Article

OBJECTIVES: To determine whether shoulder orthoses prevent or reduce
gleno-humeral subluxation and hemiplegic shoulder pain.
DATA SOURCES: OVID SP,
MEDLINE, AMED, CINAHL, PEDro and the Cochrane Central Register of Controlled
Trials. REVIEW METHODS: We included: randomised or quasi-randomised controlled
trials, controlled before and after studies and observational studies. Two
reviewers independently screened, critically appraised papers using the PEDro
tool, and extracted data.
A descriptive synthesis was performed as there were
insufficient data for meta-analysis. RESULTS: Eight studies were included,
totalling 186 participants: One randomised controlled trial with 41 participants,
one quasi-randomised with 14 participants, one before and after controlled study
with 40 participants and five observational studies with 91 participants met the
inclusion criteria. Findings suggest that applying an orthosis to an already
subluxed shoulder immediately reduced vertical subluxation on X-ray but
improvements were not maintained when orthosis was removed. Orthoses with both
proximal and distal attachments improved shoulder pain in the majority of stroke
patients when worn for four weeks (starting several days or weeks post-stroke).
There was no increase in adverse effects of contracture, spasticity or hand
oedema when compared to no orthosis. Orthoses were generally well-tolerated and
most patients rated the orthosis as comfortable to wear. CONCLUSION:
Observational studies suggest that orthoses reduce vertical subluxation whilst
in-situ. Available evidence from heterogeneous studies after stroke suggests that
orthoses may reduce pain and are well-tolerated with prolonged use. No studies
have tested whether subluxation and pain can be prevented by immediate post-stroke application of orthoses.

Langue : ANGLAIS