The three-dimensional shoulder pain alignment (3D-SPA) mobilization improves pain-free shoulder range, functional reach and sleep following stroke: a pilot randomized control trial

<b>Background and purpose:</b> Following a stroke, three-dimensional clavicular/scapular/humeral joint rotations may become restricted and contribute to post-stroke shoulder pain. This study examined whether a treatment group provided with current standard treatment plus the proposed “Three-dimensional Shoulder Pain Alignment” mobilization protocol demonstrated improved pain-free shoulder range, functional reach and sleep compared to a control group provided with standard treatment alone. <b>Methods:</b> In this double-blinded parallel-group randomized control trial, treatment and control subjects with moderate/severe post-stroke upper extremity impairment and shoulder pain were treated 3x/week for 4 weeks. Outcome measures included changes in pain-free three-dimensional clavicular/scapular/humeral range (using computerized digitization), pain during sleep and functional reach (using the Pain Intensity-Numerical Rating Scale), and pain location/prognostic indicators (using the Chedoke-McMaster Stroke Assessment-Shoulder Pain Inventory). <b>Results:</b> Compared to controls (<i>n</i> = 10) the treatment group (<i>n</i> = 10) demonstrated significantly improved three-dimensional clavicular/scapular/humeral pain-free range during shoulder flexion and abduction (<i>p</i> g &gt; 0.80), large effect sizes for decreased pain during sleep and functional reach to the head and back (OR range: 5.44-21.00), and moderate effect size for improved pain/prognostic indicators (OR = 3.86). <b>Conclusions:</b> The Three-Dimensional Shoulder Pain Alignment mobilization protocol significantly improved pain-free range of motion, functional reach and pain during sleep in shoulders with moderate/severe post-stroke upper-extremity impairment.Implications for rehabilitationAlthough three-dimensional clavicular/scapular/humeral rotations are an essential component of normal pain-free shoulder range of motion, current guidelines for treatment of post-stroke shoulder pain only includes uni-dimensional mobilizations for joint alignment and pain management.The Three-Dimensional Shoulder Pain Alignment (3D-SPA) mobilization protocol incorporates multi-dimensional mobilizations in various planes of shoulder movement.The current study results demonstrate proof-of-concept regarding the 3D-SPA mobilization, and this approach should be considered as an alternative to the uni-dimensional mobilizations currently used in clinical treatment guidelines for post-stroke shoulder pain. Although three-dimensional clavicular/scapular/humeral rotations are an essential component of normal pain-free shoulder range of motion, current guidelines for treatment of post-stroke shoulder pain only includes uni-dimensional mobilizations for joint alignment and pain management. The Three-Dimensional Shoulder Pain Alignment (3D-SPA) mobilization protocol incorporates multi-dimensional mobilizations in various planes of shoulder movement. The current study results demonstrate proof-of-concept regarding the 3D-SPA mobilization, and this approach should be considered as an alternative to the uni-dimensional mobilizations currently used in clinical treatment guidelines for post-stroke shoulder pain.

### 背景与目的：
脑卒中后，锁骨（clavicular）、肩胛骨（scapular）与肱骨（humeral）的三维关节活动可能受限，进而引发卒中后肩痛。本研究旨在对比接受标准治疗联合新型「三维肩痛对齐（Three-Dimensional Shoulder Pain Alignment, 3D-SPA）」松动术方案的干预组，与仅接受标准治疗的对照组，在无痛肩关节活动范围、功能性伸手能力及睡眠质量方面的改善情况。

### 方法：
本研究为双盲平行组随机对照试验，纳入伴中重度卒中后上肢功能障碍及肩痛的受试者，两组均每周接受3次治疗，持续4周。结局评估指标包括：采用计算机数字化技术测量的无痛性锁骨/肩胛骨/肱骨三维活动范围变化；采用疼痛强度数字评定量表（Pain Intensity-Numerical Rating Scale）评估的睡眠疼痛程度与功能性伸手能力；采用切多克-麦克马斯特脑卒中评估-肩痛量表（Chedoke-McMaster Stroke Assessment-Shoulder Pain Inventory）评估的疼痛部位与预后指标。

### 结果：
与对照组（n=10）相比，干预组（n=10）在肩关节屈曲与外展时的无痛性锁骨/肩胛骨/肱骨三维活动范围显著改善（p > 0.80）；睡眠疼痛缓解、伸手触碰头部与背部的效应量较大（比值比OR范围：5.44~21.00）；疼痛与预后指标改善的效应量中等（OR=3.86）。

### 结论：
三维肩痛对齐（3D-SPA）松动术方案可显著改善伴中重度卒中后上肢功能障碍患者的肩关节无痛活动范围、功能性伸手能力及睡眠疼痛情况。

### 康复启示：
尽管锁骨/肩胛骨/肱骨的三维关节活动是正常无痛肩关节活动范围的核心组成部分，但当前卒中后肩痛的临床治疗指南仅采用单维度关节松动术进行关节对齐与疼痛管理。三维肩痛对齐（3D-SPA）松动术方案整合了肩关节多平面的多维松动技术。本研究结果证实了3D-SPA松动术的概念可行性，该方案可作为当前临床治疗指南中采用的单维度松动术的替代方案，应用于卒中后肩痛的治疗。
尽管锁骨/肩胛骨/肱骨的三维关节活动是正常无痛肩关节活动范围的核心组成部分，但当前卒中后肩痛的临床治疗指南仅采用单维度关节松动术进行关节对齐与疼痛管理。三维肩痛对齐（3D-SPA）松动术方案整合了肩关节多平面的多维松动技术。本研究结果证实了3D-SPA松动术的概念可行性，该方案可作为当前临床治疗指南中采用的单维度松动术的替代方案，应用于卒中后肩痛的治疗。