Risk and associated factors for hemiplegic shoulder pain in people with stroke: a systematic literature review

Abstract Introduction Hemiplegic shoulder pain (HSP) is reported in up to 40% of people with stroke and has been associated with spasticity and glenohumeral subluxation. The frequency of HSP has reduced in the last two decades which is most likely due to improved therapy and nursing care. The aim of this systematic literature review was to explore the risk and associated factors for HSP for studies published between 2005 and 2020. Methods A systematic online search was conducted of CINAHL, AMED, MEDLINE and the Cochrane library databases using four key terms (risk factors, hemiplegia, shoulder pain and stroke). The search was supplemented by hand searching of relevant journals and citation tracking of the retrieved papers. All primary studies published in English language fulfilling the review’s inclusion criteria were included. Five reviewers extracted the data and independently appraised the methodological quality of the selected studies. Any discrepancies were resolved following discussions. Results Of the 50 articles that were identified, 21 studies met the criteria. The common risk factors for HSP were: poor motor function (odds ratio (OR) 0.58–3.19; 95% confidence interval (CI), 1.1–7.7); glenohumeral subluxation (OR 2.48–3.5, 95% CI 1.38–9.37) and reduced range of movement at the shoulder (OR 0.14–4.46, 95% CI 0.99–64). Conclusion Despite methodological flaws, complete loss of motor function in the affected arm and glenohumeral subluxation has been recognized as frequently reported risk factors for HSP. Further rigorously designed cohort studies are required to explore the risk factors for HSP.