Category: Stroke; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Quality Improvement and Implementation Science
Objective : To examine the impact of a comprehensive shoulder program post-stroke to reduce secondary shoulder complications and improve functional movement.
Setting : Inpatient rehabilitation
Participants (or Animals, Specimens, Cadavers) :
Eligible patients between June 2017-August 2018 were diagnosed with stroke or worsening stroke-related hemiplegia/hemiparesis, ≥3 admission FIM comprehension, and one or more clinically positive measurement of routine shoulder assessments: subluxation, anterior displacement, pain, and/or WOLF Motor Function Test (WMFT) (Median time=120, Average functional ability <3).
Interventions : Routine shoulder assessments were conducted within the first 4 days from admission and 3 days prior to discharge. The stroke shoulder program included: shoulder strapping, application of hemi-cuff sling, positioning hemiplegic extremity in bed using pillows and in wheelchair using arm troughs, stretching and ROM (passive/active assisted/active) for shoulder complex, initiating functional use of upper extremity as appropriate, patient/caregiver education, and transdisciplinary communication.
Main Outcome Measure(s) :
Change in routine shoulder assessments from admission to discharge.
Out of the 237 patients assessed, 100 patients qualified for the stroke shoulder program. Patients had an average length of stay of 25.5 ± 11, were primarily male (53%), non-Hispanic (94%), White (61%), average age of 63 ± 15.2. Patients improved from admission to discharge for all assessments: shoulder subluxation (-0.2 ± 0.5 change), anterior displacement (-0.1 ± 0.6 change), pain (-1.1 ± 2.3 change), WFMT median (-30.3 ± 48.8 change), and WFMT function (0.8 ± 1.1 change).
The stroke shoulder program was effective in reducing risk for developing shoulder complications and assisted in reducing severity of post-stroke shoulder complications. This program is a model for neurorehabilitation facilities to identify shoulder complications and intervene to improve function. Future steps include tracking patient's continuous usage of stroke shoulder program and shoulder pain one-month post–discharge.
Priyanka Kapoor– Occupational Therapist, Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
Joanna Allbright– Occupational Therapist, Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
Molly Trammell– Physical Therapy Supervisor, Baylor Scott and White Institute for Rehabilitation Dallas Texas, Frisco, Texas
Librada Callender– Epidemiologist, Baylor Scott & White Institute for Rehabilitation, Dallas, Texas