Investigating current clinical practice in the prevention of hemiplegic shoulder pain: A survey of neuro-therapists in the UK

Introduction
Hemiplegic shoulder pain (HSP) is a common medical complication following stroke, that impacts the overall functional outcomes of the person with stroke (PWS). While prevention is key, clinical guidelines offer little guidance on how to effectively achieve this. This study aimed to investigate neuro-therapists (Occupational Therapists and Physiotherapists) current clinical practice to prevent HSP.
Methods
A cross-sectional, online survey was designed, piloted and distributed through specialist interest groups, social media and encouraging sharing of the link. The survey was open for six months. Results were analysed using descriptive statistics.
Results
The study received 137 responses. The majority of respondents (n=119, 86.7%) reported they screened for HSP. Two thirds (n=91, 66.4%) reported they used preventative strategies all of the time, with just over half (n=76, 55.5%) reporting using them with people deemed at risk of developing HSP and the rest reporting using them with all PWS. The most common risk factors suggested were immobility of the upper limb, severe arm weakness and subluxation. The most common preventative strategies used in clinical practice were positioning, education and pillow support.
Conclusion
Respondents were aware of the importance of preventing HSP but lack robust evidence to support the use of certain strategies. Timing is key for prevention to be effective, ensuring strategies are implemented before the PWS develops any HSP. To do this therapists need to effectively identify those deemed most at risk of developing HSP. An improved evidence base is needed to help develop clinical guidelines for the prevention of HSP.