Protocol to prevent shoulder-hand syndrome after stroke

Objective: To determine the effectiveness of a protocol designed to restrict passive movement of affected upper extremity on the incidence of shoulder-hand syndrome (SHS) after stroke. Design: Before-and-after trial: follow-up duration of subject group and historical control group 231.6 and 257.2 days, respectively. Setting: Rehabilitation medicine department in a hospital in Japan. Participants: Subjects: 81 stroke patients treated with the protocol from 1994 to 1996 who were followed for at least 4 months from the onset of stroke; controls: 71 stroke patients treated without the protocol from 1991 to 1994 who were followed for same length of time. Intervention: Use of a set protocol for controlled passive movement by trained therapists and restriction of passive movement by the patients for 4 months after stroke. The SHS criterion used to detect early signs of SHS has not yet been validated. Corticosteroids were given to all subjects diagnosed with SHS. Main Outcome Measures: Swelling index, SHS diagnostic criteria applied in physical exam., Brunnstrom stage, and sensory disturbance evaluations. Result: The incidence of SHS in the subject group was 18.5% (n = 15), whereas the incidence of SHS in the control group was 32.4% (n = 23). The difference between the 2 groups was statistically significant (chi (2) = 3.885. p < .05). Conclusion: The protocol helped to prevent development of SHS. (C) 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.