Effect of Sling Suspension-Based Active Shoulder Joint Exercises on Shoulder Subluxation in Subacute Stroke Patients

Introduction Shoulder subluxation has an incidence of up to 80% following stroke. It commonly occurs during the flaccid stage due to reduced muscle tone in the rotator cuff muscles, allowing gravitational pull on the humerus and resulting in widening of the acromion-humeral gap. Sling suspension enables partially unloaded active movement of the shoulder joint; however, evidence regarding its effectiveness in subacute stroke patients remains limited. This study aimed to evaluate the effect of sling suspension-based active shoulder exercises on shoulder subluxation in subacute stroke patients. Methods A randomized controlled trial with a pretest-posttest design was conducted on 28 subacute stroke patients who were randomly allocated to experimental and control groups (n = 14 each). Both groups received a standard rehabilitation program consisting of weight-bearing and scapular stabilization exercises for the affected upper limb. In addition, the experimental group performed sling suspension-based active shoulder exercises, in which the limb was supported in a suspension system to facilitate gravity-minimized active movements. The control group performed conventional active-assisted range of motion (AAROM) exercises with therapist assistance, without sling support. All participants received 30 minutes of intervention per session, five days per week for four weeks. Shoulder subluxation was assessed using the measuring tape method (acromion-humeral distance) by a blinded outcome assessor. Data were analyzed using IBM SPSS Statistics version 31.0 (IBM Corp., Armonk, NY). Within-group comparisons were performed using the paired t-test, and between-group comparisons of mean difference were analyzed using the independent samples t-test. A p-value of <0.05 was considered statistically significant. Results Both groups demonstrated a significant reduction in shoulder subluxation following the intervention; however, the experimental group showed significantly greater improvement than the control group. The experimental group demonstrated a mean reduction of 6.3 ± 1.2 mm, whereas the control group demonstrated a mean reduction of 2.3 ± 0.9 mm. Between-group analysis revealed a statistically significant difference favoring the experimental group (mean difference: 4.0 mm; p < 0.001). Conclusion The findings indicate that sling suspension-based active shoulder exercises, when combined with standard rehabilitation, produce greater reductions in shoulder subluxation than conventional AAROM exercises in individuals with subacute stroke.