Poduri K R
From the Rochester Rehabilitation Center and the University of Rochester Medical Center, Rochester, NY, U.S.A.
J Stroke Cerebrovasc Dis. 1993;3(4):261-6. doi: 10.1016/S1052-3057(10)80071-0. Epub 2010 Jun 8.
The purpose of this study was to examine whether prompt diagnosis and management of shoulder pain is beneficial in decreasing pain and increasing range of motion and functional recovery. Among 116 stroke patients receiving outpatient rehabilitation, 48 had shoulder pain. Twenty-eight of the patients with shoulder pain received occupational therapy and physiatric management. Five of the 28 patients had specific diagnoses. Etiology of the pain in the remaining 23 patients (Group 1) was not known, and these patients were treated with nonsteroidal antiinflammatory drugs (NSAIDs). The remaining 20 (Group 2) received only occupational therapy and were used as the control group. Pain relief, range of motion (ROM) in flexion, and abduction and functional recovery were compared in the two groups. Results show that a significantly higher percentage of Group 1 was found to have pain relief; 91% versus 15% with p < 0.00001 for the difference. A significant number of patients improved ROM for flexion and abduction in Group 1 versus Group 2 (p < 0.006 and p < 0.055 for the difference for flexion and abduction, respectively). Functional recovery was highly significant for Group 1,100% compared to 55% for Group 2, with p < 0.0001 for the difference. These results emphasize the importance of management of shoulder pain with NSAIDs along with ROM exercises for successful rehabilitation of hemiplegic patients.
本研究的目的是检验肩部疼痛的及时诊断和处理是否有利于减轻疼痛、增加活动范围及促进功能恢复。在116例接受门诊康复治疗的中风患者中，48例有肩部疼痛。28例肩部疼痛患者接受了职业治疗和物理医学管理。28例患者中有5例得到了明确诊断。其余23例患者（第1组）疼痛病因不明，这些患者接受了非甾体抗炎药（NSAIDs）治疗。其余20例（第2组）仅接受职业治疗，并作为对照组。比较了两组患者的疼痛缓解情况、屈曲和外展活动范围（ROM）以及功能恢复情况。结果显示，第1组疼痛缓解的患者比例显著更高；分别为91%和15%，差异的p值<0.00001。与第2组相比，第1组有相当数量的患者在屈曲和外展方面的ROM得到改善（屈曲和外展差异的p值分别<0.006和<0.055）。第1组的功能恢复非常显著，为100%，而第2组为55%，差异的p值<0.0001。这些结果强调了使用NSAIDs治疗肩部疼痛并结合ROM练习对偏瘫患者成功康复的重要性。
