{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:20:15Z","timestamp":1791534015463,"version":"4.3.4"},"reference-count":59,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T00:00:00Z","timestamp":1594252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The current systematic review aimed to investigate the incidence, prevalence, and risk factors causing hemiplegic shoulder pain (HSP) after stroke. Two independent authors screened titles and abstracts for the eligibility of the included studies in the electronic databases PubMed and Web of Science. Studies which reported the incidence, prevalence, and risk factors of HSP following stroke were included. The included studies were assessed using the Newcastle\u2013Ottawa Scale for evaluating the quality of nonrandomized studies in meta-analyses. Eighteen studies were included in the final synthesis. In all studies, the number of patients ranged between 58 and 608, with the mean age ranging from 58.7 to 76 years. Seven included studies were rated as \u201cgood \u201cquality, while one study rated \u201cfair\u201d and 10 studies rated \u201cpoor\u201d quality. Eight studies reported incidence rate while 11 studies reported the prevalence of HSP following a stroke. The incidence of HSP was ranging from 10 to 22% in the metanalysis of the included studies. The prevalence of HSP was ranging from 22 to 47% in the metanalysis of the included studies. The most significant predictors of HSP were age, female gender, increased tone, sensory impairment, left-sided hemiparesis, hemorrhagic stroke, hemispatial neglect, positive past medical history, and poor National Institutes of Health Stroke Scale score. The incidence and prevalence of HSP after stroke vary considerably due to various factors. Knowledge of predictors is important to minimize the risk of developing HSP following a stroke.<\/jats:p>","DOI":"10.3390\/ijerph17144962","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T10:45:19Z","timestamp":1594291519000},"page":"4962","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Incidence, Prevalence, and Risk Factors of Hemiplegic Shoulder Pain: A Systematic Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3187-8062","authenticated-orcid":false,"given":"Shahnawaz","family":"Anwer","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia"},{"name":"Department of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Alghadir","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Pan, R., Zhou, M., Cai, H., Guo, Y., Zhan, L., Li, M., Yang, Z., Zhu, L., Zhan, J., and Chen, H. (2017). A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients. Clin. Rehabil.","DOI":"10.1177\/0269215517714830"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S1052-3057(10)80071-0","article-title":"Shoulder pain in stroke patients and its effects on rehabilitation","volume":"3","author":"Poduri","year":"1993","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.apmr.2014.09.007","article-title":"Incidence and associations of hemiplegic shoulder pain poststroke: Prospective population-based study","volume":"96","author":"Arima","year":"2015","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1615\/CritRevPhysRehabilMed.v20.i3.20","article-title":"Hemiplegic shoulder pain: Diagnosis and management","volume":"20","author":"Vasudevan","year":"2008","journal-title":"Crit. Rev. Phys. Rehabil. Med."},{"key":"ref_5","first-page":"234","article-title":"Painful hemiplegic shoulder in stroke patients: Causes and management","volume":"27","author":"Gnanakumar","year":"2012","journal-title":"Neurologia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1161\/01.STR.0000254598.16739.4e","article-title":"Shoulder pain after stroke: A prospective population-based study","volume":"38","author":"Lindgren","year":"2007","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"282","DOI":"10.3109\/09638280903127685","article-title":"Interventions for hemiplegic shoulder pain: Systematic review of randomized controlled trials","volume":"32","author":"Koog","year":"2010","journal-title":"Disabil. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1080\/09638280110062149","article-title":"Hemiplegic shoulder pain: Defining the problem and its management","volume":"23","author":"Bender","year":"2001","journal-title":"Disabil. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/01.PHM.0000138739.18844.88","article-title":"Shoulder pain in hemiplegia - results from a national rehabilitation hospital in Turkey","volume":"83","author":"Aras","year":"2004","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/S0003-9993(03)00484-2","article-title":"Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation","volume":"85","author":"McLean","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S1836-9553(10)70025-4","article-title":"Reduced active control and passive range at the shoulder increase risk of shoulder pain during inpatient rehabilitation post-stroke: An observational study","volume":"56","author":"Blennerhassett","year":"2010","journal-title":"J. Physiother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.apmr.2007.10.051","article-title":"Hemiplegic shoulder pain syndrome: Frequency and characteristics during inpatient stroke rehabilitation","volume":"89","author":"Dromerick","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/MRR.0b013e32831e455f","article-title":"Poststroke shoulder pain in Turkish stroke patients: Relationship with clinical factors and functional outcomes","volume":"32","author":"Barlak","year":"2009","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1161\/01.STR.31.6.1223","article-title":"Medical complications after stroke: A multicenter study","volume":"31","author":"Langhorne","year":"2000","journal-title":"Stroke"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1191\/0269215503cr612oa","article-title":"Shoulder pain in people with a stroke: A population-based study","volume":"17","author":"Ratnasabapathy","year":"2003","journal-title":"Clin. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/S1090-3801(02)00055-1","article-title":"Post stroke shoulder pain: A prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke","volume":"6","author":"Gamble","year":"2002","journal-title":"Eur. J. Pain"},{"key":"ref_17","first-page":"25","article-title":"Shoulder pain in hemiplegic patients","volume":"1","author":"Demirci","year":"2007","journal-title":"J. Phys. Med. Rehabil. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/00002060-199809000-00012","article-title":"Evaluation and treatment of shoulder subluxation in hemiplegia: Relationship between subluxation and pain","volume":"77","author":"Ikai","year":"1998","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1191\/0269215500cr339oa","article-title":"A randomized controlled trial of strapping to prevent post-stroke shoulder pain","volume":"14","author":"Hanger","year":"2000","journal-title":"Clin. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1191\/0269215506cr944oa","article-title":"A programme of static positional stretches does not reduce hemiplegic shoulder pain or maintain shoulder range of motion\u2014A randomized controlled trial","volume":"20","author":"Gustafsson","year":"2006","journal-title":"Clin. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1093\/ptj\/69.9.768","article-title":"Decreased shoulder range of motion on paretic side after stroke","volume":"69","author":"Andrews","year":"1989","journal-title":"Phys. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/S1058-2746(00)90002-8","article-title":"Glenohumeral motion in patients with rotator cuff tears: A comparison of asymptomatic and symptomatic shoulders","volume":"9","author":"Yamaguchi","year":"2000","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/S0003-9993(99)90146-6","article-title":"Shoulder pain and dysfunction in hemiplegia: Effects of functional electrical stimulation","volume":"80","author":"Chantraine","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/16501970306111","article-title":"Shoulder pain in hemiplegia revisited: Contribution of functional electrical stimulation and other therapies","volume":"35","author":"Vuagnat","year":"2003","journal-title":"J. Rehabil. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/01.PHM.0000150792.26793.E9","article-title":"Kinematic alterations in the ipsilateral shoulder of patients with hemiplegia due to stroke","volume":"84","author":"Meskers","year":"2005","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: A proposal for reporting","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA"},{"key":"ref_27","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2010). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses, Ottawa Health Research Institute."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1053\/eujp.2000.0192","article-title":"Post stroke shoulder pain: More common than previously realized","volume":"4","author":"Gamble","year":"2000","journal-title":"Eur. J. Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3329","DOI":"10.1161\/STROKEAHA.108.518563","article-title":"The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke","volume":"39","author":"Sackley","year":"2008","journal-title":"Stroke"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/PHM.0b013e3181909d5f","article-title":"Complications during the rehabilitation period in Thai patients with stroke: A multicenter prospective study","volume":"88","author":"Kuptniratsaikul","year":"2009","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Klit, H., Finnerup, N.B., Overvad, K., Andersen, G., and Jensen, T.S. (2011). Pain following stroke: A population-based follow-up study. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0027607"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1002\/j.1532-2149.2012.00123.x","article-title":"Pain following stroke: A prospective study","volume":"16","author":"Hansen","year":"2012","journal-title":"Eur. J. Pain"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.pmrj.2012.04.007","article-title":"Left-sided hemiparesis, pain frequency, and decreased passive shoulder range of abduction are predictors of long-lasting poststroke shoulder pain","volume":"4","author":"Lindgren","year":"2012","journal-title":"PMR"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Kuptniratsaikul, V., Kovindha, A., Suethanapornkul, S., Manimmanakorn, N., and Archongka, Y. (2013). Long-term morbidities in stroke survivors: A prospective multicenter study of Thai stroke rehabilitation registry. BMC Geriatr., 13.","DOI":"10.1186\/1471-2318-13-33"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Chen, C.-M., Hsu, H., Chang, C.-H., Lin, C.-H., Chen, K.-H., Hsieh, W.-C., and Chang, W.-M. (2014). Age-based prediction of incidence of complications during inpatient stroke rehabilitation: A retrospective longitudinal cohort study. BMC Geriatr., 14.","DOI":"10.1186\/1471-2318-14-41"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"81","DOI":"10.2340\/16501977-1238","article-title":"Clinical and sonographic risk factors for hemiplegic shoulder pain: A longitudinal observational study","volume":"46","author":"Kim","year":"2014","journal-title":"J. Rehabil. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"799","DOI":"10.2466\/26.29.PMS.119c28z2","article-title":"Prevalence and determinants of pain in the ipsilateral upper limb of stroke patients","volume":"119","author":"Kwon","year":"2014","journal-title":"Percept. Mot. Skills"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1310\/tsr2103-237","article-title":"Hemiplegic shoulder pain: Associated factors and rehabilitation outcomes of hemiplegic patients with and without shoulder pain","volume":"21","author":"Karaahmet","year":"2014","journal-title":"Top. Stroke Rehabil."},{"key":"ref_40","first-page":"924","article-title":"Prevalence and Time Course of Post-Stroke Pain: A Multicenter Prospective Hospital-Based Study","volume":"17","author":"Paolucci","year":"2016","journal-title":"Pain Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1093\/ptj\/66.12.1884","article-title":"Hemiplegic shoulder pain","volume":"66","author":"Griffin","year":"1986","journal-title":"Phys. Ther."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/026921558800200106","article-title":"Shoulder pain in hemiplegia: A literature review","volume":"2","author":"Roy","year":"1988","journal-title":"Clin. Rehabil."},{"key":"ref_43","first-page":"2","article-title":"Shoulder pain in stroke patients with hemiplegia or hemiparesis following a cerebrovascular accident","volume":"71","author":"Bruton","year":"1985","journal-title":"Physiotherapy"},{"key":"ref_44","first-page":"189","article-title":"Shoulder pain in hemiplegia","volume":"3","author":"Krotenberg","year":"1990","journal-title":"Adv. Clin. Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1017\/S0959259800003877","article-title":"The painful hemiplegic shoulder: Pathogenesis, diagnosis and management","volume":"4","author":"Wanklyn","year":"1994","journal-title":"Rev. Clin. Gerontol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1093\/ptj\/61.7.1041","article-title":"Shoulder pain in patients with hemiplegia. A literature review","volume":"61","author":"Griffin","year":"1981","journal-title":"Phys. Ther."},{"key":"ref_47","first-page":"514","article-title":"Shoulder pain in hemiplegia: Statistical relationship with five variables","volume":"67","author":"Bohannon","year":"1986","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1136\/practneurol-2013-000606","article-title":"Hemiplegic shoulder pain: A common clinical consequence of stroke","volume":"14","author":"Basaran","year":"2014","journal-title":"Pract. Neurol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1097\/PHM.0b013e318214e976","article-title":"Underlying pathology and associated factors of hemiplegic shoulder pain","volume":"90","author":"Kalichman","year":"2011","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1191\/0269215502cr491oa","article-title":"Shoulder pain after stroke: A review of the evidence base to inform the development of an integrated care pathway","volume":"16","author":"Jackson","year":"2002","journal-title":"Clin. Rehabil."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"497","DOI":"10.3109\/09638289609166035","article-title":"Hemiplegic shoulder pain (HSP): Natural history and investigation of associated features","volume":"18","author":"Wanklyn","year":"1996","journal-title":"Disabil. Rehabil."},{"key":"ref_52","first-page":"215","article-title":"Predictor factors of hemiplegic shoulder pain in a group of stroke patients","volume":"10","author":"Hadianfard","year":"2008","journal-title":"Iran Red Crescent Med. J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.pmr.2014.01.010","article-title":"Hemiplegic shoulder pain: An approach to diagnosis and management","volume":"25","author":"Vasudevan","year":"2014","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.apmr.2011.02.016","article-title":"Persistent shoulder pain in the first 6 months after stroke: Results of a prospective cohort study","volume":"92","author":"Roosink","year":"2011","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_55","first-page":"23","article-title":"Painful shoulder in hemiplegia","volume":"67","author":"Laplace","year":"1986","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_56","unstructured":"Gillen, G., and Burkhardt, A. (1998). Upper Extremity Function and Management In Stroke Rehabilitation: A Function-Based Approach, Mosby."},{"key":"ref_57","unstructured":"O\u2019Sullivan, S.B., and Schmitz, T.J. (1995). Physical Rehabilitation: Assessment and Treatment, FA Davis. [3rd ed.]."},{"key":"ref_58","unstructured":"Iannotti, J.P., and Williams, G.R. (1999). Disorders of the Shoulder: Diagnosis and Management, Lippincott Williams & Wilkins."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/S0003-9993(97)90200-8","article-title":"Frozen shoulder: Correlation between the response to physical therapy and follow-up shoulder arthrography","volume":"78","author":"Mao","year":"1997","journal-title":"Arch. Phys. Med. Rehabil."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/14\/4962\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:49:33Z","timestamp":1760176173000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/14\/4962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,9]]},"references-count":59,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["ijerph17144962"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17144962","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,9]]}}}