Beare, Ben;
(2023)
Bio-psychosocial influences on the onset, longevity and treatment of post stroke shoulder pain.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background Post Stroke Shoulder Pain (PSSP) is common in hemiparetic arm. This thesis addressed the following six questions: i) Does early passive shoulder restriction in hemiparetic arms show a relationship with developing moderate to severe pain by 8 weeks? ii) Is botulinum toxin injection effective in treating PSSP in the first 3 months post stroke? iii) Which muscle groups contribute to restriction patterns when proximal spasticity is present? iv) Are hydrodilatation injections effective in treating frozen shoulder in hemiparetic arms? v) Are there common scapula movement adaptations in hemiparetic arms with frozen shoulder? Does active glenohumeral external rotation range show a relationship with dynamic scapula axial rotation range? vi) What proportions of stroke survivors with PSSP show maladaptive levels of fear of arm movement and what aspects of their lived experience influenced this fear? Thesis Abstract (Methods and Results) Study 1: Methods: Baseline demographics and clinical measures of 32 ‘at risk’ stroke survivors were collected and pain was monitored up to 8 weeks. Results: Shoulder external rotation and abduction restriction and reduced shoulder proprioception at baseline showed a significant relationship with developing pain by 8 weeks Study 2: Methods: A systematic review examined botulinum toxin injection studies for PSSP. Needle Electromyography (EMG) was used to examine individual muscle spasticity in 11 painful and stiff hemiparetic shoulders. Results: No studies were found examining use of botulinum toxin injection for PSSP within 3 months. No consistent muscle patterns were observed in proximal spasticity. Study 3: Methods: Outcomes for 41 stroke survivors with frozen shoulder pre and post hydrodilatation injection were examined Results: Hydrodilatation was effective in improving passive range and pain. Age influenced range change as an outcome. Study 4: Methods: Scapula movement strategies were observed in 11 hemiparetic arms with frozen shoulder Results: Scapula retraction was a common initiation pattern in hemiparetic arms. Dynamic scapula axial rotation range is influenced by active glenohumeral external rotation range. Study 5: Methods: 41 stroke survivors with PSSP completed the Tampa Scale for Kinesiophobia Results: 25/41 (61%) of stroke survivors showed maladaptive levels of fear of movement. T Thesis Abstract: Conclusions These findings will help guide future interventional research and help clinicians better identify who is most at risk of developing PSSP
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Bio-psychosocial influences on the onset, longevity and treatment of post stroke shoulder pain |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | Post stroke shoulder pain, Biopsychosocial influences on pain |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10172538 |
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