Kumar P1, Murphy Z1, Burn J1, Dean M1, Naylor Z1, Rondel S1, Montgomery O1, Pearson J1
1University of West of England, Allied Health Professions, Bristol, United Kingdom
Background: Stroke is a leading cause of disability in western world. Loss of motor control leads to a range of musculoskeletal complications in the shoulder region in people with stroke. These include shoulder pain (incidence up to 65%), shoulder subluxation (incidence up to 84%), impairment in upper limb function (60%). Our previous work (case series n =10) showed that diagnostic ultrasound guided shoulder rehabilitation improved outcomes in stroke survivors. Treatment included:
1) ultrasound guided electrical stimulation to supraspinatus; lateral deltoid
2) rotator cuff training / isometric exercises.
Other treatment included scapula setting exercises (for posture and muscle imbalance). At 12 weeks, patients showed 50-75% reduction in pain, 40-60% improvement in GHS (up to 1 cm affected to unaffected difference), increase in diameter of supraspinatus at rest (0.4 cm) and contracted state (0.8cm), increase in range of movement (flexion - 30 degrees, abduction - 45 degrees, external rotation - 40 degrees), improved use of arm for function / rehabilitation, and patients reported improvement in activities of daily living. Clinicians reported improvements in designing and delivery of exercise programme.
Purpose: The aim of this study was to explore both physiotherapists and patients experiences of the shoulder rehabilitation programme that was informed following ultrasound scanning.
Methods: A qualitative study consisting of semi-structured face-to-face interviews were conducted with stroke survivors and physiotherapists in South Wales. Thirteen patients and three physiotherapists were approached. All interviews were audio recorded and transcribed verbatim. Data were analysed using principles of thematic analysis. An inductive approach was adopted to come up with themes: this involves coding the data without trying to fit it into a pre-existing coding framework and results in the themes being data driven.
Results: Three patients (mean age 64 years) and three physiotherapists participated in the interviews. Mean time since stroke in months was: Patient 1 - 45., patient 2 -27, patient 3 - 47. All three patients had hemiplegic shoulder pain and were undergoing rehabilitation. Four themes emerged:
1) 'Ultrasound informed treatment': both physiotherapists and patients reported that ultrasound imaging enhanced their understanding of deficits in the shoulder and facilitated problem specific treatment.
2) 'Psychological benefits to patients': patients understanding of the problems resulted in compliance and high participation satisfaction towards the rehabilitation programme.
3) 'Physical and functional benefits': all three patients achieved improved range of movement in shoulder and therapists described improvements in other aspects such as gait and functional independence.
4) 'Resource intensive': The cost, training involved with ultrasound may impose practical challenges for its wider use.
Conclusion(s): This study provides valuable insight into the personal experiences of novel approaches to shoulder rehabilitation in people with stroke. Physiotherapists were able to target the problem and provide specific exercises which improved patients' outcomes. These findings can be used to guide both the development and evaluation of problem specific shoulder rehabilitation programme to improve functional outcomes in people with stroke.
Implications: Findings from this study can guide both the development and evaluation of problem specific shoulder rehabilitation programme to improve functional outcomes in people with stroke.
Keywords: Stroke, Shoulder pain, Ultrasound
Funding acknowledgements: This project was undertaken as part of the BSc. (Hons) Physiotherapy programme at the University of West of England.
1) ultrasound guided electrical stimulation to supraspinatus; lateral deltoid
2) rotator cuff training / isometric exercises.
Other treatment included scapula setting exercises (for posture and muscle imbalance). At 12 weeks, patients showed 50-75% reduction in pain, 40-60% improvement in GHS (up to 1 cm affected to unaffected difference), increase in diameter of supraspinatus at rest (0.4 cm) and contracted state (0.8cm), increase in range of movement (flexion - 30 degrees, abduction - 45 degrees, external rotation - 40 degrees), improved use of arm for function / rehabilitation, and patients reported improvement in activities of daily living. Clinicians reported improvements in designing and delivery of exercise programme.
Purpose: The aim of this study was to explore both physiotherapists and patients experiences of the shoulder rehabilitation programme that was informed following ultrasound scanning.
Methods: A qualitative study consisting of semi-structured face-to-face interviews were conducted with stroke survivors and physiotherapists in South Wales. Thirteen patients and three physiotherapists were approached. All interviews were audio recorded and transcribed verbatim. Data were analysed using principles of thematic analysis. An inductive approach was adopted to come up with themes: this involves coding the data without trying to fit it into a pre-existing coding framework and results in the themes being data driven.
Results: Three patients (mean age 64 years) and three physiotherapists participated in the interviews. Mean time since stroke in months was: Patient 1 - 45., patient 2 -27, patient 3 - 47. All three patients had hemiplegic shoulder pain and were undergoing rehabilitation. Four themes emerged:
1) 'Ultrasound informed treatment': both physiotherapists and patients reported that ultrasound imaging enhanced their understanding of deficits in the shoulder and facilitated problem specific treatment.
2) 'Psychological benefits to patients': patients understanding of the problems resulted in compliance and high participation satisfaction towards the rehabilitation programme.
3) 'Physical and functional benefits': all three patients achieved improved range of movement in shoulder and therapists described improvements in other aspects such as gait and functional independence.
4) 'Resource intensive': The cost, training involved with ultrasound may impose practical challenges for its wider use.
Conclusion(s): This study provides valuable insight into the personal experiences of novel approaches to shoulder rehabilitation in people with stroke. Physiotherapists were able to target the problem and provide specific exercises which improved patients' outcomes. These findings can be used to guide both the development and evaluation of problem specific shoulder rehabilitation programme to improve functional outcomes in people with stroke.
Implications: Findings from this study can guide both the development and evaluation of problem specific shoulder rehabilitation programme to improve functional outcomes in people with stroke.
Keywords: Stroke, Shoulder pain, Ultrasound
Funding acknowledgements: This project was undertaken as part of the BSc. (Hons) Physiotherapy programme at the University of West of England.
Topic: Neurology: stroke; Musculoskeletal: upper limb
Ethics approval required: Yes
Institution: University of West of England
Ethics committee: Faculty Research Ethics Committee
Ethics number: UWE REC REF No: HAS.18.01.088
All authors, affiliations and abstracts have been published as submitted.
