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Is a Lycra sleeve an acceptable treatment for glenohumeral subluxation in people with stroke

Patients', clinicians' and family members' perspectives

Chief Investigator

Institution

Dates

Funding Stream

Amount
Dr Praveen Kumar

University of the West of England, Bristol

01/05/2017 - 31/03/2020

RCF / Above and Beyond Spring 2016

£23,412

Summary

Partial dislocation, causing a gap, in the shoulder joint is reported in up to 81% of people with stroke. The shoulder is dependent on muscles to hold the joint together and to enable the arm to be used. Weakness of shoulder muscles following stroke causing dislocation poses challenges in rehabilitation. The application of electrical stimulation to shoulder muscles is recommended to reduce the dislocation and has shown some short term benefits. However electrical stimulation can be uncomfortable, its use is limited due to time, availability of equipment and cost. An alternative, but unproven treatment, is the use of tight fitting Lycra sleeves. Our aim in the proposed project is to gather the information needed to allow us to prepare for a trial of Lycra sleeves. We will 1) Test the Lycra sleeves and our measurement methods in people early after a stroke. 2) Explore patients', nurses' and therapy staff experiences, of using the Lycra sleeves. 3) Test rate of recruitment for a future clinical trial. Methods: Patients with first time stroke resulting in shoulder weakness will be recruited. Nurses, Therapist and family members will be trained to apply the sleeves which will be worn for 8-10 hours/day for 3 months and will be an adjunct to usual care. Measurement of any gap in the shoulder and arm function will be tested before application of sleeve and again after 3 months. Results from this study will inform a future clinical trial.

Work to date

  • Ethical approval received on 9th October 2017
  • HRA approval received on 10th October 2017
  • Trust R&D approval received on 15th December 2017.
  • Recruitment commenced and first participant was recruited on 30th December 2017.  Since the start of the study, we have now recruited 16 participants. Of these, 7 have been followed-up after 3 months (as per protocol).

Following a recent research review meeting, we discussed and agreed to change the current inclusion criteria of Motor power (muscle strength) ≤2 to ≤ 3 and to change the criteria from 'first time stroke' to patients eligible to participate even if they have previous stroke. This will require application to Ethical committee for 'substantial amendments'.  We hope to have this approved by August 2018.  As a consequence, we aim to extend our last recruitment of patients to end of Dec and 3 months follow-up ending March 2019.  We intend to submit the outline NIHR application for Research for Patient Benefit grant in July 2019 (see Gantt chart).

Main Findings

Generally, observation and feedback from patients, therapists, nurses, carers and family members, suggests that the Lycra Sleeve is generally acceptable to most patients.

Impact

Existence of this study, as well as our good engagement with therapists and nurses throughout the stoke pathway has already lead to many useful and interesting discussions about how best to manage and rehabilitate people who have weakness in their upper limb following stroke.

The study has been well shared and disseminated at several events on different platforms.

Project Outputs

Work in Progress

  • A poster was presented at the Society for Research in Rehabilitation Conference held on 6th Feb 2018, at Watershed, Bristol.
  • A poster was presented at the 'Better Together' Event organised at Southmead Hospital, 22nd Feb 2018.
  • A poster was presented at the South West ACPIN AGM meeting held at UWE on 18th April 2018. 
  • A Poster was presented at the Joining Force Conference -Exeter -28th June 2018. 
  • An abstract has been submitted to the Physiotherapy UK Conference, if accepted, the work will be presented at Birmingham on 18-19th October 2018. 
  • A poster was presented at the UK Stroke Forum, Dec 2018 
  • A poster was presented at the UHBristol Trust Quality Improvement Forum on 10th July 2018 

Completed study: 

  • A poster was presented at the Society for Research in Rehabilitation conference, Warwick University, Oct 2019 
  • A poster was presented at the UK Stroke Forum, Dec 2019 

Journal Publications: 

The following papers from Praveen's previous work on Lycra sleeve, that informed this study, has been accepted for publication: 
  • Kumar P (2020) Does the application of a Lycra arm sleeve change shoulder biomechanics in people with stroke? - A preliminary study. Journal of Prosthetics and Orthotics. Accepted 27th August 2020(In Press)
  • Kumar P,Desai A, Elliot L(2020)Does the application of a Lycra arm sleeve change shoulder biomechanics in young healthy people? - A Mechanistic study. Journal of Prosthetics and Orthotics. 32(1):32-37. DOI: 10.1097/JPO.0000000000000265
  • Kumar P (2019) The effects of Lycra arm sleeves on Glenohumeral Subluxation in Post-stroke Hemiplegia - A Preliminary Study. Journal of Prosthetics and Orthotics. 31(1):70-75.