ABSTRACT
BACKGROUND: Hemiplegic shoulder pain is one of the most common complications after stroke. Although there are many treatment strategies for this complication, sometimes very resistant cases are also seen. OBJECTIVES: To evaluate the effect of suprascapular nerve pulsed radiofrequency (PRF) treatment for hemiplegic shoulder pain (HSP). STUDY DESIGN: A prospective randomized-controlled trial. SETTING: University hospital. METHODS: This study included 30 patients with HSP following stroke. The patients were randomly assigned to receive PRF to the suprascapular nerve (PRF group, n = 15) or suprascapular nerve block (NB) with lidocaine (NB group, n = 15). The patients were randomized into 2 groups (n = 15 both). In addition, the patients received physical therapy to the shoulder, including hot pack, transcutaneous electrical nerve stimulation, and stretching and strengthening exercise (5 days per week for 3 weeks in a total of 15 sessions). Visual Analog Scale (VAS) for pain, the Goal Attainment Scale (GAS) during upper-body dressing, and shoulder range of motion (ROM) were assessed at baseline, 1 month, and 3 months after the procedure. RESULTS: Between the groups, comparison revealed that decrease in the VAS score was statistically significantly higher at the first (3.5 1.9 vs. 1.2 1.0) and third month (4.2 1.7 vs. 1.2 0.9) in the PRF group compared with the NB group (P < 0.01). The PRF group had significantly higher increases in shoulder ROM compared with the NB group (P < 0.05).The positive changes in GAS score at month 3 in the PRF group was significantly higher than that in the NB group (P < 0.05). LIMITATION: There is a need for further studies with a longer follow-up period. CONCLUSIONS: In light of these findings, the combination of PRF applied to the suprascapular nerve and physical therapy was superior to the combination of suprascapular NB and physical therapy. KEY WORDS: Hemiplegic shoulder, stroke, pain, radiofrequency, suprascapular nerve.
Subject(s)
Combined Modality Therapy/methods , Pulsed Radiofrequency Treatment/methods , Shoulder Pain/etiology , Shoulder Pain/therapy , Stroke/complications , Adult , Aged , Female , Hemiplegia/etiology , Hemiplegia/therapy , Humans , Male , Middle Aged , Nerve Block/methods , Pain Measurement , Physical Therapy Modalities , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To investigate intra- and inter-observer reliability among physical medicine and rehabilitation specialists and a radiologist in interpretation of plain lumbar spine X-ray films in patients with low back pain. METHODS: Three assessors (A: a resident of PM&R, B: an experienced PM&R specialist, C: an experienced radiologist) read the standard lumbosacral plain radiographs of 79 patients with 2-3 month time interval. Each assessor recorded the presence or absence of abnormalities on the radiograph according to a standardized assessment form. RESULTS: For assessors B and C, all kappa values were > 0.40. Transitional vertebrae abnormalities reached to the highest agreement ratio. The intrarater agreement showed higher kappas than the interrater agreement. The radiologists had the highest intrarater agreement, closely followed by the experienced PM&R specialist. Agreement among three assessors was substantial in sacralisation, lumbarisation and facet joint pathologies. CONCLUSION: We usually obtained a good intrarater agreement, especially for the experienced PM&R specialist and the radiologist indicating that experience increases diagnostic consistency. Besides the systematic differences in radiographic interpretation between the assessors, institutional specific conditions (esp. patient profile and regularities) may cause the phycians to pay more attention to a specific group of pathologies.
