A Study of Post-Stroke Pain and Fatigue---Clinical Evaluation and Treatment Effect

Project: National Science and Technology CouncilNational Science and Technology Council Academic Grants

Project Details


Hemiplegic shoulder pain affects from 16%-84% of stroke patients and fatigue occurs among 39%-72% of stroke victims, which can have an adverse impact on rehabilitation outcomes by interrupting treatment process, daily functions, and quality of life (QOL) for stroke patients. Considering the high prevalence and detrimental effects of poststroke shoulder pain and fatigue, it is vital for monitoring these symptoms and therapeutic interventions to be developed for those suffering from poststroke pain and fatigue. Therefore, to validate existing assessments of pain/fatigue, and to evaluate the efficacy of potential pain/fatigue interventions are needed. A vertical Numerical Rating Scale with Face Rating Scale (NRS-FRS) could be used by all stroke patients as pain and fatigue measurement. The Brief Pain Inventory (BPI) and Brief Fatigue Inventory (BFI) measure intensity and interference, which might provide more information. The first aim of this research will be to examine the psychometric properties of the vertical NRS-FRS, BPI, and BFI. Functional electrical stimulation (FES) appears to offer benefits in relieving painful hemiplegic shoulder. Electrical stimulation of the posterior deltoid and supraspinatus muscles has shown beneficial effects on pain, subluxation, range of motion, and arm function. It is suggested that graded treadmill training (GTT) could be useful in relieving fatigue by improving fitness reserve and lowering of the energy cost of hemiparetic gait. For non-ambulatory stroke patients, body weight supported treadmill training (BWSTT) is an encouraging intensive, task-specific practice. Therefore, the second aim of this research will investigate whether the combined therapy of FES and GTT (FES-GTT) or that of FES and BWSTT (FES-BWSTT) could reduce hemiplegic shoulder pain and poststroke fatigue as compared with conventional rehabilitation (CR). Whether interventions could lead to better functional performance and higher QOL would be of interest. This 3-year project will be implemented in four stages and will recruit 160 patients with chronic stroke. At the first stage, we will conduct a test-retest study to investigate the reliability and validity of outcome measures on hemiplegic shoulder pain and poststroke fatigue in 80 patients. At the second stage, we will conduct a randomized controlled trial (RCT) to investigate the relative effects of the FES-GTT versus CR for 40 ambulatory stroke patients with hemiplegic shoulder pain, poststroke fatigue, and moderate-to-mild motor impairment. At the third stage, we will conduct another RCT to investigate the relative effects of the FES-BWSTT versus CR for 40 non-ambulatory stroke patients with hemiplegic shoulder pain, poststroke fatigue, and moderate motor impairment. Treatment regimens will be designed to ensure that patients in the 2 groups at stage 2 and 3 receive an equivalent intensity of treatment (1 hour/day, 3 days/week for 4 weeks). The fourth stage determines clinimetric properties of the outcome measures. We anticipate this research will shed light on metric properties of outcome measures of pain and fatigue and the effects of the combined therapy for stroke patients. The overall findings will contribute to guide the choice of proper assessment tool and the development of effective rehabilitation programs.

Project IDs

Project ID:PC10205-0110
External Project ID:NSC102-2314-B182-003
Effective start/end date01/08/1331/07/14


  • hemiplegic shoulder pain
  • poststroke fatigue
  • functional electrical stimulation
  • graded treadmill training
  • stroke rehabilitation


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