Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial

Abstract

<jats:sec><jats:title>Background and aims</jats:title><jats:p> Poststroke shoulder pain is a common complication. We aimed to investigate the prevalence of poststroke shoulder pain, with attention to the neuropathic component, and the relationship between poststroke shoulder pain and upper limb improvement in motor function, strength, disability, and quality of life after upper limb rehabilitation. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> This is a secondary analysis of a multicenter randomized controlled trial to compare upper limb conventional or robotic rehabilitation on 224 patients enrolled in eight rehabilitation centers. We assessed poststroke shoulder pain (using the Numerical Rating Scale and the Douleur Neuropathique 4), and upper limb motor function, strength, disability, and quality of life at baseline (T0), after 30 rehabilitation sessions (T1), and three months after the end of rehabilitation (T2). </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A moderate/severe poststroke shoulder pain was reported by 28.9% of patients, while 19.6% of them showed a neuropathic component. At T0, the intensity of pain was higher in women and in patients with neglect syndrome, positively correlated with the time since stroke and disability and negatively correlated with motor function, strength, and the physical aspects of the quality of life. Moderate/severe pain and neuropathic component significantly reduced after both treatments and this reduction was maintained at T2. Finally, the intensity of pain at baseline was negatively correlated with the improvement of upper limb motor function. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Poststroke shoulder pain negatively impact on motor performance, strength, disability, and physical aspects of the quality of life as well as on upper limb motor recovery; however, it can be reduced after a robotic or a conventional rehabilitation. Therefore, we suggest considering poststroke shoulder pain when planning the rehabilitation intervention. </jats:p></jats:sec>

Combining robot-assisted therapy with virtual reality or using it alone? A systematic review on health-related quality of life in neurological patients

“…A full report of the data extracted from the included studies is presented in a structured synoptic table (Additional file 1 : Append ix 1) [ 13 , 25 – 93 ].…”

How Do Motor and Sensory Function Correlate with Daily Performance Recovery after Post-Stroke Robotic Intervention? A Secondary Analysis of a Non-Randomized Controlled Trial

“…On the other hand, in our sample, pain showed a moderate but non-significant correlation with upper limb activity performance. Previous studies reported that the baseline intensity of pain in the paretic shoulder is related to motor performance, quality of life, and motor functions, and negatively impacts the recovery of upper limb function [ 39 ]. It is possible that the absence of a significant correlation in our work is partly explained by a lack of statistical power as a result of the small sample size.…”

ROBOCOP (ROBOtic Care of Poststroke Pain): Study Protocol for a Randomized Trial to Assess Robot-Assisted Functional and Motor Recovery and Impact on Poststroke Pain Development

“…In fact, the wide multicenter trial for the evaluation of robot-assisted training for the upper limb after stroke (RATULS) has demonstrated that robotic neurorehabilitation does not significantly improve the upper limb function (62). Pain intensity has been positively correlated with time since stroke and negatively with motor function (44), supporting the need to examine the role of robot-assisted rehabilitation in pain processing and to clear the mechanisms necessary for effective functional gain. The latter is a top ten priority for stroke survivors (63).…”

“…Different researchers/operators will independently recruit patients, generate the allocation sequence, and assign participants to interventions and no member of the trial will have access to the codes up to the end. Both males and females will be enrolled due to differences in baseline pain perception (44) and to sex-treatment interactions (45). Therefore, no blocking will occur but minimization will be performed for sex-difference in pain perception, handled to ensure that any individual who might introduce bias is not involved (46).…”