A slinging match: Preventing shoulder subluxation after stroke (A randomised trial)

Background: Shoulder subluxation is common following stroke. A range of supportive devices are used to prevent subluxation, but no randomised trials have been carried out to determine their efficacy. The aim of this study was to determine whether combining a modified lap-tray and triangular sling is more effective than a hemi-sling in preventing shoulder subluxation after stroke. Method: A prospective, randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Forty-six acute stroke survivors were included. The experimental group used a modified laptray while sitting and a triangular sling while standing to support the affected arm for four weeks. The control group used a hemi-sling while sitting and standing. The primary outcome was shoulder subluxation on Xray. Secondary outcomes were upper limb activity, pain and contracture. Results: There was no significant difference between groups for shoulder subluxation (mean difference: 3 mm, 95% CI 8 to 3). There was a trend in the experimental group for less pain at rest (mean difference: 0.7 out of 10, 95% CI 2.2 to 0.8) and during shoulder external rotation (mean difference: 1.7 out of 10, 95% C 3.7 to 0.3) and for having less shoulder external rotation contracture (mean difference: 10 deg, 95% CI 22 to 2). Conclusion: The use of a lap-tray during sitting and triangular sling during standing is not indicated as an alternative to a hemi-sling to prevent shoulder subluxation, pain or contracture after stroke. Strategies with proven efficacy, such as electrical stimulation, should be considered.