may be in part due to increased sensory feedback/awareness, re-alignment of shoulder girdle, and/or activation of certain muscles around the shoulder region. These presumptions are currently under investigation.

Conclusion: Reduction in mean AGT distance suggests Lycra sleeves may be beneficial in the management of GHS. Further research is required to establish the effectiveness in acute and chronic settings using a well-designed randomised controlled trial.

• Presentation Conference Type: Conference Paper (unpublished)
• Conference Name: International ACPIN Conference
• Start Date: Mar 17, 2016
• End Date: Mar 18, 2016
• Acceptance Date: Jan 14, 2016
• Publication Date: Jan 1, 2016
• Peer Reviewed: Peer Reviewed
• Keywords: stroke, glenohumeral subluxation, lycra sleeve
• Public URL: https://uwe-repository.worktribe.com/output/920617
• Additional Information: Title of Conference or Conference Proceedings : International ACPIN Conference