Effectiveness of Transcutaneous Electrical Nerve Stimulation in the management of patients with Hemiplegic Shoulder Pain

Abstract

Background: Hemiplegic Shoulder Pain (HSP) is a common and disabling complication after stroke, hindering recovery and quality of life. While conventional physiotherapy is standard in rehabilitation, its effect on HSP is often limited. Transcutaneous Electrical Nerve Stimulation (TENS), a non-invasive electrotherapy, has shown promise for pain relief in neurological conditions, but its specific role in HSP, especially in low-resource settings like Bangladesh, is not well established. Objective: This study aimed to evaluate the effectiveness of TENS combined with conventional physiotherapy in reducing shoulder pain, improving range of motion (ROM), and minimizing spasticity in stroke patients with hemiplegic shoulder pain. Methods: A randomized controlled trial was conducted at CRP, Savar, with 30 stroke patients with HSP. Participants were randomly assigned to an experimental group (TENS + physiotherapy, n=15) or control group (physiotherapy only, n=15) over 16 sessions. Outcome measures included the Shoulder Pain and Disability Index (SPADI), Modified Ashworth Scale (MAS), and goniometric assessment of Active and Passive ROM. Data were analyzed using SPSS 25 with t-tests, Mann-Whitney U, and Wilcoxon Signed-Rank tests. Results: Both groups showed significant within-group improvements in pain, disability, and ROM (p<0.05). However, only the experimental group showed a statistically significant reduction in disability scores (p=0.006), while the control group did not (p=0.120). Between-group comparisons revealed no significant difference in MAS or ROM post-intervention (p>0.05), though the combined use of TENS yielded better overall improvements in functional outcomes. Discussion: TENS combined with physiotherapy offers added benefits in reducing pain and improving function in HSP patients. Although no significant differences were observed in spasticity and ROM between the groups, the experimental group showed greater improvement in disability, suggesting the potential value of integrating TENS in post-stroke rehabilitation protocols. Further large-scale studies are needed. Keywords: Hemiplegic Shoulder Pain, Transcutaneous Electrical Nerve Stimulation (TENS), Range of Motion