Epidemiological characteristics of post-stroke shoulder pain: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Qian ^1,2,3 , PAN Hong ⁴ , HE Qin ² , BIAN Minjie ² , DONG Xueru ² , GU Meiru ² , HUANG Zheng ² , HUANG Dongfeng ^2,3 ,  LAN Yue ¹

1. Graduate School of Guangzhou Medical University, Guangzhou 510000, P.R.China;
2. The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen 518000, P.R.China;
3. Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou 510000, P.R.China;
4. The HongKong Polytechnic University, HongKong 999077, P.R.China;

Corresponding author：

LAN Yue, Email: bluemooning@163.com

Keywords：

Post-stroke shoulder pain; Epidemiology; Morbidity; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.202002049

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Objectives To systematically review the epidemiological characteristics of post-stroke shoulder pain (PSSP).Methods PubMed, WanFang Data, CNKI, EMbase, The Cochrane Library and SinoMed databases were electronically searched to collect studies on the morbidity of PSSP from inception to November 30^th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software.Results A total of 13 studies were included. The total sample size was 3 514, including 1 357 patients with PSSP. The results of meta-analysis showed that the total morbidity of PSSP was 45.0% with 95%CI 32.0% to 58.0%. The results of subgroup analysis showed that the morbidity of PSSP was 55.5% (95%CI 48.1% to 63.0%) prior to 2010 and 40.6% (95%CI 28.3% to 52.9%) after 2010, respectively. The morbidity of PSSP in Asia was 61.2% (95%CI 51.3% to 71.1%), and in Europe and America was 18.4% (95%CI 9.9% to 26.9%), respectively.Conclusions Current evidence suggests that PSSP has high morbidity, and it may be affected by regional factors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： ZHANG Qian, PAN Hong, HE Qin, BIAN Minjie, DONG Xueru, GU Meiru, HUANG Zheng, HUANG Dongfeng, LAN Yue. Epidemiological characteristics of post-stroke shoulder pain: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(9): 1020-1026. doi: 10.7507/1672-2531.202002049 Copy

1.	Wang W, Jiang B, Sun H, <italic>et al</italic>. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480?687 adults. Circulation, 2017, 135(8): 759-771.
2.	任占云, 汤武装, 樊垚, 等. 超敏C-反应蛋白与缺血性脑卒中发病的前瞻性队列研究. 中华疾病控制杂志, 2018, 22(1): 29-32, 51.
3.	Feigin VL. Stroke in developing countries: can the epidemic be stopped and outcomes improved? Lancet Neurol, 2007, 6(2): 94-97.
4.	李娟, 黄东辉, 王冲, 等. 辽宁省农村地区2013年脑卒中早死所致的疾病负担分析. 中华疾病控制杂志, 2017, 21(3): 255-260.
5.	Chae J, Mascarenhas D, Yu DT, <italic>et al</italic>. Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life. Arch Phys Med Rehabil, 2007, 88(3): 298-301.
6.	Nadler M, Pauls MMH. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. Clin Rehabil, 2017, 31(4): 444-453.
7.	Sanchis MN, Lluch E, Nijs J, <italic>et al</italic>. The role of central sensitization in shoulder pain: A systematic literature review. Semin Arthritis Rheum, 2015, 44(6): 710-716.
8.	Vuagnat H, Chantraine A. Shoulder pain in hemiplegia revisited: contribution of functional electrical stimulation and other therapies. J Rehabil Med, 2003, 35(2): 49-54.
9.	赵钛. 现代偏瘫治疗学. 北京: 人民军医出版社, 1996: 265-267.
10.	Koog YH, Jin SS, Yoon K, <italic>et al</italic>. Interventions for hemiplegic shoulder pain: systematic review of randomised controlled trials. Disabil Rehabil, 2010, 32(4): 282-291.
11.	Langhorne P, Stott DJ, Robertson L, <italic>et al</italic>. Medical complications after stroke: a multicenter study. Stroke, 2000, 31(6): 1223-1229.
12.	McLean DE. Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Arch Phys Med Rehabil, 2004, 85(3): 466-469.
13.	Xiantao Z, Yonggang Z, Joey SW, <italic>et al</italic>. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med, 2015, 8(1): 2-10.
14.	Haidich AB. Meta-analysis in medical research. Hippokratia, 2010, 14(1): 29-37.
15.	Aras MD, Gokkaya NK, Comert D, <italic>et al</italic>. Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey. Am J Phys Med Rehabil, 2004, 83(9): 713-719.
16.	Demirci A, Ocek B, Koseoglu F. Shoulder pain in hemiplegic patients. J PMR Sci, 2007, 1(5): 25-30.
17.	Dromerick AW, Edwards DF, Kumar A. Hemiplegic shoulder pain syndrome: frequency and characteristics during inpatient stroke rehabilitation. Arch Phys Med Rehabil, 2008, 89(8): 1589-1593.
18.	Barlak A, Unsal S, Kaya K, <italic>et al</italic>. Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes. Int J Rehabil Res, 2009, 32(4): 309-315.
19.	Klit H, Finnerup NB, Overvad K, <italic>et al</italic>. Pain following stroke: a population-based follow-up study. PloS One, 2011, 6(11): e27607.
20.	王帅, 刘志华, 王琳, 等. 脑卒中后肩痛患者肩部红外热成像观察. 中国康复医学杂志, 2014, 29(7): 645-649.
21.	贾敏, 刘志华, 于晓明, 等. 脑卒中偏瘫肩痛患者的超声图像表现. 中国康复医学杂志, 2014, 29(2): 127-132.
22.	Karaahmet OZ, Eksioglu E, Gurcay E, <italic>et al</italic>. Hemiplegic shoulder pain: associated factors and rehabilitation outcomes of hemiplegic patients with and without shoulder pain. Top Stroke Rehabil, 2014, 21(3): 237-245.
23.	Paolucci S, Iosa M, Toni D, <italic>et al</italic>. Prevalence and time course of post-stroke pain: a multicenter prospective hospital-based study. Pain Medicine, 2016, 17(5): 924-930.
24.	Janus-Laszuk B, Mirowska-Guzel D, Sarzynska-Dlugosz I, <italic>et al</italic>. Effect of medical complications on the after-stroke rehabilitation outcome. NeuroRehabilitation, 2017, 40(2): 223-232.
25.	崔高亮, 田玉红. 脑卒中患者躯干上部异常姿势与肩峰撞击综合征的相关性分析. 中华物理医学与康复杂志, 2017, 39(9): 668-671.
26.	王其响, 巩尊科, 王世雁, 等. 肌骨超声在脑卒中后偏瘫肩痛软组织病变的量化评定. 临床与病理杂志, 2018, 38(1): 96-101.
27.	Menoux D, Jousse M, Quintaine V, <italic>et al</italic>. Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years. Ann Phys Rehabil Med, 2019, 62(6): 403-408.
28.	徐菲, 金平, 王玉. 脑卒中后癫痫发作的相关危险因素分析. 中华疾病控制杂志, 2017, 21(2): 179-182.
29.	Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil, 2002, 16(3): 276-298.
30.	Payne LZ, Deng XH, Craig EV, <italic>et al</italic>. The combined dynamic and static contributions to subacromial impingement. A biomechanical analysis. Am J Sports Med, 1997, 25(6): 801-808.
31.	Gilmore PE, Spaulding SJ, Vandervoort AA. Hemiplegic shoulder pain: implications for occupational therapy treatment. Can J Occup Ther, 2004, 71(1): 36-46.
32.	Machado LA, de Souza Mv, Ferreira PH, <italic>et al</italic>. The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine (Phila Pa 1976), 2006, 31(9): E254-E262.
33.	Bi X, Zhao J, Zhao L, <italic>et al</italic>. Pelvic floor muscle exercise for chronic low back pain. J Int Med Res, 2013, 41(1): 146-152.
34.	Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man Ther, 2001, 6(1): 3-14.
35.	Chae J, Jedlicka L. Subacromial corticosteroid injection for poststroke shoulder pain: an exploratory prospective case series. Arch Phys Med Rehabil, 2009, 90(3): 501-506.
36.	Griffin C. Management of the hemiplegic shoulder complex. Top Stroke Rehabil, 2014, 21(4): 316-318.
37.	谢军, 韩造木, 尹琬凌. 音乐疗法对脑卒中患者认知和情绪的效果. 中国康复理论与实践, 2019, 25(9): 1075-1078.

1. Wang W, Jiang B, Sun H, <italic>et al</italic>. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480?687 adults. Circulation, 2017, 135(8): 759-771.
2. 任占云, 汤武装, 樊垚, 等. 超敏C-反应蛋白与缺血性脑卒中发病的前瞻性队列研究. 中华疾病控制杂志, 2018, 22(1): 29-32, 51.
3. Feigin VL. Stroke in developing countries: can the epidemic be stopped and outcomes improved? Lancet Neurol, 2007, 6(2): 94-97.
4. 李娟, 黄东辉, 王冲, 等. 辽宁省农村地区2013年脑卒中早死所致的疾病负担分析. 中华疾病控制杂志, 2017, 21(3): 255-260.
5. Chae J, Mascarenhas D, Yu DT, <italic>et al</italic>. Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life. Arch Phys Med Rehabil, 2007, 88(3): 298-301.
6. Nadler M, Pauls MMH. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. Clin Rehabil, 2017, 31(4): 444-453.
7. Sanchis MN, Lluch E, Nijs J, <italic>et al</italic>. The role of central sensitization in shoulder pain: A systematic literature review. Semin Arthritis Rheum, 2015, 44(6): 710-716.
8. Vuagnat H, Chantraine A. Shoulder pain in hemiplegia revisited: contribution of functional electrical stimulation and other therapies. J Rehabil Med, 2003, 35(2): 49-54.
9. 赵钛. 现代偏瘫治疗学. 北京: 人民军医出版社, 1996: 265-267.
10. Koog YH, Jin SS, Yoon K, <italic>et al</italic>. Interventions for hemiplegic shoulder pain: systematic review of randomised controlled trials. Disabil Rehabil, 2010, 32(4): 282-291.
11. Langhorne P, Stott DJ, Robertson L, <italic>et al</italic>. Medical complications after stroke: a multicenter study. Stroke, 2000, 31(6): 1223-1229.
12. McLean DE. Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Arch Phys Med Rehabil, 2004, 85(3): 466-469.
13. Xiantao Z, Yonggang Z, Joey SW, <italic>et al</italic>. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med, 2015, 8(1): 2-10.
14. Haidich AB. Meta-analysis in medical research. Hippokratia, 2010, 14(1): 29-37.
15. Aras MD, Gokkaya NK, Comert D, <italic>et al</italic>. Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey. Am J Phys Med Rehabil, 2004, 83(9): 713-719.
16. Demirci A, Ocek B, Koseoglu F. Shoulder pain in hemiplegic patients. J PMR Sci, 2007, 1(5): 25-30.
17. Dromerick AW, Edwards DF, Kumar A. Hemiplegic shoulder pain syndrome: frequency and characteristics during inpatient stroke rehabilitation. Arch Phys Med Rehabil, 2008, 89(8): 1589-1593.
18. Barlak A, Unsal S, Kaya K, <italic>et al</italic>. Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes. Int J Rehabil Res, 2009, 32(4): 309-315.
19. Klit H, Finnerup NB, Overvad K, <italic>et al</italic>. Pain following stroke: a population-based follow-up study. PloS One, 2011, 6(11): e27607.
20. 王帅, 刘志华, 王琳, 等. 脑卒中后肩痛患者肩部红外热成像观察. 中国康复医学杂志, 2014, 29(7): 645-649.
21. 贾敏, 刘志华, 于晓明, 等. 脑卒中偏瘫肩痛患者的超声图像表现. 中国康复医学杂志, 2014, 29(2): 127-132.
22. Karaahmet OZ, Eksioglu E, Gurcay E, <italic>et al</italic>. Hemiplegic shoulder pain: associated factors and rehabilitation outcomes of hemiplegic patients with and without shoulder pain. Top Stroke Rehabil, 2014, 21(3): 237-245.
23. Paolucci S, Iosa M, Toni D, <italic>et al</italic>. Prevalence and time course of post-stroke pain: a multicenter prospective hospital-based study. Pain Medicine, 2016, 17(5): 924-930.
24. Janus-Laszuk B, Mirowska-Guzel D, Sarzynska-Dlugosz I, <italic>et al</italic>. Effect of medical complications on the after-stroke rehabilitation outcome. NeuroRehabilitation, 2017, 40(2): 223-232.
25. 崔高亮, 田玉红. 脑卒中患者躯干上部异常姿势与肩峰撞击综合征的相关性分析. 中华物理医学与康复杂志, 2017, 39(9): 668-671.
26. 王其响, 巩尊科, 王世雁, 等. 肌骨超声在脑卒中后偏瘫肩痛软组织病变的量化评定. 临床与病理杂志, 2018, 38(1): 96-101.
27. Menoux D, Jousse M, Quintaine V, <italic>et al</italic>. Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years. Ann Phys Rehabil Med, 2019, 62(6): 403-408.
28. 徐菲, 金平, 王玉. 脑卒中后癫痫发作的相关危险因素分析. 中华疾病控制杂志, 2017, 21(2): 179-182.
29. Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil, 2002, 16(3): 276-298.
30. Payne LZ, Deng XH, Craig EV, <italic>et al</italic>. The combined dynamic and static contributions to subacromial impingement. A biomechanical analysis. Am J Sports Med, 1997, 25(6): 801-808.
31. Gilmore PE, Spaulding SJ, Vandervoort AA. Hemiplegic shoulder pain: implications for occupational therapy treatment. Can J Occup Ther, 2004, 71(1): 36-46.
32. Machado LA, de Souza Mv, Ferreira PH, <italic>et al</italic>. The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine (Phila Pa 1976), 2006, 31(9): E254-E262.
33. Bi X, Zhao J, Zhao L, <italic>et al</italic>. Pelvic floor muscle exercise for chronic low back pain. J Int Med Res, 2013, 41(1): 146-152.
34. Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man Ther, 2001, 6(1): 3-14.
35. Chae J, Jedlicka L. Subacromial corticosteroid injection for poststroke shoulder pain: an exploratory prospective case series. Arch Phys Med Rehabil, 2009, 90(3): 501-506.
36. Griffin C. Management of the hemiplegic shoulder complex. Top Stroke Rehabil, 2014, 21(4): 316-318.
37. 谢军, 韩造木, 尹琬凌. 音乐疗法对脑卒中患者认知和情绪的效果. 中国康复理论与实践, 2019, 25(9): 1075-1078.

Chinese Journal of Evidence-Based Medicine

Epidemiological characteristics of post-stroke shoulder pain: a meta-analysis

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