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. 2025 Apr 5;23(1):32.
doi: 10.1186/s12955-025-02367-x.

Association of post-stroke hemiplegic shoulder pain with sleep quality, mood, and quality of life

Marzieh Khatooni  1 , Leila Dehghankar  2 , Fatemeh Samiei Siboni  1 , Mahdieh Bahrami  3 , Mahya Shafaei  4 , Rahman Panahi  5 , Mohamad Amerzadeh  6
Affiliations

Association of post-stroke hemiplegic shoulder pain with sleep quality, mood, and quality of life

Marzieh Khatooni et al. Health Qual Life Outcomes. .

Abstract

Background: Hemiplegic Shoulder Pain (HSP) is a prevalent post-stroke complication, characterized by paralysis, spasticity, altered sensation, neuropathic pain, shoulder subluxation, and soft tissue injuries such as rotator cuff tears and bicipital tendonitis. Muscle imbalances, weakness, and altered scapular positioning further contribute to the exacerbation of HSP. These factors lead to poorer functional outcomes, reduced hand function, and difficulties in performing daily activities. HSP is often associated with substantial mental and physical health burdens. The disorder significantly impacts the rehabilitation process, as evidenced by the negative effects it can have on quality of life (QoL), sleep quality, and mental status.This study aimed to determine the relationships between pain intensity, sleep quality, depressive symptoms and QoL in patients with post-stroke HSP.

Methods: This study was a cross-sectional survey of patients with chronic post-stroke HSP. The study included 164 patients who were referred to physiotherapy, rehabilitation, and neurology clinics for palliative and rehabilitative care. Demographic data, pain intensity (Numeric Pain Rating Scale, NPRS), QoL (SF- 36), sleep quality (Pittsburgh Sleep Quality Index, PSQI), and depression (Beck Depression Inventory-II, BDI-II) were assessed.

Results: Participants exhibited low QoL, with a mean SF- 36 score of 46.25 ± 4.21. The mean and standard deviation for depression, sleep quality, and pain intensity were 12.375 ± 3.569 (moderate level), 9.901 ± 3.213 (relatively low level), and 4.689 ± 2.547 (moderate level), respectively. The variables of sleep quality, depression, pain intensity, education level, and duration of HSP were found to be significant predictors of QoL (P < 0.05). Individuals experiencing intense and moderate pain had 0.538 and 0.605 times the likelihood of having a favorable QoL, respectively, compared to those with mild pain. Similarly, individuals with intense and moderate depression had 0.461 and 0.551 times the likelihood of achieving a favorable QoL compared to those without depression. Participants with a diploma or university degree (OR: 2.475) were more likely to have a favorable QoL than those who were illiterate. Additionally, individuals who had experienced HSP for more than one year had 0.631 times the likelihood of achieving a favorable QoL compared to those whose HSP duration was less than one year. Regarding functional independence, individuals who were completely dependent and semi-dependent in performing daily activities had 0.391 and 0.462 times the likelihood of having a favorable QoL, respectively, compared to those who were completely independent.

Conclusion: Post-stroke HSP patients exhibited significant shoulder pain, depression, and poor sleep quality, leading to reduced QoL. Factors such as duration of HSP, sleep quality, depression, pain intensity, and education level were identified as influential in determining QoL for these patients.

Keywords: Depression; Quality of life; Shoulder pain; Sleep quality; Stroke.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Ethical Committee of Qazvin University of Medical Sciences (QUMS)- Iran approved this study. Ethical code: IR.QUMS.REC.1400.512. The Ethical Committee approved all experimental protocols. All methods were carried out in accordance with relevant guidelines and regulations. We provided the participants or their legal guardian(s) with an information sheet, reassured them about anonymity, freedom to withdraw, confidentiality and explained the study's purpose, and obtained their informed consent form." Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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