RESEARCH REPORT POSTER DISPLAY

PREVENTION OF SUBLUXATION OF THE SHOULDER IN PATIENTS AFTER STROKE: A THAI PHYSICAL THERAPY SURVEY. Foongchomcheay A, Chamonchant D, Atichatmanee U; Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand

PURPOSE: Supportive devices such as slings, wheelchair/chair attachments and orthoses as well as electrical stimulation have been used by physical therapists to treat shoulder subluxation in patients after stroke. The aim of this study was to investigate the prevalence of and rationale for the methods used by physical therapists for the prevention of subluxation within Thai hospitals. RELEVANCE: Shoulder subluxation can hinder the recovery of upper arm function and when it occurs, may be irreversible. Therefore, prevention of shoulder subluxation is crucial for neurological rehabilitation. This study will provide essential information of current practice of physical therapy on the prevention of subluxation of the shoulder in Thailand. PARTICIPANTS: Three hundred and fourteen hospitals across Thailand were invited. These hospitals provided neurological physical therapy services to stroke patients and were chosen to ensure all major institutions treating stroke patients were surveyed. METHODS: A self administered questionnaire was mailed to physical therapy departments. A representative physical therapist from each hospital was asked about methods used to prevent subluxation, who perform them, the criteria for using, the criteria for discontinuing their use and when they were used. The institutional ethics committee approved the procedures for the survey and consent was assumed by return of the questionnaire. ANALYSIS: The data was analysed descriptively to determine the percentage of respondents. RESULTS: Two hundred and twenty-six questionnaires were returned, ie, a 72% response rate. 98% of the respondents used assisted exercise, 51% used electrical stimulation and 31% used shoulder sling for the prevention of subluxation. The most frequently prescribed assisted exercise was shoulder exercise (45% of those who prescribed exercise). The exercise was performed 30 minutes a day, 5 days/week. The most frequently prescribed electrical stimulation was electrical stimulation that applied to supraspinatus muscle (38% of those who prescribed electrical stimulation). The stimulation frequencies used were greater than 30 Hz and stimulation time of 20 minutes a day, 5 days/week. The most frequently prescribed shoulder sling was Bobath sling (87% of those who prescribed slings). The sling was worn all day time. Inadequate muscle strength was the most frequently-cited criterion used to prescribe assisted exercise and electrical stimulation (27% and 31% of those who prescribed) and continued the use until full recovery of arm function was obtained. Shoulder subluxation was the most frequently-cited criterion used to prescribe Bobath sling (31% of those who prescribed slings) and continued the use until subluxation was repositioned. CONCLUSIONS: Given that assisted exercises are so commonly selected by Thai physical therapists as a method to prevent subluxation of the shoulder after stroke, it is unfortunate that there is so little evidence to provide guidance for its use. IMPLICATIONS: Therefore, it is necessary for prescription of assisted exercise to become evidence-based. KEYWORDS: stroke, shoulder subluxation, questionnaires. FUNDING ACKNOWLEDGEMENTS: This work was supported by a grant from the Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand. CONTACT: Anchalee.F@chula.ac.th

ETHICS COMMITTEE: Institute of Health Research Chulalongkorn University