THE EFFECT OF SHOULDER STABILITY TRAINING ON UPPER LIMB FUNCTION AND QUALITY OF LIFE IN PATIENTS WITH HEMIPLEGIA: A PILOT STUDY

¹University of the Free State, Physiotherapy, Bloemfontein, South Africa

Background: Stroke is a major cause of mortality and long-term adult disability and has a significant physical and psychosocial impact and HRQoL. The loss of upper-limb function post-stroke directly impacts on shoulder stability of affected side. Shoulder stability is essential for optimal functioning of the upper-limb; is a prerequisite for hand function and ADL. Rehabilitation of the upper-limb post-stroke remains challenging.

Purpose: To determine the effect of shoulder stability training using the Biodex Balance System (BBS) on upper-limb function and HRQoL in patients with hemiplegia post-stroke.

Methods: Utilised a quantitative longitudinal randomised control trial design with single blinding. Participants who met the inclusion criteria and who gave informed consent were assigned to one of two groups, the experimental or the control group, using computer-generated random numbers with concealed allocation. Participants were included in the study if they met the following criteria: male or female patients, had a stroke, hemiplegia and/or shoulder instability, and between ages 18 and 85 years. In addition to usual care, shoulder girdle stability training using the BBS was given to the experimental group. Assessments were done at baseline and one, three and six month’s post-baseline. All the participants were assessed by the research assistant for upper limb function (FMAUE) and HRQoL (SF-36v2).

Results: Seventeen participants were included after screening. The median age of the study sample was 53 years. The control group comprised more female (n=5) than male (n=2) participants, while the experimental group comprised more male (n=7) than female (n=3) participants. All the participants in control group were right-handed implying that more had their dominant hand affected than those in the experimental group. At baseline the two groups were comparable with regard to upper-limb function and HRQoL. No significant difference in upper-limb function (baseline p=0.5, one month follow-up post-baseline p=0.93) between control and experimental groups during studyperiod. The severity of the impairment of upper-limb function for both control and experimental group was comparable at baseline and improved from moderate (56-79) to mild (>79). At baseline a statistically significant difference was found regarding the impact of emotional problems on role limitation (p = 0.03) and pain (p = 0.05) between the two groups, with the control group indicating lower scores than the experimental group. At one month a statistically significant difference was found between the two groups regarding the extent of impaired social functioning (p = 0.05). The participants in the experimental group reported improvement in their health over time (baseline = 67.5 and six-month follow-up post baseline = 86.11). None of the factors investigated in this study impacted on HRQoL outcomes over time.

Conclusion(s): Shoulder girdle stability training using the BBS did not result in significant improvements in upper limb function and HRQoL post-stroke in this cohort. The findings in this study could have been influenced by the small sample size (the power calculation was done only for the shoulder girdle stability) and also by participants in the control and experimental group continuing with their standard care, which included an intensive rehabilitation programme.

Implications: Further research in this field is required.

Funding acknowledgements: Received from the SASP and the University of the Witwatersrand's Faculty of Health Sciences Research Committee (FRC).

Topic: Neurology: stroke

Ethics approval: Obtained from the University of the Witwatersrand Ethics Committee (M130405) and from the University of the Free State (79/2013).

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