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Evidence summaries

Supportive Devices for Subluxation of the Shoulder after Stroke

There is insufficient evidence to conclude whether slings and wheelchair attachments prevent subluxation, decrease pain, increase function or adversely increase contracture in the shoulder after stroke. Level of evidence: "D"

A Cochrane review [Abstract] 1 included four studies with a total of 142 subjects. One trial testing a hemisling versus no device reported that no participants had subluxation greater than 10 mm, the same number had lost more than 30 degrees of shoulder external rotation (OR = 1.00, 95% CI 0.1 to 9.3), and more participants in the hemisling group had pain (OR = 8.7, 95% CI 1.1 to 67.1). The other three showed that strapping was effective in delaying the onset of pain (weighted mean difference (WMD) = 14 days, 95% CI 9.7 to 17.8), but was ineffective in reducing pain severity (WMD = -0.7 cm on a visual analogue scale, 95% CI -2.0 to 0.7), increasing upper limb function (WMD = 0.8, 95% CI -1.5 to 3.1) or affecting the degree of contracture (WMD = -1.4 degrees, 95% CI -10.9 to 8.1) at the shoulder.

Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment) and imprecise results (limited study size for each comparison).

    References

    • Ada L, Foongchomcheay A, Canning C. Supportive devices for preventing and treating subluxation of the shoulder after stroke. Cochrane Database Syst Rev 2005 Jan 25;(1):CD003863. [PubMed]

Primary/Secondary Keywords