Management of upper limb pain in stroke survivors: The current practices of Occupational Therapists in South Africa

Abstract

Introduction: Stroke is one of the leading causes of adult disability and mortality in South Africa. Post-stroke upper limb pain affects various functions, hindering activities and participation. Occupational therapists play a crucial role in pain management, enabling occupational performance, despite pain. However, there are gaps in recognising and managing post-stroke pain. This study aimed to describe occupational therapist practices in managing upper limb pain post-stroke in South Africa.

Methodology: A quantitative descriptive cross-sectional study surveyed occupational therapists who routinely treat stroke survivors, using descriptive statistics and content analysis.

Results: One hundred responses were included for analysis. Most of the participants (96.7%) recognised pain as an issue for stroke survivors. In particular, 48.9% always include pain management, 43.5% consider it but lack intervention skills, and 16.3% report time constraints. Occupational therapists focus primarily on neuromusculoskeletal and movement-related functions in pain management, some considering mental functions, activities, participation, and/or the environment.

Conclusion: The study highlights a significant burden of post-stroke upper limb pain in South Africa. Occupational therapists mainly address body structures and functions associated with pain, indicating the potential to strengthen the focus on activity and participation while considering contextual factors. Incorporating pain management into occupational therapy interventions for stroke survivors at all levels of care is recommended, along with the development of evidence-based guidelines tailored to occupational therapy.

Implications for Practice

• Highlights the significant prevalence and complexity of post-stroke upper limb pain.
• Occupational therapists should continue to mobilise the upper limb to prevent the development of post-stroke pain syndromes.
• Prescription of wheelchair tray tables, subluxation slings and electrical stimulation should supplement current pain prevention practices.
• Occupational therapists should refer clients for pharmacological interventions, especially for focal spasticity or suspected neuropathic pain.
• Occupational therapists have the capacity to make valuable contributions to the multidisciplinary team by using psychosocial interventions.