The Application Of Pain Management Based On Exercise-rehabilitation In Stroke Patients With Hemiplegia Shoulder Pain

Objective To Understand the status of hemiplegia shoulder pain in stroke patients and hemiplegia,to explore the impact of pain management based on exercise-rehabilitation intervention for hemiplegic shoulder pain in stroke patients.To explore how to improve the quality of pain management for stroke patients with hemiplegia shoulder pain,and provide a reference and method for improving the pain management of stroke patients and hemiplegia shoulder pain.Methods A randomized controlled experimental trial was used to select 102 stroke patients with hemiplegia shoulder pain who were treated in the Department of Neurology at two third-class hospitals in Hefei from March2018 to October 2019.There were 51 cases in each group.Patients in the control group were routinely treated according to neurology.The intervention group adopted the rehabilitation pain management based on exercise-rehabilitation.In addition to the routine care,it included: 1.joint mobility training;2.postural adaptation training;3.upper limb motor function training;4.pain management Quality control of team formation and management process.The generaldata questionnaire,visual analogue scale(VAS),Barthel index,simplified Fugl-Meyer motor function assessment scale(upper limbs),and the range of passiveshoulder joint were used to enroll the patients in the two groups.Pain degree,self-care ability,assessment of motor function of hemiplegia shoulder.VAS scores,BI index,simplified Fugl-Meyer motor function assessment scale(upper limbs),and the range of passive shoulder joint were used to re-evaluate the pain,self-care ability,and hemiplegia shoulder function of the two groups at discharge.Epidata 3.1 and SPSS 24.0 software was used for statistical analysis.Results A total of 102 stroke patients with hemiplegia shoulder pain completed the intervention in this study(51 in the intervention group and 51 in the control group).There were no significant differences in demographic sociology and general health data between the two groups before the intervention in terms of gender,age,education,marital status,and stroke type(all P >0.05).There were no significant differences in the VAS score,BI index,simplified Fugl-Meyer motor function assessment scale(upper limbs),and shoulder passive movement between the two groups before the intervention(all P >0.05).(1)Comparison of the degree of shoulder pain in hemiplegia shoulder: the average VAS score of the control group after the intervention was 3.55 ± 0.90,and the average VAS score of the intervention group was 3.39 ± 1.22.There was no significant difference between the two groups(t = 0.739,P = 0.204> 0.05).The comparison results of VAS scores in the control group were t = 20.946,P= 0.000 <0.05,the comparison results of VAS scores in the intervention group were t = 18.090,P = 0.000 <0.05.(2)Comparison of self-care ability in daily life: The average daily self-care ability BI index score of the control group patients after the intervention was 65.98± 7.62,and the average BI index score of the intervention group patients was69.90 ± 10.12.There is a statistical difference between the two groups.Significance(t =-2.211,P = 0.010 <0.05).(3)Comparison of upper limb motor function: The average simple FMA score of the control group patients after the intervention was 29.06 ± 5.53,and the average simple FMA score of the intervention group patients was 32.25 ± 6.71.The difference between the two groups was statistically significant(t =-2.625,P = 0.027 <0.05).(4)Comparison of the passive mobility of the shoulder joints: After the intervention,the shoulder joints of the two groups were excluded in terms of forward flexion,abduction,internal rotation and posterior extension(all P <0.05).Conclusion The results of this study show that,the pain management intervention based on exercise-rehabilitation,in addition to the degree of hemiplegia shoulder pain,patients with hemiplegia shoulder pain after stroke have significantly improved their daily self-care ability,upper limb motor function,and the range of shoulder joints.It shows that the improvement of pain management mode can improve the ability of daily living,upper limb motor function and the passive range of shoulder joint mobility in patients with hemiplegia shoulder pain.It can provide a reference for the formulation of pain management suitable for China.