Comparison of low-level laser therapy versus neuromuscular electrical nerve stimulation at hemiplegic shoulder pain and upper extremity functions

This study aimed to assess and compare the effectiveness of adding low-level laser therapy (LLLT) and neuromuscular electrical nerve stimulation (NMES) to conventional physical therapy exercises, for stroke patients with hemiplegic shoulder pain (HSP). Seventy-five stroke patients with shoulder pain were included in this prospective randomized controlled study. Participants were divided into three groups. All patients underwent a multidisciplinary rehabilitation program five days a week for four weeks for a total of twenty sessions with classical physical therapy exercises. In addition, Group 1 received LLLT for three days a week for four weeks. Group 2 received NMES for twenty minutes for five days a week for four weeks. Group 3 control group received classical physical therapy exercises. Brunnstrom (BRS) upper extremity, BRS Hand, Barthel index, Shoulder Pain and Disability Index (SPADI), Fugl Meyer, Modified Ashworth Scale (MAS) and visual analog scale (VAS) were assessed, prior to the treatment and at the end of four weeks. After treatment, statistically significant improvements were found in BRS upper extremity, BRS Hand, Barthel index, SPADI, Fugl Meyer and VAS in all three groups (all p < 0.005). When the groups were compared, significant improvements in Bartel, SPADI and VAS in the LLLT and NMES groups than the control group(all p < 0.005), however the LLLT and NMES groups were statistically similar. LLLT, NMES and conventional exercise therapy have demonstrated efficacy in treating HSP and improving upper extremity functions and disability. Laser and NMES were more effective while the effects of laser and NMES were similar.