Bobath Approach On Hemiplegic Shoulder Pain

Study Overview
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Brief Summary
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In this study, it is investigated that whether Bobath approach is superior to conventional physiotherapy in terms of improving hemiplegic shoulder pain, spasticity and upper extremity functionality in stroke patients.

Detailed Description
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Objective: This study aims to determine the effect of Bobath approach on hemiplegic shoulder pain, spasticity and upper extremity functionality in stroke patients. Patients and Methods: For this prospective, randomized, controlled and single-blind trial, 30 stroke patients aged 40-65 years with hemiplegic shoulder pain were included. Patients were divided into two groups and randomized into these groups. Only conventional physiotherapy was applied to the control group, whereas both conventional physiotherapy and Bobath exercises were also applied to the experimental group. Visual analog scale (horizontal) for shoulder pain, modified Ashworth scale for spasticity and Fugl-Meyer assessment of the upper extremity for functionality were used for both pre-test and post-test.

Official Title
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The Effect Of Bobath Approach On Hemiplegic Shoulder Pain, Spasticity And Upper Extremity Functionality In Stroke Patients: A Prospective, Randomized, Controlled And Single-Blind Trial

Conditions
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Hemiplegic Shoulder Pain

Intervention / Treatment
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* Procedure: Bobath treatment approach
* Procedure: Conventional physiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients between the ages of 40 and 65 Patients who had a stroke for the first time and had a disease duration of at least four weeks Patients who were diagnosed with ischemic or hemorrhagic stroke Patients who had Brunnstrom stage 3, 4 or 5 and had hemiplegic shoulder pain were included in the study. Exclusion Criteria: Patients with severe cognitive impairment who could not understand simple verbal commands Those who had severe dysarthria to prevent verbal communication Those with unilateral neglect syndrome Those with loss of sensation in the upper extremity of the hemiplegic side Those with botulinum toxin-A injected to the hemiplegic upper extremity muscles Those with previous shoulder-related trauma or pain history Those with other accompanying neurological disease were excluded from the study.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A PROSPECTIVE, RANDOMIZED, CONTROLLED AND SINGLE-BLIND TRIAL
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Bobath group<br>A conventional physiotherapy program was applied to this group. Additionally, Bobath treatment approach was applied for 10 repetitions during a 30-min session in the experimental group, in addition to the conventional physiotherapy program. | Procedure: Bobath treatment approach<br>* scapulothoracic mobilization exercise, reaching in different directions in the supine position and upper extremity weight transfer exercise.<br>* Other names: Neurodevelopmental treatment;Procedure: Conventional physiotherapy<br>* range of motion, stretching, strengthening exercises, electrotherapy, thermotherapy, balance and mobility exercises and exercises for daily living activities.<br>|
| Active Comparator: Conventional physiotherapy group<br>Only conventional physiotherapy program was applied to this group. | Procedure: Conventional physiotherapy<br>* range of motion, stretching, strengthening exercises, electrotherapy, thermotherapy, balance and mobility exercises and exercises for daily living activities.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline Fugl-Meyer Assessment score at 30 sessions, 6 weeks | Upper extremity functionality, min-max: 0-66, 0 indicates no function of upper extremity, 66 indicates the highest functionality of upper extremity as possible. | First evaluation: immediately before starting the treatment; the last evaluation: at the end of the treatment of 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline Visual Analog Scale (horizontal) value at 30 sessions, 6 weeks | Hemiplegic shoulder pain, 0-10 cm scale, 0 shows no pain at hemiplegic shoulder, 10 shows unbearable pain intensity at hemiplegic shoulder | First evaluation: immediately before starting the treatment; the last evaluation: at the end of the treatment of 6 weeks | 
| Change from baseline modified Ashworth scale value at 30 sessions, 6 weeks | Upper extremity spasticity, 0: No increase in tone, 1: slight increase in tone giving a catch when slight increase in muscle tone manifested by the limb was moved in flexion or extension. 1+: slight increase in muscle tone, manifested by a catch followed by minimal resistance throughout (ROM ) 2: more marked increase in tone but more marked increased in muscle tone through most limb easily flexed 3: considerable increase in tone, passive movement difficult 4: limb rigid in flexion or extension | First evaluation: immediately before starting the treatment; the last evaluation: at the end of the treatment of 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hemiplegia, hemiplegic shoulder pain, neurodevelopmental treatment, spasticity, stroke