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Risk and associated factors for hemiplegic shoulder pain in people with stroke: A systematic literature review

Kumar, Praveen; Shah, Riya; Fernando, Ciara; Mendoza, Deanna


Riya Shah

Ciara Fernando

Deanna Mendoza


Introduction: Hemiplegic shoulder pain (HSP) is reported in up to 47% of people with stroke. Since
the development of the national guidelines for stroke, the management of HSP has evolved. The aim of
this systematic literature review was to explore the risk and associated factors for HSP for studies
published in the last 15 years.
Methods: A systematic online search was conducted of CINAHL, AMED, MEDLINE and the Cochrane
Library databases using appropriate keywords. The search was supplemented by hand searching of
relevant journals and citation tracking of the retrieved papers. All primary studies published in English
language fulfilling the review’s inclusion criteria were included. Five reviewers extracted the data and
independently appraised the methodological quality of the selected studies. Any discrepancies were
resolved following discussions.
Results: Of the 50 articles that were identified, 21 studies met the criteria. The common risk factors
for HSP were: Poor motor function (odds ratio (OR) ranging from 0.58–3.19; 95% confidence interval
(CI), 1.1–7.7); glenohumeral subluxation (OR ranging from 2.48–3.5, 95% CI 1.38–9.37) and reduced
range of movement at the shoulder (OR 0.14–4.46, 95% CI 0.99–64).
Conclusions: Despite methodological flaws, complete loss of motor function in the affected arm and
glenohumeral subluxation have been recognized as significant risk factors for HSP. Further rigorously
designed research studies are required. The best way to prevent HSP, based upon current evidence, is
to strengthen shoulder rotator cuff muscles and improve motor control around the shoulder region. In
addition, education to both the caregivers and patients is critical.


Kumar, P., Shah, R., Fernando, C., & Mendoza, D. (2021). Risk and associated factors for hemiplegic shoulder pain in people with stroke: A systematic literature review. International Journal of Stroke, 16(3), 9-37.

Journal Article Type Conference Paper
Conference Name UK Stroke Forum, 2021
Conference Location Online
Acceptance Date Aug 27, 2021
Online Publication Date Dec 17, 2021
Publication Date Dec 17, 2021
Deposit Date Dec 10, 2022
Journal International Journal of Stroke
Print ISSN 1747-4930
Electronic ISSN 1747-4949
Publisher SAGE Publications
Volume 16
Issue 3
Pages 9-37
Series Title K Stroke Supplement: 001 – High Scoring Oral Presentation – Swallowing and Nutrition: SWALLOWING THERAPY FOR DYSPHAGIA IN ACUTE AND SUB-ACUTE STROKE (COCHRANE SYSTEMATIC REVIEW)
Keywords Neurology
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