{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:47:40Z","timestamp":1789670860195,"version":"4.0.1"},"reference-count":45,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Yonsei Fellowship, funded by Lee Youn Jae"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Shoulder subluxation and pain are common complications of stroke that impair upper limb function. Objectives: This study conducted a systematic review and network meta-analysis to compare multiple therapeutic interventions for post-stroke shoulder subluxation, establishing an evidence-based hierarchy of treatment efficacy to optimize rehabilitation strategies and guide clinical practice. Methods: A comprehensive search was conducted using the MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases until 8 August 2025. Randomized controlled trials evaluating treatments for shoulder subluxation, including neuromuscular electrical stimulation (NMES), Kinesio taping, corticosteroid injections, slings, repetitive peripheral magnetic stimulation, and electroacupuncture, were included. The follow-up duration in the included trials ranged from 1 to 12 weeks. Effect sizes were calculated using standardized mean differences with a random-effects model, and treatment rankings were determined using surface under the cumulative ranking curve (SUCRA). Results: Thirteen studies including 402 patients were analyzed. NMES was the most effective intervention for reducing subluxation distance (SUCRA: 84.9), while corticosteroid injections provided the greatest pain relief at rest (SUCRA: 73.6). Kinesio taping was most effective for functional recovery, as measured by the Fugl\u2013Meyer Assessment (SUCRA: 98.5), and for pain relief during activity (SUCRA: 87.7). Conclusions: Our network meta-analysis suggests that different interventions are optimal for specific aspects of post-stroke shoulder impairment. NMES most effectively reduces subluxation distance, whereas corticosteroid injections are most effective for alleviating pain at rest. Kinesio taping appears superior for enhancing functional recovery and reducing pain during movement. These findings, based on short-term follow-up durations (1\u201312 weeks), provide an evidence-based ranking of interventions to support multimodal rehabilitation and inform clinical decision-making. The observed heterogeneity across studies underscores the need for standardized treatment protocols and rigorous long-term investigations.<\/jats:p>","DOI":"10.3390\/jcm14196913","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:12:23Z","timestamp":1759223543000},"page":"6913","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Effectiveness of Treatments for Shoulder Subluxation After Stroke: A Systematic Review and Network Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4272-7489","authenticated-orcid":false,"given":"Jong-Mi","family":"Park","sequence":"first","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4000-4868","authenticated-orcid":false,"given":"Hee-Jae","family":"Park","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0365-2923","authenticated-orcid":false,"given":"Seo-Yeon","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5234-2454","authenticated-orcid":false,"given":"Yong-Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2326-1820","authenticated-orcid":false,"given":"Jae-Il","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"},{"name":"The Center for Medical Education Training and Professional Development in Yonsei-Donggok Medical Education Institute, Seoul 03722, Republic of Korea"},{"name":"Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6241-7392","authenticated-orcid":false,"given":"Sang-Chul","family":"Lee","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1682\/JRRD.2004.08.0112","article-title":"Glenohumeral subluxation in hemiplegia: An overview","volume":"42","author":"Paci","year":"2005","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1179\/174328809X405883","article-title":"A critical review of shoulder subluxation and its association with other post-stroke complications","volume":"14","author":"Kumar","year":"2009","journal-title":"Phys. Ther. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1177\/0269215516648753","article-title":"Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: Systematic review","volume":"31","author":"Nadler","year":"2017","journal-title":"Clin. Rehabil."},{"key":"ref_4","first-page":"774","article-title":"Effect of kinesiology taping on hemiplegic shoulder pain and functional outcomes in subacute stroke patients: A randomized controlled study","volume":"52","author":"Huang","year":"2016","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1177\/0269215517700696","article-title":"Effectiveness of neuromuscular electrical stimulation for management of shoulder subluxation post-stroke: A systematic review with meta-analysis","volume":"31","author":"Lee","year":"2017","journal-title":"Clin. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"400","DOI":"10.3349\/ymj.2008.49.3.400","article-title":"Long-term outcomes of acute ischemic stroke in patients aged 80 years and older","volume":"49","author":"Minn","year":"2008","journal-title":"Yonsei Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1179\/174328810X12647087218596","article-title":"Risk factors for inferior shoulder subluxation in patients with stroke","volume":"15","author":"Kumar","year":"2010","journal-title":"Phys. Ther. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.2147\/IJGM.S200929","article-title":"Interventions for post-stroke shoulder pain: An overview of systematic reviews","volume":"13","author":"Dyer","year":"2020","journal-title":"Int. J. Gen. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1080\/10749357.2017.1383712","article-title":"Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: A systematic review","volume":"25","author":"Arya","year":"2018","journal-title":"Top. Stroke Rehabil."},{"key":"ref_10","first-page":"525","article-title":"The effect of electroacupuncture on shoulder subluxation for stroke patients","volume":"16","author":"Chen","year":"2000","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101602","DOI":"10.1016\/j.rehab.2021.101602","article-title":"Efficacy of rehabilitative techniques in reducing hemiplegic shoulder pain in stroke: Systematic review and meta-analysis","volume":"65","author":"Moggio","year":"2022","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"216","DOI":"10.23736\/S1973-9087.24.08264-9","article-title":"Repetitive peripheral magnetic stimulation for preventing shoulder subluxation after stroke: A randomized controlled trial","volume":"60","author":"Fujimura","year":"2024","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.54724\/lc.2022.e9","article-title":"Prisma 2020 statement and guidelines for systematic review and meta-analysis articles, and their underlying mathematics: Life cycle committee recommendations","volume":"2","author":"Lee","year":"2022","journal-title":"Life Cycle"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1186\/s13643-021-01626-4","article-title":"The prisma 2020 statement: An updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_15","first-page":"14898","article-title":"Rob 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Nikolakopoulou, A., Higgins, J.P., Papakonstantinou, T., Chaimani, A., Del Giovane, C., Egger, M., and Salanti, G. (2020). Cinema: An approach for assessing confidence in the results of a network meta-analysis. PLoS Med., 17.","DOI":"10.1371\/journal.pmed.1003082"},{"key":"ref_17","unstructured":"Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V. (2019). Cochrane Handbook for Systematic Reviews of Interventions, Wiley."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1002\/sim.3767","article-title":"Checking consistency in mixed treatment comparison meta-analysis","volume":"29","author":"Dias","year":"2010","journal-title":"Stat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/jrsm.1045","article-title":"Consistency and inconsistency in network meta-analysis: Model estimation using multivariate meta-regression","volume":"3","author":"White","year":"2012","journal-title":"Res. Synth. Methods"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/s13643-017-0473-z","article-title":"Approaches to interpreting and choosing the best treatments in network meta-analyses","volume":"6","author":"Mbuagbaw","year":"2017","journal-title":"Syst. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2017047","DOI":"10.4178\/epih.e2017047","article-title":"Network meta-analysis: Application and practice using stata","volume":"39","author":"Shim","year":"2017","journal-title":"Epidemiol. Health"},{"key":"ref_22","first-page":"400","article-title":"A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients","volume":"53","author":"Lambrecht","year":"2017","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"560","DOI":"10.3109\/09638280903183811","article-title":"The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial","volume":"32","author":"Koyuncu","year":"2010","journal-title":"Disabil. Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5329881","DOI":"10.1155\/2021\/5329881","article-title":"Effect of electroacupuncture on shoulder subluxation in poststroke patients with hemiplegic shoulder pain: A sham-controlled study using multidimensional musculoskeletal ultrasound assessment","volume":"2021","author":"Sui","year":"2021","journal-title":"Pain. Res. Manag."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lavi, C., Elboim-Gabyzon, M., Naveh, Y., and Kalichman, L. (2022). A combination of long-duration electrical stimulation with external shoulder support during routine daily activities in patients with post-hemiplegic shoulder subluxation: A randomized controlled study. Int. J. Env. Res. Public Health, 19.","DOI":"10.3390\/ijerph19159765"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1161\/01.STR.30.5.963","article-title":"Prevention of shoulder subluxation after stroke with electrical stimulation","volume":"30","author":"Linn","year":"1999","journal-title":"Stroke"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e944222","DOI":"10.12659\/MSM.944222","article-title":"Effectiveness of shoulder taping in treating hemiplegic shoulder subluxation: A randomized controlled study of 35 patients","volume":"30","author":"Yim","year":"2024","journal-title":"Med. Sci. Monit."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4103\/1947-2714.179933","article-title":"The california tri-pull taping method in the treatment of shoulder subluxation after stroke: A randomized clinical trial","volume":"8","author":"Chatterjee","year":"2016","journal-title":"N. Am. J. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"8346432","DOI":"10.1155\/2018\/8346432","article-title":"The effect of kinesiology taping on the hemiplegic shoulder pain: A randomized controlled trial","volume":"2018","author":"Yang","year":"2018","journal-title":"J. Healthc. Eng."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/0003-9993(94)90341-7","article-title":"The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients","volume":"75","author":"Faghri","year":"1994","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/MRR.0000000000000319","article-title":"Effects of functional electrical stimulation-cycling on shoulder pain and subluxation in patients with acute-subacute stroke: A pilot study","volume":"42","author":"Karaahmet","year":"2019","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"287","DOI":"10.5606\/tftrd.2017.953","article-title":"Ultrasonographic assessment of neuromuscular electrical stimulation efficacy on glenohumeral subluxation in patients with hemiplegia: A randomized-controlled study","volume":"63","year":"2017","journal-title":"Turk. J. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/PHM.0b013e3181b71c65","article-title":"The effect of local injections in hemiplegic shoulder pain: A prospective, randomized, controlled study","volume":"88","author":"Lakse","year":"2009","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_34","first-page":"100025","article-title":"Efficacy of functional electrical stimulation for hemiplegic shoulder pain: A systematic review and meta-analysis","volume":"1","author":"Wang","year":"2025","journal-title":"Healthc. Rehabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.03.021","article-title":"Systematic review on effectiveness of shoulder taping in hemiplegia","volume":"28","author":"Ravichandran","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"208","DOI":"10.2340\/16501977-2197","article-title":"Effects of kinesio taping for stroke patients with hemiplegic shoulder pain: A double-blind, randomized, placebo-controlled study","volume":"49","author":"Huang","year":"2017","journal-title":"J. Rehabil. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/0269215520964950","article-title":"Effect of kinesio taping on hemiplegic shoulder pain: A systematic review and meta-analysis of randomized controlled trials","volume":"35","author":"Deng","year":"2021","journal-title":"Clin. Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1080\/10749357.2020.1747672","article-title":"Effects of trunk rehabilitation with kinesio and placebo taping on static and dynamic sitting postural control in individuals with chronic stroke: A randomized controlled trial","volume":"27","author":"Cho","year":"2020","journal-title":"Top. Stroke Rehabil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.apmr.2012.02.002","article-title":"Subacromial corticosteroid injection on poststroke hemiplegic shoulder pain: A randomized, triple-blind, placebo-controlled trial","volume":"93","author":"Rah","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"247","DOI":"10.3349\/ymj.2007.48.2.247","article-title":"Abduction motion analysis of hemiplegic shoulders with a fluoroscopic guide","volume":"48","author":"Yoon","year":"2007","journal-title":"Yonsei Med. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"167","DOI":"10.5535\/arm.2014.38.2.167","article-title":"The comparison of effects of suprascapular nerve block, intra-articular steroid injection, and a combination therapy on hemiplegic shoulder pain: Pilot study","volume":"38","author":"Jeon","year":"2014","journal-title":"Ann. Rehabil. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1177\/0269215510380827","article-title":"Which treatment approach is better for hemiplegic shoulder pain in stroke patients: Intra-articular steroid or suprascapular nerve block? A randomized controlled trial","volume":"25","author":"Yasar","year":"2011","journal-title":"Clin. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1161\/01.STR.31.10.2396","article-title":"Effect of triamcinolone acetonide injections on hemiplegic shoulder pain: A randomized clinical trial","volume":"31","author":"Snels","year":"2000","journal-title":"Stroke"},{"key":"ref_44","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_45","doi-asserted-by":"crossref","first-page":"194","DOI":"10.5014\/ajot.50.3.194","article-title":"Shoulder pain and subluxation after stroke: Correlation or coincidence?","volume":"50","author":"Zorowitz","year":"1996","journal-title":"Am. J. Occup. Ther."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6913\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:51:51Z","timestamp":1759225911000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6913"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":45,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196913"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196913","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]}}}