Assessment, diagnosis and management of hemiplegic shoulder pain: A UK-Wide online survey of physiotherapy and occupational therapy practice

Kumar, Praveen; McCabe, Candy; Turton, Ailie; Cramp, Mary; Smith, Mark

Abstract

Background: Hemiplegic shoulder pain (HSP) is a common complication of stroke that can lead to functional dependency and reduced quality of life. HSP can develop at any time from the early weeks after stroke to several (3-6) months after onset. Approximately 65% of patients with chronic stroke have HSP six months after stroke. HSP is multi-factorial in nature and interventions for shoulder pain are very varied but are generally unsatisfactory. Therapists play an important role in the management of HSP and therefore outcomes may often depend on their practice in assessment and selecting appropriate treatments. With lack of recommendations for management of HSP in national guidelines, it is important to determine what is current practice.
Aims: The primary aim of the present study was to identify how HSP is assessed, diagnosed and managed in routine clinical practice by physiotherapists (PTs) and occupational therapists (OTs) in the UK. A secondary aim was to identify the challenges to services in the management of HSP in the UK.
Methods: A questionnaire was developed from similar surveys of musculoskeletal/neurological practice, a review of the literature and consultation with researchers and clinicians. Draft surveys were initially distributed to and commented upon by members of the research team and subsequently were distributed to PTs and OTs in local clinical practice also. A total of three iterations of the survey were developed and refined in this way before the final, fourth version was agreed upon. The survey was distributed online to potential participants (PTs and OTs) working in stroke rehabilitation via professional bodies’ interest groups (Association of Chartered Society of Physiotherapy in Neurology and College of Occupational Therapy Specialisit Section Neurological Practice). In addition, the survey was distributed to PTs and OTs involved in the treatment of HSP following stroke via the university database (email contact list) of South West Clinical Educators.
Results: Sixty seven responses were received from PTs (60%) and OTs (40%). The majority (84%) of participants worked in the NHS, 52% at Band 6 level and 42% had less than 5 years of experience in stroke rehabilitation. The respondents gained knowledge in HSP management through in-service training, clinical supervision and reading (80%). They reported routinely checking for HSP (89%); spending 10 minutes (mean time) on assessment. Commonly used assessments were glenohumeral subluxation (94%), strength (76%), range of movement (67%), spasticity (79%) and palpation (63%). Only 15% reported referring patients for diagnostic ultrasound to investigate the cause of pain. Usual rehabilitation duration (including HSP management) was 6-8 weeks, patients were discharged when treatment options were exhausted (80%). Interventions offered included education, exercise and self-management. Time constraints (62%); lack of diagnosis (54%) and lack of training in managing HSP (60%) were the major challenges in providing appropriate care for people with HSP.
Conclusion: HSP is routinely addressed in clinical practice, however, there is lack of consistency in both assessment and treatment approaches for this debilitating problem. Reported assessments excluded specific shoulder biomechanical,altered sensation and neuropathic pain assessments. The results suggest that a wide range of approaches are utilised by clinicans and that patients are potentially receiving treatment irrespective of the underlying problem due to lack of comprehensive assessment and accurate diagnosis of the cause of HSP. A comprehensive diagnostic protocol including approapriate referral to imaging services and additional training specific to HSP are required to improve the patients outcome.

• Presentation Conference Type: Poster
• Conference Name: British Pain Society Annual Scientific Meeting
• Start Date: May 10, 2016
• End Date: May 12, 2016
• Acceptance Date: Jan 10, 2016
• Publication Date: May 10, 2016
• Peer Reviewed: Peer Reviewed
• Keywords: shoulder pain, assessment, management, survey, physiotherapist, occupational therapist
• Public URL: https://uwe-repository.worktribe.com/output/912087
• Additional Information: Title of Conference or Conference Proceedings : British Pain Society