Use of devices to prevent subluxation of the shoulder after stroke

Background and Purpose. Supportive devices, such as slings, wheelchair or chair attachments and orthoses, have been used for many years by physiotherapists to support the affected shoulder after stroke. The purpose of the present paper was to examine the alignment between current practice with evidence for the use of supportive devices in the prevention of subluxation of the shoulder after stroke and to provide guidance for clinical practice and future research. Method. In order to determine the evidence regarding the most appropriate supportive devices to prevent subluxation after stroke, a systematic review was undertaken following the guidelines set out by the Cochrane Collaboration. In order to determine current practice with regard to the most commonly used supportive devices to prevent subluxation after stroke, a questionnaire was designed and administered for use in Australia. Results. The collar-and-cuff sling is the most commonly used sling. However, a small amount of lower-level evidence shows that the collar-and-cuff sling only reduces subluxation by half, suggesting that it may not be the most effective to use for prevention. In contrast, this evidence supports the use of wheelchair or chair attachments. Conclusions. We found that there was a lack of high-level evidence to guide clinical practice. In order to determine evidence-based practice for the prevention of shoulder subluxation, there is a need to test the efficacy of the most promising supportive devices based on available evidence. Copyright (C) 2005 John Wiley & Sons, Ltd.