ArticlesThirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: A randomized controlled trial
Section snippets
Design
The study was a randomized controlled trial. Subjects were measured before and after 4 weeks of participation in a shoulder positioning program consisting of two 30-minute sessions a day 5 days a week. Patients were measured at discharge if their stay was less than 4 weeks. Measurement and positioning was done at separate times to eliminate possible short-term effects of the intervention. An assessor blinded to group allocation carried out measurements.
Participants
Subjects were recruited from the
Contracture
By posttest, loss of shoulder external rotation range was significantly greater (F1,29=4.2, P=.05) in the control group than in the experimental group (fig 2A). The result was the same if the loss of ROM was expressed as a contracture (ie, loss as a percentage of intact range). By posttest, the control group had developed a significantly larger internal rotator contracture than the experimental group (F1,29=4.9, P=.03). In addition, there were fewer subjects with pain on maximum passive
Discussion
This study’s major finding is that implementing the positioning program described here early after stroke for people who have little or no upper arm activity inhibits the development of external rotation but not of flexion contracture. In addition, the partial prevention of external rotation contracture had no effect on upper-arm function, although there was little recovery of function in either group during the 4-week intervention period.
This is the first study to show a significant effect of
Conclusions
We recommend that stroke patients with little upper-limb function undergo a program of positioning the affected shoulder in maximum comfortable external rotation at least 30 minutes a day. The program should be commenced as soon as possible after the stroke.
Acknowledgement
We acknowledge assistance of the staff of the Physiotherapy and Occupational Therapy Departments of Balmain Hospital, Royal Prince Alfred Hospital, Bankstown Hospital, Lady Davidson Private Hospital, and Concord Repatriation General Hospital. In particular, we thank Esther Tucker, Shelley Murtagh, and Lisa Russell from Balmain Hospital and Simone Dorsch from Bankstown Hospital for their diligence in carrying out the positioning program. Thanks to Stephen Chan for drawing the diagrams of
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Supported by the Central Sydney Area Health Service, NSW, Department of Health (equipment) and the Faculty of Health Sciences, University of Sydney.
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