Title : Effectiveness of nonpharmacological interventions for poststroke hemiplegic shoulder pain: A systematic review and network meta-analysis
Abstract:
Background: Hemiplegic shoulder pain is a common complication after stroke. It causes limitation of shoulder mobility and delays functional recovery. Several nonpharmacological interventions have been developed to manage this condition. However, their comparative effectiveness remains unclear.
Objective: This study aimed to evaluate and compare the effectiveness of various nonpharmacological interventions for poststroke hemiplegic shoulder pain through a systematic review and network meta-analysis.
Information sources: Randomized controlled trials investigating nonpharmacological interventions for hemiplegic shoulder pain were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science up to April 26, 2025.
Methods: Eligible studies included adult stroke survivors with hemiplegic shoulder pain receiving non-pharmacological interventions compared with conventional therapy, sham, or other interventions. The primary outcome was pain intensity; secondary outcomes were shoulder range of motion, upper limb motor function, and activities of daily living. Risk of bias was assessed using the Cochrane RoB 2 tool. A frequentist network meta-analysis using random-effects models was conducted in R software 4.4.1. Interventions were ranked using P-scores.
Results: Twenty-two studies involving 798 patients were included. Peripheral nerve stimulation (SMD = −3.87, 95% CI: −6.58 to −1.15), Functional electrical stimulation (MD = −1.76, 95% CI: −3.26 to −0.25), and Neuromuscular electrical stimulation (SMD = −1.35, 95% CI: −2.60 to −0.10) were significantly more effective than conventional therapy in reducing pain. Interferential current showed the greatest benefit in improving shoulder flexion (MD = 20.28, 95% CI: −2.64 - 43.19) and abduction (MD = 31.10, 95% CI: 5.23 - 56.97). The functional electrical stimulation ranked highest for upper limb motor recovery. Transcutaneous electrical nerve stimulation ranked first for activities of daily living improvement, although the difference was not statistically significant.
Conclusions: This network meta-analysis demonstrated that electrical stimulation interventions, particularly peripheral nerve stimulation, functional electrical stimulation, and neuromuscular electrical stimulation, provide significant pain relief for poststroke hemiplegic shoulder pain patients, whereas interferential current and functional electrical stimulation show advantages in shoulder mobility and motor recovery, respectively. Although transcutaneous electrical nerve stimulation has shown potential in improving activities of daily living, evidence remains limited. These findings support the integration of effective nonpharmacological interventions into routine rehabilitation practice. Future large-scale, multicenter randomized controlled trials with longer follow-up periods are needed to confirm long-term efficacy and explore multimodal combination therapies.
