Impact of Shoulder–Hand Syndrome on Upper Extremity–Related Functional Independence Among Chronic Stroke Patients

Abstract

Background: Shoulder–hand syndrome (SHS), commonly conceptualized within post-stroke complex regional pain syndrome type I, is a disabling complication that may exacerbate dependence in chronic stroke survivors by limiting functional use of the affected upper limb. Objective: To determine the association between SHS pain intensity and activities-of-daily-living (ADL) functional independence among chronic stroke patients. Methods: A cross-sectional observational study was conducted over six months at PSRD Hospital and Lahore General Hospital. Using non-probability convenience sampling, 164 chronic ischemic supratentorial stroke patients (>6 months post-stroke) meeting Budapest criteria for SHS were enrolled. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS; 0–10), and functional independence was evaluated using the Barthel Index. Pearson correlation was applied to examine the association between NPRS and Barthel total score (SPSS v25; two-tailed α=0.05). Results: Participants had a mean age of 59.35±9.52 years; 152 (92.7%) were male. Mean NPRS pain intensity was 2.48±2.03, and mean Barthel total score was 63.4±18.9. Greater pain intensity was associated with lower ADL independence (r=−0.414; 95% CI −0.54 to −0.27; p<0.001). Dependency was most pronounced in stair negotiation (42.7% unable) and transfers (56.1% requiring assistance). Conclusion: In chronic stroke patients with SHS, higher pain intensity is significantly associated with poorer functional independence, supporting the clinical importance of targeted pain management within long-term stroke rehabilitation.