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Randomized Controlled Trial
. 2024 Apr;60(2):216-224.
doi: 10.23736/S1973-9087.24.08264-9. Epub 2024 Mar 14.

Repetitive peripheral magnetic stimulation for preventing shoulder subluxation after stroke: a randomized controlled trial

Kenta Fujimura  1 , Hitoshi Kagaya  2   3 , Ryoka Itoh  4 , Chiharu Endo  4 , Hiroki Tanikawa  5 , Hirofumi Maeda  3
Affiliations
Randomized Controlled Trial

Repetitive peripheral magnetic stimulation for preventing shoulder subluxation after stroke: a randomized controlled trial

Kenta Fujimura et al. Eur J Phys Rehabil Med. 2024 Apr.

Abstract

Background: Shoulder subluxation caused by paralysis after stroke is a serious issue affecting shoulder pain and functional prognosis. However, its preventive treatment has not been fully investigated.

Aim: To investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on the prevention of shoulder subluxation.

Design: A single-center, parallel-group, prospective randomized, open-blinded, end-point study.

Setting: Convalescent rehabilitation ward.

Population: We included 50 inpatients in the convalescent rehabilitation ward with post-stroke, having upper limb paralysis, and the acromio-humeral interval (AHI) was within 1/2 finger-breadth.

Methods: A blinded computer-based allocation system was used to randomly assign patients into two groups: 1) conventional rehabilitation plus rPMS therapy (rPMS group, N=25); and 2) conventional rehabilitation alone (control group, N=25). Blinded assessors evaluated the patients before the intervention (T0), 6 weeks after (T1), and 12 weeks after (T2). The primary outcome was the change in AHIs from T0 to T1 between the groups. In contrast, the secondary outcomes were shoulder pain, spasticity, active range of motion, and Fugl-Meyer Assessment upper extremity (FMA-UE) score.

Results: Twenty-two patients in the rPMS group and 24 in the control group completed T1, whereas 16 in the rPMS group and 11 in the control group completed T2. The change in AHI was significantly lower in the rPMS group than in the control group ([95% CI, -5.15 to -0.390], P=0.023). Within-group analysis showed that AHI in the rPMS group did not change significantly, whereas it increased in the control group (P=0.004). There were no significant differences between T1 and T2 within or between the groups. Moreover, AHI did not show differences in patients with severe impairment but decreased in the rPMS group in patients with mild impairment (P=0.001).

Conclusions: The rPMS may be a new modality for preventing shoulder subluxation. The association between motor impairment and the sustained effect needs to be further examined.

Clinical rehabilitation impact: Applying rPMS to the muscles of the paralyzed shoulder after a stroke may prevent shoulder subluxation.

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Conflict of interest statement

Conflicts of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
—rPMS therapy to the supraspinatus muscle.
Figure 2
Figure 2
—Design and flow of participants through the study.
Figure 3
Figure 3
—The AHIs from T0 to T2 in 16 rPMS and 11 control group patients for whom T2 evaluation was possible.
Figure 4
Figure 4
—AHI change from T0 to T1 between severe and mild function measured by the upper extremity Fugl-Meyer Assessment scale (FMA-UE).
See this image and copyright information in PMC

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