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A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients

Anke Van Bladel (UGent) , Gert Lambrecht (UGent) , Kristine Oostra (UGent) , Guy Vanderstraeten (UGent) and Dirk Cambier (UGent)
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Abstract
BACKGROUND: Arm slings are often used in clinical practice to support the hemiplegic arm aiming to prevent or treat glenohumeral subluxation. Evidence supporting the corrective effect of slings on subluxation is scarce and long-term studies are lacking. AIM: The aim of this study was to determine both the immediate and long-term effect on acromiohumeral distance using the Actimove (R) sling and Shoulderlift and to determine the effect of slings on pain and passive range of motion of the shoulder in stroke patients with glenohumeral subluxation. DESIGN: Randomized control trial. SETTING: Hospital inpatients. POPULATION : Stroke patients. METHODS: Twenty-eight stroke patients, with severe upper limb impairments, were randomly allocated to 3 groups (Actimove, Shoulderlift, No sling). Patients wore their supportive device for 6 weeks and no sling in the control group. Immediate and postinterventional effect on acromiohumeral distance was measured using sonography. Pain (VAS), ROM (goniometry), spasticity (Modified Ashworth Scale), Fugl-Meyer Assessment and trunk stability (TIS) were also assessed before and after the intervention. RESULTS: The level of immediate correction of both slings was different at baseline and after 6 weeks (0 weeks: Shoulderlift 63%, Actimove 36%; 6 weeks: Shoulderlift 28%, Actimove 24%). Comparing the level of subluxation over time shows a distinct decrease in subluxation but only for the control group (-37.59% or 3.30 mm). Subluxation remained the same in the Actimove group (-2.77% or 0.27 mm) but increased in the Shoulderlift group (+ 12.44% or 1.03 mm). After 6 weeks, the Actimove group reported more pain at rest (P=0.036). ROM for abduction and external rotation decreased in 2 groups and remained un-altered in the Shoulderlift group. CONCLUSIONS : Results of immediate correction varied. Subluxation seemed to reduce in patients that did not wear a sling. CLINICAL REHABILITATION IMPACT: The (assumed) presence of subluxation may not benefit from wearing an arm sling which may itself inhibit active correction. If a sling is indicated the Shoulderlift may be preferable to the Actimove sling.
Keywords
Stroke, Orthotic devices, Shoulder dislocation, Shoulder pain, QUALITY-OF-LIFE, HEMIPLEGIC SHOULDER, POSTSTROKE HEMIPLEGIA, MOTOR IMPAIRMENT, PAIN, REHABILITATION, RELIABILITY, KINEMATICS, FREQUENCY, ACROMION

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Chicago
Van Bladel, Anke, Gert Lambrecht, Kristine Oostra, Guy Vanderstraeten, and Dirk Cambier. 2017. “A Randomized Controlled Trial on the Immediate and Long-term Effects of Arm Slings on Shoulder Subluxation in Stroke Patients.” European Journal of Physical and Rehabilitation Medicine 53 (3): 400–4009.
APA
Van Bladel, A., Lambrecht, G., Oostra, K., Vanderstraeten, G., & Cambier, D. (2017). A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients. EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE, 53(3), 400–4009.
Vancouver
1.
Van Bladel A, Lambrecht G, Oostra K, Vanderstraeten G, Cambier D. A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients. EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE. 2017;53(3):400–4009.
MLA
Van Bladel, Anke, Gert Lambrecht, Kristine Oostra, et al. “A Randomized Controlled Trial on the Immediate and Long-term Effects of Arm Slings on Shoulder Subluxation in Stroke Patients.” EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 53.3 (2017): 400–4009. Print.
@article{8548587,
  abstract     = {BACKGROUND: Arm slings are often used in clinical practice to support the hemiplegic arm aiming to prevent or treat glenohumeral subluxation. Evidence supporting the corrective effect of slings on subluxation is scarce and long-term studies are lacking. 
AIM: The aim of this study was to determine both the immediate and long-term effect on acromiohumeral distance using the Actimove (R) sling and Shoulderlift and to determine the effect of slings on pain and passive range of motion of the shoulder in stroke patients with glenohumeral subluxation. 
DESIGN: Randomized control trial. 
SETTING: Hospital inpatients. 
POPULATION : Stroke patients. 
METHODS: Twenty-eight stroke patients, with severe upper limb impairments, were randomly allocated to 3 groups (Actimove, Shoulderlift, No sling). Patients wore their supportive device for 6 weeks and no sling in the control group. Immediate and postinterventional effect on acromiohumeral distance was measured using sonography. Pain (VAS), ROM (goniometry), spasticity (Modified Ashworth Scale), Fugl-Meyer Assessment and trunk stability (TIS) were also assessed before and after the intervention. 
RESULTS: The level of immediate correction of both slings was different at baseline and after 6 weeks (0 weeks: Shoulderlift 63\%, Actimove 36\%; 6 weeks: Shoulderlift 28\%, Actimove 24\%). Comparing the level of subluxation over time shows a distinct decrease in subluxation but only for the control group (-37.59\% or 3.30 mm). Subluxation remained the same in the Actimove group (-2.77\% or 0.27 mm) but increased in the Shoulderlift group (+ 12.44\% or 1.03 mm). After 6 weeks, the Actimove group reported more pain at rest (P=0.036). ROM for abduction and external rotation decreased in 2 groups and remained un-altered in the Shoulderlift group. 
CONCLUSIONS : Results of immediate correction varied. Subluxation seemed to reduce in patients that did not wear a sling. 
CLINICAL REHABILITATION IMPACT: The (assumed) presence of subluxation may not benefit from wearing an arm sling which may itself inhibit active correction. If a sling is indicated the Shoulderlift may be preferable to the Actimove sling.},
  author       = {Van Bladel, Anke and Lambrecht, Gert and Oostra, Kristine and Vanderstraeten, Guy and Cambier, Dirk},
  issn         = {1973-9087},
  journal      = {EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE},
  keyword      = {Stroke,Orthotic devices,Shoulder dislocation,Shoulder pain,QUALITY-OF-LIFE,HEMIPLEGIC SHOULDER,POSTSTROKE HEMIPLEGIA,MOTOR IMPAIRMENT,PAIN,REHABILITATION,RELIABILITY,KINEMATICS,FREQUENCY,ACROMION},
  language     = {eng},
  number       = {3},
  pages        = {400--4009},
  title        = {A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients},
  url          = {http://dx.doi.org/10.23736/S1973-9087.17.04368-4},
  volume       = {53},
  year         = {2017},
}

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