Multimodal Treatment for Hemiplegic Shoulder Pain

偏瘫肩痛的多模式治疗

• 批准号: 9335936
• 负责人: Richard Dwillis Wilson
• 金额: $ 51.55万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9335936
• 关键词: Activities of Daily Living; Affect; Aftercare; Axilla; Biomechanics; Chronic; Clinical; Combined Modality Therapy; Communities; Devices; Double-Blind Method; Effectiveness; Electrodes; Future; Goals; Hemiplegia; Hour; Impairment; Intramuscular; Knowledge; Lead; Measures; Mechanics; Motor; Nerve; Outcome; Pain; Pain Threshold; Pain interference; Pain management; Participant; Patients; Perception; Peripheral Nerve Stimulation; Phase; Physical therapy; Placebo Control; Placebos; Positioning Attribute; Practice Guidelines; Quality of life; Randomized Controlled Trials; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Personnel; Risk; Role; Secondary Hyperalgesias; Sensory; Severities; Shoulder; Shoulder Pain; Site; Stroke; Testing; Therapeutic Effect; Therapeutic Intervention; Torque; Treatment Protocols; Upper Extremity; central sensitization; chronic shoulder pain; clinical practice; community setting; comparative efficacy; deltoid muscle; design; disability; experience; hemiparesis; improved; kinematics; response; stroke survivor; systematic review; trial comparing

PROJECT SUMMARY Shoulder pain following stroke is a major rehabilitation problem affecting approximately 60% of moderate to severely impaired stroke survivors. While many treatments for HSP have been proposed, most do not result in long-term relief of pain. Our long-term goal is to develop a therapeutic intervention to reduce pain related to HSP. In a systematic review of randomized controlled trials, intramuscular peripheral nerve stimulation (PNS), developed by our research group, was the only treatment to provide long-term relief of pain for those with HSP. Our recent pilot RCT compared PNS to physical therapy (PT) and 67% vs. 25% of participants experienced successful pain relief (i.e., ≥ 2-pt or 30% reduction) from PNS and PT, respectively. Although PNS produced better outcomes than PT, there was still a large percentage of non-responders (50%) in the study. Furthermore, amongst responders, pain relief was incomplete in 63% of the PNS group and 100% in the PT group. Yet, both treatments did produce pain relief in a significant number of participants. Thus, a complementary, multimodal treatment of PNS + PT may increase the percentage of patients who experience significant pain relief and will produce a greater reduction in pain than with PNS or PT alone. The primary objective of this study is to determine if multimodal treatment of HSP with PNS + PT is more efficacious for pain relief than PNS or PT alone. The secondary objective is to investigate mechanisms of pain reduction by PNS and PT. In order to accomplish these objectives, the investigators designed a multi-site, placebo controlled, double-blinded RCT to determine if multimodal treatment of HSP with PNS + PT is more efficacious for pain relief than PNS or PT alone. Measures of pain, pain interference with ADLs, QoL, shoulder biomechanics (shoulder abduction torque, shoulder kinematics, and Fugl-Meyer score), and measures of central sensitization (pain thresholds, secondary hyperalgesia, and temporal summation) will be measured. Participants will be followed for a total of 24 weeks after treatment has concluded.

项目摘要 中风后的肩部疼痛是一个主要的康复问题，影响了大约60％的现代化 严重受损的中风存活。尽管已经提出了许多HSP治疗，但大多数没有导致 长期缓解疼痛。我们的长期目标是开发一种治疗性干预措施，以减轻与HSP相关的疼痛。 在对随机对照试验的系统综述中，肌内周围神经刺激（PNS）， 由我们的研究小组开发的是唯一为HSP提供长期缓解疼痛的治疗方法。 我们最近的试点RCT将PNS与物理疗法（PT）和67％和25％的参与者进行了比较 PN和PT的成功缓解疼痛（即≥2PT或减少30％）。虽然PNS产生 比PT更好的结果，研究中仍然有很大一部分的非反应者（50％）。此外， 在响应者中，PNS组63％的疼痛缓解不完整，而PT组100％。但是，两个 治疗确实会减轻大量参与者的疼痛。那是一个完整的多模式 PNS + PT的治疗可能会增加经历明显缓解疼痛并且会增加的患者百分比 与单独使用PN或PT相比，疼痛的减少更大。这项研究的主要目的是确定 如果用PNS + PT对HSP进行多模式处理，则比单独使用PN或PT更有效。这 次要目标是研究PNS和PT减轻疼痛的机制。为了完成这些 目的，调查人员设计了一个多站点，安慰剂控制的双盲RCT，以确定是否是否 用PNS + PT对HSP的多模式处理比单独使用PN或PT更有效。措施 疼痛，疼痛干扰ADL，QOL，肩膀生物力学（肩部绑架扭矩，肩膀 运动学和FUGL-MEYER评分）和中枢灵敏度的度量（疼痛阈值，次级 将测量痛苦和临时求和）。参与者将遵循总计24周 治疗结束后。