Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke

A randomized trial

Louise Ada, Anchalee FOONGCHOMCHEAY, Birgitta LANGHAMMER, Elisabeth PRESTON, Rosalyn Stanton, John ROBINSON, Serene PAUL, Colleen Canning

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Shoulder subluxation is a common secondary impairment of the upper limb following stroke. A range of supportive devices are used in rehabilitation to prevent shoulder subluxation, including hemi-slings and firm supports, such as arm troughs, however, there is little evidence regarding their efficacy. AIM: To determine whether a modified lap-tray during sitting and a triangular sling during standing is more effective than a hemi-sling in preventing shoulder subluxation, pain, contracture and upper limb activity limitation after stroke. DESIGN: A prospective, randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis. SETTING: Three inpatient rehabilitation units in Australia and Norway. POPULATION: Forty-six acute stroke survivors within 3 weeks of stroke who were at risk of subluxation. METHODS: The experimental group used a modified lap-tray 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 amount of shoulder subluxation on X-ray. Secondary outcomes were upper limb activity, pain and contracture. RESULTS: There was no significant difference between groups in terms of shoulder subluxation (MD -3 mm, 95% CI -8 to 3). There was a trend for the experimental group to develop less pain at rest (MD -0.7 out of 10, 95% CI -2.2 to 0.8) and during shoulder external rotation (MD -1.7 out of 10, 95% CI -3.7 to 0.3) and a trend towards having less contracture of shoulder external rotation (MD -10 deg, 95% CI -22 to 2). There was no significant difference between groups in terms of other contractures and activity of the upper limb. CONCLUSIONS: A lap-tray during sitting combined with a triangular sling during standing is no more effective than a hemi-sling in preventing subluxation, pain, contracture and activity limitation in acute stroke survivors at risk of shoulder subluxation. CLINICAL REHABILITATION IMPACT: The use of a lap-tray during sitting and triangular sling during standing is not indicated as an alternative to the hemi-sling to prevent shoulder subluxation in patients after stroke, so alternative strategies with proven efficacy, such as electrical stimulation, should be considered.
Original languageEnglish
Pages (from-to)41-48
Number of pages8
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume53
Issue number1
DOIs
Publication statusPublished - 2017

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Stroke
Contracture
Upper Extremity
Rehabilitation
Pain
Arm
Shoulder Pain
Intention to Treat Analysis
Norway
Electric Stimulation
Survivors
Inpatients
X-Rays
Equipment and Supplies
Control Groups

Cite this

Ada, Louise ; FOONGCHOMCHEAY, Anchalee ; LANGHAMMER, Birgitta ; PRESTON, Elisabeth ; Stanton, Rosalyn ; ROBINSON, John ; PAUL, Serene ; Canning, Colleen. / Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke : A randomized trial. In: European Journal of Physical and Rehabilitation Medicine. 2017 ; Vol. 53, No. 1. pp. 41-48.
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title = "Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke: A randomized trial",
abstract = "BACKGROUND: Shoulder subluxation is a common secondary impairment of the upper limb following stroke. A range of supportive devices are used in rehabilitation to prevent shoulder subluxation, including hemi-slings and firm supports, such as arm troughs, however, there is little evidence regarding their efficacy. AIM: To determine whether a modified lap-tray during sitting and a triangular sling during standing is more effective than a hemi-sling in preventing shoulder subluxation, pain, contracture and upper limb activity limitation after stroke. DESIGN: A prospective, randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis. SETTING: Three inpatient rehabilitation units in Australia and Norway. POPULATION: Forty-six acute stroke survivors within 3 weeks of stroke who were at risk of subluxation. METHODS: The experimental group used a modified lap-tray 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 amount of shoulder subluxation on X-ray. Secondary outcomes were upper limb activity, pain and contracture. RESULTS: There was no significant difference between groups in terms of shoulder subluxation (MD -3 mm, 95{\%} CI -8 to 3). There was a trend for the experimental group to develop less pain at rest (MD -0.7 out of 10, 95{\%} CI -2.2 to 0.8) and during shoulder external rotation (MD -1.7 out of 10, 95{\%} CI -3.7 to 0.3) and a trend towards having less contracture of shoulder external rotation (MD -10 deg, 95{\%} CI -22 to 2). There was no significant difference between groups in terms of other contractures and activity of the upper limb. CONCLUSIONS: A lap-tray during sitting combined with a triangular sling during standing is no more effective than a hemi-sling in preventing subluxation, pain, contracture and activity limitation in acute stroke survivors at risk of shoulder subluxation. CLINICAL REHABILITATION IMPACT: The use of a lap-tray during sitting and triangular sling during standing is not indicated as an alternative to the hemi-sling to prevent shoulder subluxation in patients after stroke, so alternative strategies with proven efficacy, such as electrical stimulation, should be considered.",
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author = "Louise Ada and Anchalee FOONGCHOMCHEAY and Birgitta LANGHAMMER and Elisabeth PRESTON and Rosalyn Stanton and John ROBINSON and Serene PAUL and Colleen Canning",
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Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke : A randomized trial. / Ada, Louise; FOONGCHOMCHEAY, Anchalee; LANGHAMMER, Birgitta; PRESTON, Elisabeth; Stanton, Rosalyn; ROBINSON, John; PAUL, Serene; Canning, Colleen.

In: European Journal of Physical and Rehabilitation Medicine, Vol. 53, No. 1, 2017, p. 41-48.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke

T2 - A randomized trial

AU - Ada, Louise

AU - FOONGCHOMCHEAY, Anchalee

AU - LANGHAMMER, Birgitta

AU - PRESTON, Elisabeth

AU - Stanton, Rosalyn

AU - ROBINSON, John

AU - PAUL, Serene

AU - Canning, Colleen

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Shoulder subluxation is a common secondary impairment of the upper limb following stroke. A range of supportive devices are used in rehabilitation to prevent shoulder subluxation, including hemi-slings and firm supports, such as arm troughs, however, there is little evidence regarding their efficacy. AIM: To determine whether a modified lap-tray during sitting and a triangular sling during standing is more effective than a hemi-sling in preventing shoulder subluxation, pain, contracture and upper limb activity limitation after stroke. DESIGN: A prospective, randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis. SETTING: Three inpatient rehabilitation units in Australia and Norway. POPULATION: Forty-six acute stroke survivors within 3 weeks of stroke who were at risk of subluxation. METHODS: The experimental group used a modified lap-tray 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 amount of shoulder subluxation on X-ray. Secondary outcomes were upper limb activity, pain and contracture. RESULTS: There was no significant difference between groups in terms of shoulder subluxation (MD -3 mm, 95% CI -8 to 3). There was a trend for the experimental group to develop less pain at rest (MD -0.7 out of 10, 95% CI -2.2 to 0.8) and during shoulder external rotation (MD -1.7 out of 10, 95% CI -3.7 to 0.3) and a trend towards having less contracture of shoulder external rotation (MD -10 deg, 95% CI -22 to 2). There was no significant difference between groups in terms of other contractures and activity of the upper limb. CONCLUSIONS: A lap-tray during sitting combined with a triangular sling during standing is no more effective than a hemi-sling in preventing subluxation, pain, contracture and activity limitation in acute stroke survivors at risk of shoulder subluxation. CLINICAL REHABILITATION IMPACT: The use of a lap-tray during sitting and triangular sling during standing is not indicated as an alternative to the hemi-sling to prevent shoulder subluxation in patients after stroke, so alternative strategies with proven efficacy, such as electrical stimulation, should be considered.

AB - BACKGROUND: Shoulder subluxation is a common secondary impairment of the upper limb following stroke. A range of supportive devices are used in rehabilitation to prevent shoulder subluxation, including hemi-slings and firm supports, such as arm troughs, however, there is little evidence regarding their efficacy. AIM: To determine whether a modified lap-tray during sitting and a triangular sling during standing is more effective than a hemi-sling in preventing shoulder subluxation, pain, contracture and upper limb activity limitation after stroke. DESIGN: A prospective, randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis. SETTING: Three inpatient rehabilitation units in Australia and Norway. POPULATION: Forty-six acute stroke survivors within 3 weeks of stroke who were at risk of subluxation. METHODS: The experimental group used a modified lap-tray 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 amount of shoulder subluxation on X-ray. Secondary outcomes were upper limb activity, pain and contracture. RESULTS: There was no significant difference between groups in terms of shoulder subluxation (MD -3 mm, 95% CI -8 to 3). There was a trend for the experimental group to develop less pain at rest (MD -0.7 out of 10, 95% CI -2.2 to 0.8) and during shoulder external rotation (MD -1.7 out of 10, 95% CI -3.7 to 0.3) and a trend towards having less contracture of shoulder external rotation (MD -10 deg, 95% CI -22 to 2). There was no significant difference between groups in terms of other contractures and activity of the upper limb. CONCLUSIONS: A lap-tray during sitting combined with a triangular sling during standing is no more effective than a hemi-sling in preventing subluxation, pain, contracture and activity limitation in acute stroke survivors at risk of shoulder subluxation. CLINICAL REHABILITATION IMPACT: The use of a lap-tray during sitting and triangular sling during standing is not indicated as an alternative to the hemi-sling to prevent shoulder subluxation in patients after stroke, so alternative strategies with proven efficacy, such as electrical stimulation, should be considered.

KW - Physical therapy modalities

KW - Randomized controlled trial

KW - Shoulder dislocation

KW - Stroke

KW - Stroke/complications

KW - Prospective Studies

KW - Humans

KW - Male

KW - Hemiplegia/complications

KW - Orthotic Devices

KW - Shoulder Dislocation/etiology

KW - Norway

KW - Stroke Rehabilitation/instrumentation

KW - Female

KW - Aged

KW - Muscle Weakness/complications

KW - Australia

KW - Upper Extremity/physiopathology

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UR - http://www.mendeley.com/research/laptray-triangular-sling-more-effective-hemisling-preventing-shoulder-subluxation-those-risk-early-a

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DO - 10.23736/S1973-9087.16.04209-X

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