Price C I, Pandyan A D
Geriatric Medicine, University of Newcastle, c/o Helen Rodgers secretary, Centre for Health Services Research, 21 Claremont Place, Newcastle Upon Tyne, Tyne and Wear, UK, NE2 4AA.
Cochrane Database Syst Rev. 2000;2000(4):CD001698. doi: 10.1002/14651858.CD001698.
Shoulder pain after stroke is common and disabling. The optimal management is uncertain, but electrical stimulation (ES) is often used to treat and prevent pain.
The objective of this review was to determine the efficacy of any form of surface ES in the prevention and / or treatment of pain around the shoulder at any time after stroke.
We searched the Cochrane Stroke Review Group trials register and undertook further searches of MEDLINE, EMBASE and CINAHL. Contact was established with equipment manufacturers and centres that have published on the topic of ES.
We considered all randomised trials that assessed any surface ES technique (functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) or other), applied at any time since stroke for the purpose of prevention or treatment of shoulder pain.
Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data.
Four trials (a total of 170 subjects) fitted the inclusion criteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no significant change in pain incidence (Odds Ratio (OR) 0.64; 95% CI 0.19 to 2.14) or change in pain intensity (Standardised Mean Difference (SMD) 0.13; 95% CI -1.0 to 1.25) after ES treatment compared to control. There was a significant treatment effect in favour of ES for improvement in pain-free range of passive humeral lateral rotation (Weighted Mean Difference (WMD) 9.17; 95% CI 1.43 to 16.91). In these studies ES reduced the severity of glenohumeral subluxation (SMD -1.13; 95% CI -1.66 to -0.60), but there was no significant effect on upper limb motor recovery (SMD 0.24; 95% CI -0.14 to 0.62) or upper limb spasticity (WMD 0.05; 95% CI -0.28 to 0.37). There did not appear to be any negative effects of electrical stimulation at the shoulder.
REVIEWER'S CONCLUSIONS: The evidence from randomised controlled trials so far does not confirm or refute that ES around the shoulder after stroke influences reports of pain, but there do appear to be benefits for passive humeral lateral rotation. A possible mechanism is through the reduction of glenohumeral subluxation. Further studies are required.
中风后肩部疼痛很常见且会导致功能障碍。最佳治疗方法尚不确定，但电刺激（ES）常被用于治疗和预防疼痛。
本综述的目的是确定任何形式的表面电刺激在中风后任何时间预防和/或治疗肩部周围疼痛的疗效。
我们检索了Cochrane中风综述组试验注册库，并对MEDLINE、EMBASE和CINAHL进行了进一步检索。与设备制造商和发表过电刺激相关主题的中心建立了联系。
我们纳入了所有评估任何表面电刺激技术（功能性电刺激（FES）、经皮电神经刺激（TENS）或其他）的随机试验，这些试验自中风后任何时间应用于预防或治疗肩部疼痛。
两名综述员独立选择纳入试验、评估试验质量并提取数据。
四项试验（共170名受试者）符合纳入标准。研究设计和电刺激技术差异很大，常常排除了研究合并的可能性。样本量较小。与对照组相比，电刺激治疗后疼痛发生率无显著变化（优势比（OR）0.64；95%置信区间0.19至2.14），疼痛强度也无显著变化（标准化均数差（SMD）0.13；95%置信区间-1.0至1.25）。在被动肱骨外旋无痛范围改善方面，电刺激有显著的治疗效果（加权均数差（WMD）9.17；95%置信区间1.43至16.91）。在这些研究中，电刺激降低了肩肱关节半脱位的严重程度（SMD -1.13；95%置信区间-1.66至-0.60），但对上肢运动恢复（SMD 0.24；95%置信区间-0.14至0.62）或上肢痉挛（WMD 0.05；95%置信区间-0.28至0.37）无显著影响。肩部电刺激似乎没有任何负面影响。
目前随机对照试验的证据既未证实也未反驳中风后肩部周围的电刺激会影响疼痛报告，但对于被动肱骨外旋似乎确实有好处。一种可能的机制是通过减少肩肱关节半脱位。还需要进一步的研究。
