Electrical stimulation in the treatment of hemiplegic shoulder pain: a meta-analysis of randomized controlled trials

OBJECTIVE To determine the effect of electrical stimulation (ES) in the treatment of hemiplegic shoulder pain (HSP). DESIGN Eight databases were systematically searched for randomized controlled trials (RCTs) with a treatment duration of at least two weeks comparing ES with sham stimulation or no stimulation for patients with HSP. Shoulder pain on the hemiplegic side after stroke at baseline was required at study selection. The overall effects of ES were calculated using a meta-analytic method. RESULTS Six studies were included. The pooled data indicated that ES may have a positive effect for patients with HSP on pain reduction (n=193; SMD [standardized mean difference] = -1.89; 95% CI [-3.05, -0.74]) and pain-free external rotation (PFER) (n=164; WMD [weighted mean difference] = 18.92; 95% CI [7.00, 30.84]). Meta-analysis also showed better recovery of activities of daily living (ADL) independence in patient groups receiving ES (n=167; WMD = 8.96; 95% CI [5.26, 12.66]). CONCLUSIONS ES may be an effective pain management methodology for hemiplegic shoulders and may contribute to pain-free range of external rotation as well as ADL recovery. However, these results should be interpreted with caution, given the low number of selected studies and risk of potential bias. Contributed equally, Huaide Qiu, Jiahui Li, Ting Zhou Correspondence to two authors below: Prof. Hongxing Wang, MD, PhD, School of Rehabilitation Medicine, Nanjing Medical University, 140 Hanzhong Road, Nanjing, Jiangsu Province, China, 210029, Tel:+86-25-86862196, Email: hongxingwangphd@aol.com. Prof. Jianan Li, MD, School of Rehabilitation Medicine, Nanjing Medical University, 140 Hanzhong Road, Nanjing, Jiangsu Province, China, 210029, Tel:+86-25-83318752, E-mail:lijianan_rehab@sina.com Funding: This work was supported by Science and Technology Projects in Clinical Medicine of Jiangsu Province (BL2012029) (Jianan Li) and Priority Academic Program Development of Jiangsu Higher Education Institutions (JX10231801) (Hongxing Wang). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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