Hemiplegic shoulder pain: a study of two methods of physiotherapy treatment

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Abstract
A study was undertaken to examine the effectiveness of two methods of physiotherapy treatment for hemiplegic shoulder pain. Sixty-five patients were randomly allocated to receive either cryotherapy or the Bobath approach. Patients were assessed before and after a four-week period of treatment. The differences between the scores of the two groups on exit were not found to reach statistically significant levels for severity of pain at rest, on movement, or for reported distress; however the proportion of patients who reported no pain after the four weeks' treatment was greater in those who received the Bobath approach. The differences in reported frequency of occurrence of pain reached a significant level (p < .05), those in the Bobath group reporting less frequent pain. It is suggested that reasons forthe lack of expected differences in outcome between the two groups may be in part due to the diversity of underlying pathology, and to further trauma which occurred in the study period. The difference between before and after ratings for all pain variables was significant; for reported severity and frequency p < .05, and for reported distress p < .001. These findings suggest that physiotherapy may have a role to play in the treatment and management of hemiplegic shoulder pain, but further investigations are needed. It may be appropriate to set up and monitor programmes of careful handling to see if shoulder pain can be avoided, and it is also suggested that those with severe pain at rest and on movement may be considered as a separate group for study.

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