Article

OBJECTIVE: To identify factors associated with persistent poststroke shoulder
pain (pPSSP) in the first 6 months after stroke. DESIGN: Prospective inception
cohort study. SETTING:
Stroke units of 2 teaching hospitals. PARTICIPANTS:
Patients (N=31) with a clinical diagnosis of stroke. INTERVENTIONS: Not
applicable. MAIN OUTCOME : The development of pPSSP within the first 6
months after stroke. Clinical assessment of motor, somatosensory, cognitive,
emotional, and autonomic functions, undertaken within 2 weeks (t0), at 3 months
(t1), and at 6 months (t2) after stroke. RESULTS: Patients with pPSSP (n=9) were
compared with patients without pPSSP (n=22). Bivariate logistic regression
analyses showed that pPSSP was significantly associated with impaired voluntary
motor control (t0, t1, t2), diminished proprioception (t0, t1), tactile
extinction (t0), abnormal sensation (t1, t2), spasticity of the elbow flexor
muscles (t1, t2), restricted range of motion (ROM) for both shoulder abduction
(t2) and shoulder external rotation (t1, t2), trophic changes (t1), and type 2
diabetes mellitus (t0). CONCLUSIONS: These findings suggest a multifactorial
etiology of pPSSP. The association of pPSSP with restricted, passive, pain-free
ROM and signs indicative of somatosensory sensitization may implicate a vicious
cycle of repetitive (micro)trauma that can establish itself rapidly after stroke.
Intervention should therefore be focused on maintaining and restoring joint ROM
as well as preventing injury and somatosensory sensitization. In this perspective, strategies that aim to intervene simultaneously at various levels of
function can be expected to be more effective than treatment directed at merely 1 level.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS