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Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years - 04/12/19

Doi : 10.1016/j.rehab.2018.03.003 
Diane Menoux, Marylène Jousse , Victorine Quintaine, Leila Tlili, Alain P. Yelnik
 Physical and Rehabilitation Medicine Department, GH Lariboisière-Fernand Widal, AP-HP, Paris Diderot University, UMR8257 200 rue du Faubourg Saint-Denis, 75010 Paris, France 

Corresponding author at: Service de Médecine Physique et de Réadaptation Hôpital Fernand Widal, 200 rue du Faubourg Saint-Denis, 75010 Paris, France.Service de Médecine Physique et de Réadaptation Hôpital Fernand Widal200 rue du Faubourg Saint-DenisParis75010France

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Abstract

Objectives

The usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.

Methods

This was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.

Results

We reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%–10%; P<0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P<0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P<0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P<0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P<0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P<0.05).

Conclusions

Disabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.

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Keywords : Spasticity, Stroke, Shoulder pain, Rehabilitation, Thrombectomy, Thrombolysis


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Vol 62 - N° 6

P. 403-408 - novembre 2019 Ritorno al numero
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  • Association of spasticity and motor dysfunction in chronic stroke
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