Incidence, Time Course and Predictors of Impairments Relating to Caring for the Profoundly Affected arm After XXXX : A Systematic Review.

@entity64 @entity508 @entity425 @entity158 @entity1159
BACKGROUND AND PURPOSE: A significant number of @entity64 survivors will not recover the use of their affected arm. A proportion will experience @entity158 , stiffness and difficulty with basic care activities. The purpose of the review was to identify predictors of difficulty caring for the profoundly affected arm and establish the incidence and time-course of the related impairments of @entity158 , @entity508 and @entity1159 . METHOD: Data sources: Databases (PubMED, MEDLINE, AMED, EMBASE, CINAHL and the Cochrane Controlled Trials Register) were searched from inception to December 2013. Additional studies were identified from citation tracking. REVIEW METHODS: Independent reviewers used pre-defined criteria to identify eligible studies. Quality assessment and risk of bias were assessed using the McMasters Assessment Tool. A narrative evidence synthesis was performed. RESULTS: Thirty-nine articles reporting 34 studies were included. No studies formally measured difficulty caring for the arm, but related impairments were common. Incidence of @entity508 in those with @entity425 ranged from 33% to 78%, shoulder @entity158 affected 22% to 90% and @entity1159 was present in at least 50%. @entity508 and @entity158 appear within 1   week of @entity64 , and @entity1159 within two weeks. Impairments continued to develop over at least 3-6   months. The most frequent predictors of @entity508 and @entity1159 were @entity425 and reduced motor control, and the risk of @entity158 is most commonly predicted by reduced sensation, shoulder subluxation, @entity425 and @entity64 severity. DISCUSSION: There is no published evidence on predicting the likelihood of difficulty caring for the arm following @entity64 . However, the related impairments of @entity508 , @entity158 and @entity1159 are common. Given the time-course of development, clinicians may need not only to intervene early but also be prepared to act over a longer time period. Further research is needed to examine difficulty caring for the arm and the relationship with associated impairments to enable researchers and clinicians to develop targeted interventions. Copyright    2015 John Wiley _ Sons, Ltd.
