Strapping the hemiplegic shoulder prevents development of pain during rehabilitation: a randomized controlled trial

Abstract

Objective: To determine whether strapping (therapeutic or placebo) the 'at risk' shoulder prevented or delayed development of hemiplegic shoulder pain better than standard care.

Design: Randomized controlled trial.

Setting: Three inpatient rehabilitation hospitals, Melbourne, Australia.

Patients: Thirty-three patients 'at risk' of developing hemiplegic shoulder pain were randomized, one withdrew. Patients at risk were considered to be those with low or no muscle function around the shoulder (Motor Assessment Scale, upper arm score < 3).

Interventions: Standard care for control group. Therapeutic strapping or placebo strapping with lightweight adhesive tape. All strapping was maintained over four weeks.

Main outcome measures: The primary outcome was number of pain-free days measured on Ritchie Articular Index. Secondary outcome measures included range of movement, function (Motor Assessment Scale, upper arm component) and affected arm muscle tone (Modified Ashworth Scale).

Results: Only one patient in the therapeutic strapping group developed pain. One-way ANOVA revealed that mean number of pain-free days over the 28-day period was significantly different (P = 0.02), with the difference between the therapeutic strapping and the control group. Patients in the therapeutic strapping group had a mean of 26.2 pain-free days, while those in the placebo group and control group had a mean of 19.1 and 15.9 pain-free days respectively. Range of movement and function improved between admission and discharge but were not significantly different between groups.

Conclusions: Therapeutic strapping limited development of hemiplegic shoulder pain during rehabilitation in at risk stroke patients. Placebo strapping has an effect, with a larger study (n = 30 per group) needed to detect whether there are differences between therapeutic and placebo strapping.