Electrical Stimulation for Hemiplegic Shoulder Pain

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

25 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-01-31

Study Completion Date

2013-02-28

Brief Summary

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Post-stroke shoulder pain is a major rehabilitation problem affecting moderate to severely impaired stroke survivors. Surface electrical stimulation (ES) of muscles surrounding the hemiparetic shoulder has been demonstrated to be beneficial, but despite the evidence for therapeutic benefit, the clinical implementation of surface ES for poststroke shoulder pain has been difficult. In order to address the limitations of surface ES, the investigative team pioneered the development of percutaneous intramuscular (IM) ES for the treatment of post-stroke shoulder pain. However, prior to acceptance by the clinical community, additional gaps in the scientific and clinical knowledge need to be addressed. This study begins to do so. The primary objective is to estimate the relative pain reduction associated with IM ES vs. "usual care." We hypothesize that the IM ES group will exhibit a larger effect size with respect to pain reduction compared to "usual care". A secondary objective is to estimate the effect on health related QOL of IM ES vs. "usual care." Demonstration of improvement in QOL will validate the clinical relevance of the intervention. We hypothesize that the IM ES group will exhibit greater improvement in health related QOL compared to "usual care".

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Detailed Description

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Conditions

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Stroke Shoulder Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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IM Electrical Stimulation (IM ES)

The IM ES Group will receive electrical stimulation treatment for three weeks (6 hrs daily) with an Intramuscular Electrical Stimulator following a one week electrode stabilization period.

Group Type EXPERIMENTAL

Intramuscular Electrical Stimulator

Intervention Type DEVICE

A sterile percutaneous IM electrode is implanted in the shoulder using a 20-gauge hypodermic needle and connected to an external cable. The exit site and electrode are covered by a bandage, but the cable extends out. After a one week stabilization period, the cable is connected to a stimulator. A self-adhesive surface electrode serves as the indifferent electrode. Stimulation intensity is set by the investigator. The prescription for daily stimulation treatment will be 6 hrs. The duty cycle and daily dose will remain constant throughout the treatment, but stimulus parameters may be adjusted by the research staff as deemed appropriate. The treatment period will be 3 weeks, after which the electrode will be removed. Total time of electrode implantation is no more than 29 days.

Usual Care (UC)

The Usual Care Group will receive outpatient therapy for four weeks, coupled with prescribed daily home exercises.

Group Type ACTIVE_COMPARATOR

Outpatient Therapy

Intervention Type OTHER

Subjects will receive 8 hrs of outpatient therapy over a four week period from a treating therapist, coupled with prescribed daily home exercises. The therapist will implement an individualized treatment plan consistent with the needs of the participant.

Interventions

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Intramuscular Electrical Stimulator

A sterile percutaneous IM electrode is implanted in the shoulder using a 20-gauge hypodermic needle and connected to an external cable. The exit site and electrode are covered by a bandage, but the cable extends out. After a one week stabilization period, the cable is connected to a stimulator. A self-adhesive surface electrode serves as the indifferent electrode. Stimulation intensity is set by the investigator. The prescription for daily stimulation treatment will be 6 hrs. The duty cycle and daily dose will remain constant throughout the treatment, but stimulus parameters may be adjusted by the research staff as deemed appropriate. The treatment period will be 3 weeks, after which the electrode will be removed. Total time of electrode implantation is no more than 29 days.

Intervention Type DEVICE

Outpatient Therapy

Subjects will receive 8 hrs of outpatient therapy over a four week period from a treating therapist, coupled with prescribed daily home exercises. The therapist will implement an individualized treatment plan consistent with the needs of the participant.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* shoulder pain localized to the glenohumeral joint, subacromial area or deltoid insertion associated with any of the following conditions: a) rest; b) passive abduction or external rotation ROM; c) active abduction or external rotation ROM; or d) manual palpation
* weakness of shoulder abductors (≤4/5 on MRC if isolated movement is present)
* age ≥21-yrs
* time from stroke ≥ 3-mo
* shoulder pain onset after the most recent stroke
* duration of shoulder pain ≥ 3-mo
* severity of shoulder pain on BPI-SF 3 ≥4
* cognitive ability to fulfill study requirements \[a) exhibit 3 object immediate and 30 minute recall; b) ability to use a numeric rating scale (using a 0-10 numeric rating scale) by correctly ranking the tightness they feel on the unaffected arm of 3 low-pressure inflations with a standard sphygmomanometer cuff which follow a predetermined sequence (20, 40 and 0 mm Hg); and c) ability to follow 3-stage commands\]
* availability of a reliable adult who can check the skin and assist the participant with the treatment protocol
* willing and able to report severity of shoulder pain throughout the study period
* willing to make all scheduled study visits post-implantation.

Exclusion Criteria

* evidence of joint or overlying skin infection
* insensate skin
* \>1 opioid or nonopioid analgesics daily for shoulder pain
* daily intake of pain medications for any other chronic pain
* intra-articular or subacromial steroid injections to the shoulder in the previous 12-wks
* botulinum toxin injection to the trapezius, pectoralis or subscapularis muscle in the previous 12-wks
* receiving physical or occupational therapies for shoulder pain
* physician-diagnosed shoulder pathology symptomatic within the 5 yrs prior to CVA
* bleeding disorder
* INR\>3.0 for those on warfarin \[INR\>3.0\]
* poorly controlled diabetes \[HbA1c\>7.0\]
* medical instability
* pregnancy
* uncontrolled seizures (\>1/mo for 6-mo)
* uncompensated hemi-neglect
* severely impaired communication
* moderate to severe depression
* other confounding conditions such as ipsilateral upper limb lower motorneuron lesion, Parkinson's Disease, spinal cord injury, traumatic brain injury or multiple sclerosis
* other medical issues such as complex regional pain syndrome, bicipital tendonitis, myofacial pain syndrome, etc.
* the following cardiac conditions: a) history of arrhythmia with hemodynamic instability, such as ventricular tachycardia, supraventricular tachycardia and rapid ventricular response atrial fibrillation; b) any implantable stimulator such as demand pacemakers or defibrillators; and c) valvular heart disease including artificial valves (due to risk of infection and endocarditis)
* likely non-compliance factors such as distance from the center, inadequate social support, or psychiatric/psychologic factors

Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No