Summary of the best evidence for physical therapy in patients with post-stroke shoulder hand syndrome

Shoulder-hand syndrome (SHS) is a common complication after stroke, characterized by shoulder pain, hand swelling, and limited mobility, which severely impacts patient rehabilitation and quality of life. Physical therapy is central to its comprehensive management, yet clinical intervention approaches vary and lack standardization.

To systematically retrieve, evaluate, and integrate the best evidence on physical therapy and nursing for post-stroke SHS, providing a basis for clinical practitioners to develop standardized management protocols.

Following evidence summary methodology and the "6S" pyramid model, we systematically searched domestic and international databases, guideline repositories, and professional association websites. The search period covered from database inception to 1 December 2025. Two researchers independently assessed the quality of the literature using the AGREE II instrument for guidelines and the relevant Joanna Briggs Institute (JBI) critical appraisal tools for other study types. Evidence was subsequently extracted and summarized.

The initial search identified 734 records. After screening, 22 articles were included, comprising 4 guidelines, 1 clinical decision, 14 systematic reviews, 1 evidence summary, and 2 expert consensus. Ultimately, 18 best practice recommendations were synthesized across 6 themes: early prevention and protection, comprehensive assessment, symptom management, transfers and mobility, posture management, and health education and follow-up.

This study summarizes the best available evidence for the physical therapy and nursing management of post-stroke SHS, forming a comprehensive strategy covering prevention, assessment, intervention, and health education. It provides an evidence-based foundation for standardizing clinical practice and enhancing patient recovery.

This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is "Summary of the best evidence for physical therapy in patients with post-stroke shoulder hand syndrome", the registration number is "ES20258280".