Integrating Pain Assessment and Personalized Goals: A Preliminary Study on Rehabilitation Outcomes for Post-Stroke Hemiplegic Shoulder Pain
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Published:
Dec 24, 2025
Keywords:
GAS, Hemiplegic, Shoulder, Stroke, Pain
Main Article Content
Abstract
Introduction: Hemiplegic shoulder pain (HSP) is a frequent complication in stroke survivors, negatively impacting rehabilitation and overall quality of life. HSP can make it hard to do everyday things, which can make patient anxious, stressed, and depressed because of muscle pain, spasticity, and less ability to do things. This study aims to clarify the correlation between shoulder pain intensity and clinical variables, also to evaluate the efficacy of Goal Attainment Scaling (GAS) in facilitating patients' achievement of rehabilitation goals following intervention.
Methods: This cross-sectional study collected data from post-stroke patients with HSP at the Neurorehabilitation Department of Hasan Sadikin Hospital over a one-year period. The demographics of the patients (age, sex), clinical measure such as Range of Motion (ROM), Motor Assessment Scale (MAS), Brunnstrom stage, Manual Muscle Test (MMT), Depression Anxiety Stress Scales (DASS), Scale of Pain Intensity (SPIN), and Goal Attainment Scaling (GAS), were carefully recorded.
Results: Pain during movement was considerably greater than pain at rest (3.3±0.9 vs 3.0±1.3; p<0.05). GAS analysis indicated improvements following to the rehabilitation program (37.2±0.44 vs 52.6±0.4; p<0.05). A significant correlation was identified only in DASS Depression scores (r=0.55; p<0.05), when other variables shown no significant correlation.
Conclusions: HSP demonstrate greater intensity during movement and a moderate correlation with depression; a significant enhancement in GAS scores following intervention confirms the crucial role of goal-oriented rehabilitation in improving functional outcomes for post-stroke HSP patients. It is recommended to continue future research with larger sample sizes to strengthen the statistical correlations among clinical variables.
Keywords : GAS, Hemiplegic, Shoulder, Stroke, Pain
Methods: This cross-sectional study collected data from post-stroke patients with HSP at the Neurorehabilitation Department of Hasan Sadikin Hospital over a one-year period. The demographics of the patients (age, sex), clinical measure such as Range of Motion (ROM), Motor Assessment Scale (MAS), Brunnstrom stage, Manual Muscle Test (MMT), Depression Anxiety Stress Scales (DASS), Scale of Pain Intensity (SPIN), and Goal Attainment Scaling (GAS), were carefully recorded.
Results: Pain during movement was considerably greater than pain at rest (3.3±0.9 vs 3.0±1.3; p<0.05). GAS analysis indicated improvements following to the rehabilitation program (37.2±0.44 vs 52.6±0.4; p<0.05). A significant correlation was identified only in DASS Depression scores (r=0.55; p<0.05), when other variables shown no significant correlation.
Conclusions: HSP demonstrate greater intensity during movement and a moderate correlation with depression; a significant enhancement in GAS scores following intervention confirms the crucial role of goal-oriented rehabilitation in improving functional outcomes for post-stroke HSP patients. It is recommended to continue future research with larger sample sizes to strengthen the statistical correlations among clinical variables.
Keywords : GAS, Hemiplegic, Shoulder, Stroke, Pain
Article Details
How to Cite
Khairina, F., Arisanti, F., Novitri, sari, D. M., & Nazir, A. (2025). Integrating Pain Assessment and Personalized Goals: A Preliminary Study on Rehabilitation Outcomes for Post-Stroke Hemiplegic Shoulder Pain. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 208 - 214. https://doi.org/10.36803/indojpmr.v14i2.527
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References
1. Adey-Wakeling Z, Arima H, Crotty M, Leyden J, Kleinig T, Anderson CS, et al. Incidence and Associations of Hemiplegic Shoulder Pain Poststroke: Prospective Population-Based Study. Arch Phys Med Rehabil [Internet]. 2015 Feb;96(2):241-247.e1. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0003999314010727
2. Chun H yan Y, Ford A, Kutlubaev MA, Almeida OP, Mead GE. Depression , Anxiety , and Suicide After Available Evidence. 2022;(April):1402–10.
3. Khatooni M, Dehghankar L, Samiei Siboni F, Bahrami M, Shafaei M, Panahi R, et al. Association of post-stroke hemiplegic shoulder pain with sleep quality, mood, and quality of life. Health Qual Life Outcomes [Internet]. 2025 Apr 5;23(1):32. Available from: https://hqlo.biomedcentral.com/articles/10.1186/s12955-025-02367-x
4. Lindgren I, Jo?nsson AC, Norrving B, Lindgren A. Shoulder Pain After Stroke. Stroke [Internet]. 2007 Feb;38(2):343–8. Available from: https://www.ahajournals.org/doi/10.1161/01.STR.0000254598.16739.4e
5. Liao YK, Wu CH, Özçakar L. Hemiplegic Shoulder Pain: A Narrative Review. Rehabil Pract Sci. 2025;2025(1).
6. Kumar P, Christodoulou A, Loizou M. Assessment approaches for hemiplegic shoulder pain in people living with stroke–A scoping review. Disabil Rehabil [Internet]. 2025;47(7):1677–87. Available from: https://doi.org/10.1080/09638288.2024.2385736
7. Turner-Stokes L, Jackson D. Assessment of shoulder pain in hemiplegia: Sensitivity of the ShoulderQ. Disabil Rehabil [Internet]. 2006 Jan 7;28(6):389–95. Available from: http://www.tandfonline.com/doi/full/10.1080/09638280500287692
8. Jung Y, Sim J, Park J, Kim J, Kim M. Usefulness of Goal Attainment Scaling in Intensive Stroke Rehabilitation During the Subacute Stage. Ann Rehabil Med [Internet]. 2020 Jun 30;44(3):181–94. Available from: http://e-arm.org/journal/view.php?doi=10.5535/arm.19087
9. Eftekhar P, Mochizuki G, Dutta T, Richardson D, Brooks D. Goal Attainment Scaling in Individuals with Upper Limb Spasticity Post Stroke. Occup Ther Int. 2016;23(4):379–89.
10. Renedo D, Acosta JN, Leasure AC, Sharma R, Krumholz HM, de Havenon A, et al. Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019. JAMA Neurol [Internet]. 2024 Apr 1;81(4):394. Available from: https://jamanetwork.com/journals/jamaneurology/fullarticle/2815830
11. Paolucci S, Iosa M, Toni D, Barbanti P. Prevalence and Time Course of Post-Stroke Pain?: A Multicenter Prospective Hospital-Based Study. 2015;1–7.
12. Facts S. Centers for Disease Control and Prevention. 2024.
13. Xu M, Hbid Y, Stanley K, Wolfe C, O’Connell MDL, Douiri A, et al. Sex Differences in Stroke Care and Outcomes: A National Stroke Registry Study. J Am Heart Assoc [Internet]. 2025 Aug 5;14(15). Available from: https://www.ahajournals.org/doi/10.1161/JAHA.124.040926
14. Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res [Internet]. 2017 Feb 3;120(3):472–95. Available from: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.116.308398
15. Li Y, Yang S, Cui L, Bao Y, Gu L, Pan H, et al. Prevalence, risk factor and outcome in middle-aged and elderly population affected by hemiplegic shoulder pain: An observational study. Front Neurol [Internet]. 2023 Jan 12;13. Available from: https://www.frontiersin.org/articles/10.3389/fneur.2022.1041263/full
16. Anwer S, Alghadir A. Incidence, Prevalence, and Risk Factors of Hemiplegic Shoulder Pain: A Systematic Review. Int J Environ Res Public Health [Internet]. 2020 Jul 9;17(14):4962. Available from: https://www.mdpi.com/1660-4601/17/14/4962
17. Lee IS, Shin YB, Moon TY, Jeong YJ, Song JW, Kim DH. Sonography of Patients with Hemiplegic Shoulder Pain After Stroke: Correlation with Motor Recovery Stage. Am J Roentgenol [Internet]. 2009 Feb;192(2):W40–4. Available from: https://www.ajronline.org/doi/10.2214/AJR.07.3978
18. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. AHA / ASA Guideline Guidelines for Adult Stroke Rehabilitation and Recovery. 2016. 98–169 p.
2. Chun H yan Y, Ford A, Kutlubaev MA, Almeida OP, Mead GE. Depression , Anxiety , and Suicide After Available Evidence. 2022;(April):1402–10.
3. Khatooni M, Dehghankar L, Samiei Siboni F, Bahrami M, Shafaei M, Panahi R, et al. Association of post-stroke hemiplegic shoulder pain with sleep quality, mood, and quality of life. Health Qual Life Outcomes [Internet]. 2025 Apr 5;23(1):32. Available from: https://hqlo.biomedcentral.com/articles/10.1186/s12955-025-02367-x
4. Lindgren I, Jo?nsson AC, Norrving B, Lindgren A. Shoulder Pain After Stroke. Stroke [Internet]. 2007 Feb;38(2):343–8. Available from: https://www.ahajournals.org/doi/10.1161/01.STR.0000254598.16739.4e
5. Liao YK, Wu CH, Özçakar L. Hemiplegic Shoulder Pain: A Narrative Review. Rehabil Pract Sci. 2025;2025(1).
6. Kumar P, Christodoulou A, Loizou M. Assessment approaches for hemiplegic shoulder pain in people living with stroke–A scoping review. Disabil Rehabil [Internet]. 2025;47(7):1677–87. Available from: https://doi.org/10.1080/09638288.2024.2385736
7. Turner-Stokes L, Jackson D. Assessment of shoulder pain in hemiplegia: Sensitivity of the ShoulderQ. Disabil Rehabil [Internet]. 2006 Jan 7;28(6):389–95. Available from: http://www.tandfonline.com/doi/full/10.1080/09638280500287692
8. Jung Y, Sim J, Park J, Kim J, Kim M. Usefulness of Goal Attainment Scaling in Intensive Stroke Rehabilitation During the Subacute Stage. Ann Rehabil Med [Internet]. 2020 Jun 30;44(3):181–94. Available from: http://e-arm.org/journal/view.php?doi=10.5535/arm.19087
9. Eftekhar P, Mochizuki G, Dutta T, Richardson D, Brooks D. Goal Attainment Scaling in Individuals with Upper Limb Spasticity Post Stroke. Occup Ther Int. 2016;23(4):379–89.
10. Renedo D, Acosta JN, Leasure AC, Sharma R, Krumholz HM, de Havenon A, et al. Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019. JAMA Neurol [Internet]. 2024 Apr 1;81(4):394. Available from: https://jamanetwork.com/journals/jamaneurology/fullarticle/2815830
11. Paolucci S, Iosa M, Toni D, Barbanti P. Prevalence and Time Course of Post-Stroke Pain?: A Multicenter Prospective Hospital-Based Study. 2015;1–7.
12. Facts S. Centers for Disease Control and Prevention. 2024.
13. Xu M, Hbid Y, Stanley K, Wolfe C, O’Connell MDL, Douiri A, et al. Sex Differences in Stroke Care and Outcomes: A National Stroke Registry Study. J Am Heart Assoc [Internet]. 2025 Aug 5;14(15). Available from: https://www.ahajournals.org/doi/10.1161/JAHA.124.040926
14. Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res [Internet]. 2017 Feb 3;120(3):472–95. Available from: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.116.308398
15. Li Y, Yang S, Cui L, Bao Y, Gu L, Pan H, et al. Prevalence, risk factor and outcome in middle-aged and elderly population affected by hemiplegic shoulder pain: An observational study. Front Neurol [Internet]. 2023 Jan 12;13. Available from: https://www.frontiersin.org/articles/10.3389/fneur.2022.1041263/full
16. Anwer S, Alghadir A. Incidence, Prevalence, and Risk Factors of Hemiplegic Shoulder Pain: A Systematic Review. Int J Environ Res Public Health [Internet]. 2020 Jul 9;17(14):4962. Available from: https://www.mdpi.com/1660-4601/17/14/4962
17. Lee IS, Shin YB, Moon TY, Jeong YJ, Song JW, Kim DH. Sonography of Patients with Hemiplegic Shoulder Pain After Stroke: Correlation with Motor Recovery Stage. Am J Roentgenol [Internet]. 2009 Feb;192(2):W40–4. Available from: https://www.ajronline.org/doi/10.2214/AJR.07.3978
18. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. AHA / ASA Guideline Guidelines for Adult Stroke Rehabilitation and Recovery. 2016. 98–169 p.