Predictors of risk for shoulder pain in the six months after stroke

Abstract

Purpose: Shoulder pain is an important cause of reduced function in people following stroke. There is limited information about the risk of shoulder pain from population-based studies. The Auckland Stroke Study examined the predictors of risk for shoulder pain following stroke. Methods: This study, a population-based case-cohort study, which registered all cases of stroke including those managed outside hospital over a twelve month period ending February 1992. Self-reported shoulder pain was assessed at one week, one month and six months after the onset of the stroke for each person. Results: A total of 1761 people with stroke events were registered in the Auckland region (population 945,000 aged over 15 years). Self reported shoulder pain among survivors increased from 256/1474 (17%) at one week, to 261/1336 (20%) at one month and 284/1201 (23%) at six months and was positively associated with motor deficit and severity of deficit. Amongst survivors at six months, 11% reported shoulder pain for the first time. Amongst those who reported shoulder pain as a post stroke event, 21% ascribed it to the stroke, 15% to physiotherapy and exercise, 12% to methods of handling and the remainder to non stroke causes such as injury or arthritis. Repeated measures analysis of those participants who survived to six months revealed that the risk of shoulder pain increased for those with an upper limb motor deficit (OR 2.48, 95% CI, 1.86–3.31), was higher for females who were overweight (OR 1.42, 95% CI, 1.03 - 1.95), and with age (in 10 year increments, OR 1.10, 95% CI, 1.02 - 1.20). The risk of shoulder pain changed with time, increasing if the participant had a lower limb motor deficit (p,0.001) and decreasing for those in institutional care compared to those living at home (p50.02). Conclusion: These data indicate that shoulder pain occurs in about 20% of stroke survivors. The predictors of shoulder pain risk over six months are: age, females who are over-weight, those with an upper or lower limb weakness and in those living at home. Shoulder pain may possibly be avoided by better training of home-based carers, particularly in those who care for people who are older, with severe deficits or heavier women.