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European Journal of Physical and Rehabilitation Medicine 2017 February;53(1):41-8

DOI: 10.23736/S1973-9087.16.04209-X

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke: a randomized trial

Louise ADA 1, Anchalee FOONGCHOMCHEAY 2, Birgitta LANGHAMMER 3, Elisabeth PRESTON 4, Rosalyn STANTON 1, John ROBINSON 5, Serene PAUL 6, Colleen CANNING 1

1 Discipline of Physiotherapy, The University of Sydney, Sydney, Australia; 2 Department of Physical Therapy, Chulalongkorn University, Chulalongkorn, Thailand; 3 Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; 4 Discipline of Physiotherapy, The University of Canberra, Canberra, Australia; 5 Discipline of Medical Radiation Sciences, The University of Sydney, Sydney, Australia; 6 The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia


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BACKGROUND: Shoulder subluxation is a common secondary impairment of the upper limb following stroke. A range of supportive devices are used in rehabilitation to prevent shoulder subluxation, including hemi-slings and firm supports, such as arm troughs, however, there is little evidence regarding their efficacy.
AIM: To determine whether a modified lap-tray during sitting and a triangular sling during standing is more effective than a hemi-sling in preventing shoulder subluxation, pain, contracture and upper limb activity limitation after stroke.
DESIGN: A prospective, randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis.
SETTING: Three inpatient rehabilitation units in Australia and Norway.
POPULATION: Forty-six acute stroke survivors within 3 weeks of stroke who were at risk of subluxation.
METHODS: The experimental group used a modified lap-tray while sitting and a triangular sling while standing to support the affected arm for four weeks. The control group used a hemi-sling while sitting and standing. The primary outcome was amount of shoulder subluxation on X-ray. Secondary outcomes were upper limb activity, pain and contracture.
RESULTS: There was no significant difference between groups in terms of shoulder subluxation (MD -3 mm, 95% CI -8 to 3). There was a trend for the experimental group to develop less pain at rest (MD -0.7 out of 10, 95% CI -2.2 to 0.8) and during shoulder external rotation (MD -1.7 out of 10, 95% CI -3.7 to 0.3) and a trend towards having less contracture of shoulder external rotation (MD -10 deg, 95% CI -22 to 2). There was no significant difference between groups in terms of other contractures and activity of the upper limb.
CONCLUSIONS: A lap-tray during sitting combined with a triangular sling during standing is no more effective than a hemi-sling in preventing subluxation, pain, contracture and activity limitation in acute stroke survivors at risk of shoulder subluxation.
CLINICAL REHABILITATION IMPACT: The use of a lap-tray during sitting and triangular sling during standing is not indicated as an alternative to the hemi-sling to prevent shoulder subluxation in patients after stroke, so alternative strategies with proven efficacy, such as electrical stimulation, should be considered.


KEY WORDS: Randomized controlled trial - Stroke - Shoulder dislocation - Physical therapy modalities

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