Comparing Mobilization Techniques for the Hemiplegic Shoulder

Study Overview
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Brief Summary
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One of the main complications after stroke is hemiplegic shoulder pain. It is known that one of the most frequent causes of hemiplegic shoulder pain is a restricted range of motion in the shoulder joint. Therefore, it is necessary to preserve the passive range of motion by using the most optimal mobilization technique. The aim of this study is to compare 2 different techniques in order to document their influence on shoulder range of motion and shoulder pain in stroke patients.

Official Title
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Comparing Mobilization Techniques for the Hemiplegic Shoulder

Conditions
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Hemiplegic Shoulder, Mobility Limitation

Intervention / Treatment
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* Other: Glenohumeral mobilization
* Other: Scapular mobilization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: First stroke Upper limb impairment Exclusion Criteria: Shoulder pain on the hemiplegic side with onset before the stroke Surgery at the hemiplegic shoulder Active movement possible within the whole range of motion

Ages Eligible for Study
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Minimum Age: 18 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: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Angular mobilization<br>Angular mobilization of the shoulder joint in the frontal plane. | Other: Glenohumeral mobilization<br>* Comparing the effect of angular mobilization in frontal or scapular plane and of providing soft tissue techniques on hemiplegic shoulder range of motion and pain.<br>|
| Active Comparator: Angular mobilization with soft tissue techniques<br>Angular mobilization performed in the scapular plane. Additional soft tissue techniques to eliminate limitations created by tensed muscles in order to perform capsular stretch. | Other: Glenohumeral mobilization<br>* Comparing the effect of angular mobilization in frontal or scapular plane and of providing soft tissue techniques on hemiplegic shoulder range of motion and pain.<br>|
| Placebo Comparator: Scapular mobilization<br>Scapular mobilization without glenohumeral movement. | Other: Scapular mobilization<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Range of motion of the shoulder using goniometry | Range of motion of the shoulder joint is measured using a goniometer | Measuring every 4 weeks up to 12 weeks after admission to the study protocol | 
| Shoulder pain using visual analogue scale | Shoulder pain during rest, night and activities by using visual analogue scale (0-10) | Measuring every 4 weeks up to 12 weeks after admission to the study protocol | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Spasticity of the shoulder muscles using the Modified Ashworth Scale | Spasticity of upper limb muscles related to the shoulder using Modified Ashworth Scale | Measuring every 4 weeks up to 12 weeks after admission to the study protocol | 
| Trunk Impairment Scale to assess trunk stability | Trunk stability using the Trunk Impairment Scale | Measuring every 4 weeks up to 12 weeks after admission to the study protocol | 
| Fugl-Meyer Assessment - upper limb part to assess voluntary muscle activity | voluntary muscle activity upper limb using the upper limb part of the Fugl-Meyer Scale | Measuring every 4 weeks up to 12 weeks after admission to the study protocol |