Effects of Adding a Floss-Band Procedure with Additional Active Shoulder Movement to Conventional Physiotherapy in...

Background: Hemiplegic shoulder pain (HSP) can hinder post-stroke rehabilitation. This trial evaluated the incremental effect of adding a floss-band procedure with active shoulder movement to conventional physiotherapy in a selected chronic HSP subgroup. Methods: In this randomized trial with blinded goniometric assessment, 40 adults aged 30-55 years, ≥6 months post-stroke, with VAS pain ≥ 3, restricted shoulder motion, ≥90° active flexion and abduction, and Modified Ashworth Scale score 0 were allocated to conventional physiotherapy plus the floss-band procedure (n = 20) or physiotherapy alone (n = 20), three times weekly for 6 weeks. SPADI and PSQI were co-primary outcomes; VAS and shoulder range of motion were secondary outcomes. SPADI and PSQI were analyzed using group × baseline interaction models with HC3 robust inference; secondary outcomes used baseline-adjusted ANCOVA. Holm correction covered seven outcome-level tests. Results: Experimental-minus-control differences favored the experimental group for SPADI at the 25th percentile, median, and 75th percentile of baseline severity (-20.87, -25.32, and -28.34 points) and for PSQI (-2.48, -2.91, and -3.87 points; all p < 0.001). Adjusted differences also favored the experimental group for VAS (-2.33), flexion (+32.68°), abduction (+29.13°), internal rotation (+16.35°), and external rotation (+15.95°). Both co-primary joint tests and all five secondary-outcome tests remained significant after Holm correction. The experimental group had worse baseline pain and mobility. No adverse events were observed. Conclusions: In this younger, higher-functioning, non-spastic subgroup, the complete experimental procedure produced greater short-term improvements than physiotherapy alone. Because it also included additional movement, treatment time, therapist interaction, and novelty, the specific effect of tissue flossing or band compression cannot be isolated. Larger matched-control trials are required.