Caring Stroke Patients with Musculoskeletal Problem: A Narrative Review


  • Xue Yang Department of Basic Medical Sciences for Nursing, Kulliyyah of Nursing, International Islamic University Malaysia
  • Norlinda Abd Rashid Department of Basic Medical Sciences for Nursing, Kulliyyah of Nursing, International Islamic University Malaysia
  • Ma Ning Department of Rehabilitation, Hospital of Ning Xia Medical University
  • Siti Hazariah Abdul Hamid Department of Special Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia
  • Muhammad Kamil Che Hasan Department of Medical-Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia



Care, Musculoskeletal, Nursing, Rehabilitation, Review, Stroke


Background: The purpose of this paper is to narratively review the literature on caring for stroke patients with a musculoskeletal problem which involves rehabilitation of nursing and health care. Through the review, this paper addresses five questions: What are the typical difficulties of a stroke patient? What are the effects of a stroke on the musculoskeletal system? How to take care of musculoskeletal problem and pain? What is good musculoskeletal care for patients with stroke? How to take care of the musculoskeletal problem through active rehabilitation? Method: The relevant articles published between 2010-2020 were identified through searches in PubMed, Google Scholar, CINAHL, PsychInfo and by inspecting the reference list using keywords of ‘stroke’ and ‘musculoskeletal’.  Result: A total of 19 selected address this topic and consequently answer the questions posed. Findings flow with the typical difficulties of a stroke patient, the effects of a stroke on the musculoskeletal system, caring for musculoskeletal problem and pain, good musculoskeletal care for patients with stroke and caring for the musculoskeletal problem through active rehabilitation. Conclusion: This paper highlights that stroke patients with the musculoskeletal problem have restricted day-to-day movement functions and needed interdisciplinary care approaches from nursing, physical and occupational therapies, and other health care professionals. Stroke patients may need a structured programme to improve the outcome of stroke rehabilitation for the musculoskeletal problem.



Chandra A, Li W, Stone C, Geng X, Ding Y. The cerebral circulation and cerebrovascular disease I: Anatomy. Brain circulation, 3(2), 45. Brain Circ. 2017;(June):35–40.

Mohr JP, Albers GW, Amarenco P, Babikian VL, Biller J, Brey RL, et al. Etiology of stroke. In: Stroke [Internet]. Lippincott Williams and Wilkins; 1997 [cited 2020 Dec 6]. p. 1501–6. Available from:

Feigin VL, Krishnamurthi R V., Parmar P, Norrving B, Mensah GA. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: The GBD 2013 study. Neuroepidemiology. 2015;45(3):161–76.

Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults. Circulation [Internet]. 2017 Feb 21 [cited 2020 Dec 7];135(8):759–71. Available from:

Stroke guidelines | RCP London [Internet]. [cited 2020 Jan 16]. Available from: Hotter B, Padberg I, Liebenau A, Knispel P, Heel S, Steube D, et al. Identifying unmet needs in long-term stroke care using in-depth assessment and the Post-Stroke Checklist – The Managing Aftercare for Stroke (MAS-I) study. Eur Stroke J [Internet]. 2018 Sep 19 [cited 2020 Dec 6];3(3):237–45. Available from:

Obembe A, Mapayi B, Johnson O, Agunbiade T, Emechete A. Community reintegration in stroke survivors: Relationship with motor function and depression. Hong Kong Physiother J. 2013 Dec 1;31(2):69–74.

Veerbeek JM, Kwakkel G, Van Wegen EEH, Ket JCF, Heymans MW. Early prediction of outcome of activities of daily living after stroke: A systematic review [Internet]. Vol. 42, Stroke. Lippincott Williams & WilkinsHagerstown, MD; 2011 [cited 2020 Nov 16]. p. 1482–8. Available from:

Zhang Y, Jia H, Li A, Liu J, Li H. Study on Prediction of Activities of Daily Living of the Aged People Based on Longitudinal Data. In: Procedia Computer Science. Elsevier B.V.; 2016. p. 470–7.

Hunnicutt JL, Gregory CM. Skeletal muscle changes following stroke: A systematic review and comparison to healthy individuals [Internet]. Vol. 24, Topics in Stroke Rehabilitation. Taylor and Francis Ltd.; 2017 [cited 2020 Dec 6]. p. 463–71. Available from: /pmc/articles/PMC5801663/?report=abstract

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics-2016 update a report from the American Heart Association [Internet]. Vol. 133, Circulation. Lippincott Williams and Wilkins; 2016 [cited 2020 Dec 6]. p. e38–48. Available from:

Murphy AC, Muldoon SF, Baker D, Lastowka A, Bennett B, Yang M, et al. Structure, function, and control of the human musculoskeletal network. PLoS Biol [Internet]. 2018 Jan 1 [cited 2020 Dec 6];16(1). Available from: /pmc/articles/PMC5773011/?report=abstract

Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta - Mol Basis Dis [Internet]. 2016 May 1 [cited 2020 Dec 6];1862(5):915–25. Available from: /pmc/articles/PMC4827373/?report=abstract

Raghavan P. Upper Limb Motor Impairment After Stroke [Internet]. Vol. 26, Physical Medicine and Rehabilitation Clinics of North America. W.B. Saunders; 2015 [cited 2020 Dec 6]. p. 599–610. Available from: /pmc/articles/PMC4844548/?report=abstract

Coleman ER, Moudgal R, Lang K, Hyacinth HI, Awosika OO, Kissela BM, et al. Early Rehabilitation After Stroke: a Narrative Review [Internet]. Vol. 19, Current Atherosclerosis Reports. Current Medicine Group LLC 1; 2017 [cited 2020 Dec 6]. Available from:

Chindamo MC, Marques MA. Role of ambulation to prevent venous thromboembolism in medical patients: Where do we stand? [Internet]. Vol. 18, Jornal Vascular Brasileiro. Sociedade Brasileira de Angiologia e Cirurgia Vascular; 2019 [cited 2020 Dec 6]. Available from:

Prasad K, Kaul S, Padma M V., Gorthi SP, Khurana D, Bakshi A. Stroke management. Ann Indian Acad Neurol [Internet]. 2011 Jul [cited 2020 Dec 6];14(SUPPL. 1):S82. Available from:

Dworzynski K, Ritchie G, Playford D. Stroke rehabilitation: Long-term rehabilitation after stroke. Clin Med J R Coll Physicians London [Internet]. 2015 Oct 5 [cited 2020 Dec 6];15(5):461–4. Available from: /pmc/articles/PMC4953232/?report=abstract

Westerlind E, Singh R, Persson HC, Sunnerhagen KS. Experienced pain after stroke: A cross-sectional 5-year follow-up study. BMC Neurol [Internet]. 2020 Jan 7 [cited 2020 Nov 24];20(1):4. Available from:

Hamzat TK, Osundiya OC. Musculoskeletal pain and its impact on motor performance among stroke survivors. Hong Kong Physiother J. 2010 Jan 1;28(1):11–5.

Tse MMY, Tang SK, Wan VTC, Vong SKS. The effectiveness of physical exercise training in pain, mobility, and psychological well-being of older persons living in nursing homes. Pain Manag Nurs [Internet]. 2014 Dec 1 [cited 2020 Nov 24];15(4):778–88. Available from:

van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, et al. Decrease of Muscle Strength Is Associated With Increase of Activity Limitations in Early Knee Osteoarthritis: 3-Year Results From the Cohort Hip and Cohort Knee Study. Arch Phys Med Rehabil. 2014;95(10):1962–8.

Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke [Internet]. Vol. 2014, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2014 [cited 2020 Nov 24]. Available from:

Bouffioulx D, Arnould C, Thonnard JL. Satisfaction with activity and participation and its relationships with body functions, activities, or environmental factors in stroke patients. Arch Phys Med Rehabil. 2011 Sep 1;92(9):1404–10.

Taylor M, Stevens G, Agho K, Raphael B. The Impacts of Household Financial Stress, Resilience, Social Support, and Other Adversities on the Psychological Distress of Western Sydney Parents. Int J Popul Res [Internet]. 2017 [cited 2020 Dec 6];2017:1–12. Available from:

Langhammer B, Sunnerhagen KS, Lundgren-Nilsson Å, Sällström S, Becker F, Stanghelle JK. Factors enhancing activities of daily living after stroke in specialized rehabilitation: an observational multicenter study within the Sunnaas International Network. Eur J Phys Rehabil Med [Internet]. 2017 Oct 1 [cited 2020 Nov 16];53(5):725–34. Available from:

Wang TC, Tsai AC, Wang JY, Lin Y Te, Lin KL, Chen JJ, et al. Caregiver-mediated intervention can improve physical functional recovery of patients with chronic stroke: A randomized controlled trial. Neurorehabil Neural Repair. 2015 Jan 19;29(1):3–12.

Choi YH, Ku J, Lim H, Kim YH, Paik NJ. Mobile game-based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke. Restor Neurol Neurosci. 2016 Jun 14;34(3):455–63.

Peurala SH, Kantanen MP, Sjögren T, Paltamaa J, Karhula M, Heinonen A. Effectiveness of constraint-induced movement therapy on activity and participation after stroke: A systematic review and meta-analysis of randomized controlled trials [Internet]. Vol. 26, Clinical Rehabilitation. SAGE PublicationsSage UK: London, England; 2012 [cited 2020 Nov 21]. p. 209–23. Available from:

Nijland R, Kwakkel G, Bakers J, Van Wegen E. Constraint-induced movement therapy for the upper paretic limb in acute or sub-acute stroke: A systematic review [Internet]. Vol. 6, International Journal of Stroke. SAGE Publications Sage UK: London, England; 2011 [cited 2020 Nov 21]. p. 425–33. Available from:

Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, et al. Mirror therapy for improving motor function after stroke [Internet]. Vol. 2018, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2018 [cited 2020 Nov 21]. Available from: /pmc/articles/PMC6513639/?report=abstract

Fletcher-Smith JC, Walker DM, Sprigg N, James M, Walker MF, Allatt K, et al. ESCAPS study protocol: A feasibility randomised controlled trial of “Early electrical stimulation to the wrist extensors and wrist flexors to prevent the post-stroke complications of pain and contractures in the paretic arm.” BMJ Open. 2016;6(1).

McNulty PA, Thompson-Butel AG, Faux SG, Lin G, Katrak PH, Harris LR, et al. The efficacy of Wii-based Movement therapy for upper limb rehabilitation in the chronic poststroke period: A randomized controlled trial. Int J Stroke. 2015 Dec 1;10(8):1253–60.

Choi W, Han D, Kim J, Lee S. Whole-body vibration combined with treadmill training improves walking performance in post-stroke patients: A randomized controlled trial. Med Sci Monit. 2017 Oct 14;23:4918–25.

Bernhardt J, Indredavik B, Langhorne P. When Should Rehabilitation Begin after Stroke? Int J Stroke [Internet]. 2013 Jan 24 [cited 2020 Nov 24];8(1):5–7. Available from:

Che Hasan, M. K. (2019). Does the ESCAPE-Pain Programme for Patients with Knee Osteoarthritis Work in Malaysia? A Mixed-Methods Study Evaluating Feasibility in the Malaysian Healthcare Context (The University of Manchester (United Kingdom)). Retrieved from




How to Cite

Yang, X. ., Abd Rashid, N., Ma Ning, Abdul Hamid, S. H., & Che Hasan, M. K. (2020). Caring Stroke Patients with Musculoskeletal Problem: A Narrative Review. INTERNATIONAL JOURNAL OF CARE SCHOLARS, 3(2), 57–62.




Most read articles by the same author(s)

1 2 3 > >>