Protocols Used by Occupational Therapists on Shoulder Pain after Stroke: Systematic Review and Meta-Analysis

Abstract

Introduction. Shoulder pain as a consequence after a stroke has multifactorial causes and can prevent the functional return of the upper limb. In addition, the effectiveness of clinical protocols applied by occupational therapists remains uncertain. Objective. To identify the main treatments currently used by occupational therapists for pain in the shoulder after a stroke. Method. Articles in English published between 2015 and 2019, of the randomized clinical trial type, with populations that stroke survivors a stroke and sequelae of shoulder pain were selected. The terms and combinations used were “shoulder pain and stroke and occupational therapy,” in the electronic databases, Directory of Open Access Journals (DOAJ), Occupational Therapy Systematic Evaluation of Evidence (OTseeker), and PubMed. Statistical Review Manager (version 5.3) established the significance level $P\le 0.05$ . Results. Thirty-nine articles were found, but only four met the inclusion criteria. Electrical stimulation, therapeutic bandaging, and dry needling were eventually employed. For the meta-analysis, pain was the primary outcome, and range of motion (ROM) and upper limb function were secondary. Pain, ROM (external rotation, abduction, and flexion), and manual function were compared, and the meta-analysis showed improvement in the treatment group in clinical trials: pain (MD -2.08; 95% CI -3.23, -0.93; $P=0.0004$ ), ROM (MD 4.67; 95% CI 1.54, 7.79; $P=0.0003$ ), and manual function (MD 1.84; 95% CI 0.52, 3.16; $P=0.006$ ). Conclusion. Dry needling, California tripull taping (CTPT), and functional electrical stimulation controlled by brain-machine interface (BCI-FES) are proved effective in shoulder pain and functionality.