Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
Senior Services, Credit Valley Hospital-Trillium Health Partners, Mississauga, Canada.
Disabil Rehabil. 2020 Oct;42(21):3072-3083. doi: 10.1080/09638288.2019.1585487. Epub 2019 Mar 23.
Following a stroke, three-dimensional clavicular/scapular/humeral joint rotations may become restricted and contribute to post-stroke shoulder pain. This study examined whether a treatment group provided with current standard treatment plus the proposed "Three-dimensional Shoulder Pain Alignment" mobilization protocol demonstrated improved pain-free shoulder range, functional reach and sleep compared to a control group provided with standard treatment alone. In this double-blinded parallel-group randomized control trial, treatment and control subjects with moderate/severe post-stroke upper extremity impairment and shoulder pain were treated 3x/week for 4 weeks. Outcome measures included changes in pain-free three-dimensional clavicular/scapular/humeral range (using computerized digitization), pain during sleep and functional reach (using the Pain Intensity-Numerical Rating Scale), and pain location/prognostic indicators (using the Chedoke-McMaster Stroke Assessment-Shoulder Pain Inventory). Compared to controls ( = 10) the treatment group ( = 10) demonstrated significantly improved three-dimensional clavicular/scapular/humeral pain-free range during shoulder flexion and abduction ( < 0.05; Hedges > 0.80), large effect sizes for decreased pain during sleep and functional reach to the head and back (OR range: 5.44-21.00), and moderate effect size for improved pain/prognostic indicators (OR = 3.86). The Three-Dimensional Shoulder Pain Alignment mobilization protocol significantly improved pain-free range of motion, functional reach and pain during sleep in shoulders with moderate/severe post-stroke upper-extremity impairment.Implications for rehabilitationAlthough three-dimensional clavicular/scapular/humeral rotations are an essential component of normal pain-free shoulder range of motion, current guidelines for treatment of post-stroke shoulder pain only includes uni-dimensional mobilizations for joint alignment and pain management.The Three-Dimensional Shoulder Pain Alignment (3D-SPA) mobilization protocol incorporates multi-dimensional mobilizations in various planes of shoulder movement.The current study results demonstrate proof-of-concept regarding the 3D-SPA mobilization, and this approach should be considered as an alternative to the uni-dimensional mobilizations currently used in clinical treatment guidelines for post-stroke shoulder pain.
中风后，三维锁骨/肩胛/肱骨关节旋转可能会受限，并导致中风后肩部疼痛。本研究旨在探讨在接受标准治疗的基础上，给予治疗组“三维肩部疼痛对线”松动方案治疗后，与仅接受标准治疗的对照组相比，疼痛无缓解的肩部活动范围、功能伸展和睡眠是否得到改善。在这项双盲平行组随机对照试验中，治疗组和对照组均为上肢功能障碍和肩部疼痛中度/重度的中风患者，每周治疗 3 次，共治疗 4 周。结果测量包括疼痛无缓解的三维锁骨/肩胛/肱骨活动范围（使用计算机数字化）、睡眠时疼痛和功能伸展（使用疼痛强度数字评分量表）以及疼痛部位/预后指标（使用 Chedoke-McMaster 中风评估-肩部疼痛量表）的变化。与对照组（n=10）相比，治疗组（n=10）在肩部前屈和外展时，三维锁骨/肩胛/肱骨疼痛无缓解的活动范围显著改善（ < 0.05；Hedges > 0.80），睡眠时疼痛和功能伸展至头部和背部的效果明显减小（OR 范围：5.44-21.00），疼痛/预后指标改善的效果中等（OR=3.86）。三维肩部疼痛对线松动方案可显著改善中重度上肢功能障碍中风后肩部的无痛运动范围、功能伸展和睡眠时疼痛。
康复意义尽管三维锁骨/肩胛/肱骨旋转是无痛肩部活动范围的重要组成部分，但目前治疗中风后肩部疼痛的指南仅包括针对关节对线和疼痛管理的一维松动。三维肩部疼痛对线（3D-SPA）松动方案在肩部运动的各个平面上采用多维松动。目前的研究结果证明了 3D-SPA 松动的概念验证，因此应考虑将其作为目前用于中风后肩部疼痛临床治疗指南的一维松动的替代方法。
