Relative Effectiveness of Transcutaneous Electrical Nerve Stimulation and Hot Packs in the Management of Hemiplegic Shoulder Pain

Abstract

Transcutaneous electrical nerve stimulation (TENS) and hot packs (HP) are among the common modalities used in the management of hemiplegic shoulder pain (HSP). The choice of either of the modalities is dependent on personal discretion rather than on proven relative effectiveness. This study examined the relative effectiveness of TENS and hot packs in the management of HSP in stroke patients. Nineteen stroke patients with shoulder pain were randomized into two intervention groups. Both groups were treated with massage, passive and active mobilization of the shoulder joint twice a week with at least 24 hours interval for 6 consecutive weeks. In addition, each participant also received either TENS or hot packs for 30 minutes as adjuncts. Pain intensity and shoulder functional status were assessed on the Brief Pain Inventory Short Form Question-12 (BPI SF-12) and Action Research Arm Test (ARAT) at baseline and fortnightly by a blinded investigator. Data analysis included Friedman’s mean rank and Mann-Whitney U tests for differences in the variables within and between groups respectively. P<0.05 (two-tailed) was considered statistically significant. The study neither showed statistically significant (P>0.05) reduction in pain nor did it meet the set minimal clinically important difference (MCID) for both groups. However, there was equal statistically significant improvement (P 0.05) and MCID in shoulder functions for both interventions. It was concluded that both modalities modulated HSP in stroke survivors within six weeks of treatment without either being superior to the other. Thus either could be used to augment other forms of intervention.