Wheelchair User's Shoulder Pain Index Research Articles

휠체어 사용자를 위한 한국어판 WUSPI의 신뢰도와 타당도

PURPOSE: The purpose of this study was to establish the reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI), which was translated into Korean for long-term wheelchair users. This index measured 15 functional activities, including transfer, self-care, wheelchair mobility and general activities. METHODS: To assess test-retest reliability, 23 long-term wheelchair users completed this self-administered index twice within the same day. Reliability was determined by the intraclass correlation coefficient (ICC), and Cronbach's alpha was used to measure internal consistency. To examine concurrent validity, 21 long-term wheelchair users completed the questionnaire, and we examined the correlation between the index score and the shoulder range of motion measurements. RESULT: The results showed that the intraclass correlation for test-retest reliability of the total index score ranging from .88 to .99 was good to excellent. Additionally, Cronbach's alpha was .96. The internal consistency indicated excellent. Concurrent validity showed negative correlations of total index score to range of motion measurements of shoulder flexion (rho=-.58), extension (rho=-.09), abduction (rho=-.59), external rotation (rho=-.07) and internal rotation (rho=-.3), suggesting a relationship of total index score to loss of shoulder range of motion. CONCLUSION: The Korean WUSPI shows not only high reliability and internal consistency, but also concurrent validity with loss of shoulder flexion and abduction.

Relationship Between Shoulder Pain and Kinetic and Temporal-Spatial Variability in Wheelchair Users

ObjectiveTo examine intra-individual variability of kinetic and temporal-spatial parameters of wheelchair propulsion as a function of shoulder pain in manual wheelchair users (MWUs). DesignCohort. SettingUniversity research laboratory. ParticipantsAdults with physical disabilities (N=26) who use a manual wheelchair for mobility full time (>80% ambulation). InterventionsParticipants propelled their own wheelchairs with force-sensing wheels at a steady-state pace on a dynamometer at 3 speeds (self-selected, 0.7m/s, 1.1m/s) for 3 minutes. Temporal-spatial and kinetic data were recorded unilaterally at the hand rim. Main Outcome MeasuresShoulder pain was quantified with the Wheelchair Users Shoulder Pain Index. Intra-individual mean, SD, and coefficient of variation (CV=mean/SD) with kinetic and temporal-spatial metrics were determined at the handrim. ResultsThere were no differences in mean kinetic and temporal-spatial metrics as a function of pain group (P values >.016). However, individuals with pain displayed less relative variability (CV) in peak resultant force and push time than pain-free individuals (P<.016). ConclusionsShoulder pain had no influence on mean kinetic and temporal-spatial propulsion variables at the handrim; however, group differences were found in relative variability. These results suggest that intra-individual variability analysis is sensitive to pain. We propose that variability analysis may offer an approach for earlier identification of MWUs at risk for developing shoulder pain.

EMG Biofeedback and Exercise for Treatment of Cervical and Shoulder Pain in Individuals with a Spinal Cord Injury: A Pilot Study

Chronic or recurrent musculoskeletal pain in the cervical and shoulder region is a common secondary problem after spinal cord injury (SCI), reported by 30% to 70% of individuals. The purpose of this study was to investigate the effect of electromyographic (EMG) biofeedback training, in addition to a standard exercise program, on reducing shoulder pain in manual wheelchair users with SCI. Fifteen individuals with SCI, C6 or lower, who were manual wheelchair users with shoulder pain were randomly assigned to 1 of 2 interventions. The Exercise group (n = 7) received instruction on a standard home-based exercise program. The EMG Biofeedback plus Exercise group (n = 8) received identical exercise instruction plus EMG biofeedback training to improve muscle balance and muscle relaxation during wheelchair propulsion. Shoulder pain was assessed by the Wheelchair Users Shoulder Pain Index (WUSPI) at baseline, at posttest 10 weeks after the start of intervention, and at follow-up 16 weeks after posttest. The number of participants per group allowed only within-group comparisons; however, the findings indicated a beneficial effect from EMG biofeedback training. Shoulder pain, as measured by WUSPI, decreased 64% from baseline to posttest for the EMG Biofeedback plus Exercise group (P = .02). Shoulder pain for the Exercise group decreased a nonsignificant 27%. At follow-up, both groups showed continued improvement, yet the benefit of EMG biofeedback training was still discernible. The EMG Biofeedback plus Exercise group had an 82% reduction in shoulder pain from baseline to follow-up (P = .004), while the Exercise group showed a 63% reduction (P = .03) over the same time period. This study provides preliminary evidence that EMG biofeedback has value when added to an exercise intervention to reduce shoulder pain in manual wheelchair users with SCI. These findings indicate that EMG biofeedback may be valuable in remediating musculoskeletal pain as a secondary condition in SCI. This preliminary conclusion will need to be studied and verified through future work.

Shoulder Pain among Rehabilitated Spinal Cord Injured Persons Using Manually Propelled Wheelchairs in the Gaza Strip: A Survey

Shoulder pain among paraplegic persons has negative effects on their lives. The prevalence of shoulder pain among persons with spinal cord injury (SCI) varies from 30% to 70% in different studies and may be related to repetitive use of the shoulder during self-care and wheelchair-related activities. Purpose : This study focused on the prevalence of shoulder pain and examined its effects on activities of daily living and social participation, and on functional, work and recreational or athletic activities. It also aimed to detect the degree of satisfaction with shoulder functioning wheelchair users who were paraplegic due to spinal cord injury, in the Gaza strip. Methods: Cross sectional study design was used to collect data from 80 persons with paraplegia, post rehabilitation, who were still using manual wheelchairs (MWC) for ambulation. After giving informed consent, the selected persons were interviewed directly in their homes, and filled questionnaires which included the demographic data, Wheelchair User?s Shoulder Pain Index (WUSPI) and Shoulder Rating Questionnaire (SRQ). Results: The prevalence rate of shoulder pain among paraplegics who use manual wheelchairs was 62%. Pushing a wheelchair for 10 minutes or more, and propulsion up ramps or inclines outdoors were the most common activities that caused and exacerbated shoulder pain. Sixty four percent from among the study sample mentioned that they had no limitation in shoulder-using ability during daily personal and household activities, while the rest experienced different degrees of limitation. Seventy-four percent reported no limitation during recreational or athletic activities, while the rest (26%) agreed that pain has variably limited their participation in these activities. Fourteen percent from the sample rated the overall degree of satisfaction with their shoulder functioning as fair, and the rest rated their satisfaction from good to excellent. Conclusion : Shoulder pain, ranging from mild to severe, was highly prevalent among SCI paraplegics who use MWCs during their usual activities, and other activities which involve wheelchair propulsion. About two- thirds of the subjects reported no limitation in shoulder use during daily personal and household activities and in recreational or athletic activities. doi 10.5463/DCID.v23i2.105

Shoulder pain in cases of spinal injury

The objective of this study was to determine the relationship between shoulder pain and the position of the seat of a wheelchair relative to the ground and to determine the relationship between shoulder pain and structural damage. A transversal study of a patient cohort of 140 patients with grade A and B spinal cord injuries below the T1 vertebra, who were full-time users of self-propelled wheelchairs, was made. The main variables are angle of the seat of the wheelchair, nuclear magnetic resonance measurements, shoulder joint range, Spinal Cord Index Measurement scale value, Wheelchair User Shoulder Pain Index and visual analogue scale value. Of the 140 patients, 99 were males (70.7%), and 41 were females (29.3%). Of these patients, 78 (55.7%) used a wheelchair seat at a straight angle, whereas 62 (44.3%) maintained an acute angle. A total of 57 (40.7%) patients presented shoulder pain within the last 6 months, and 83 (59.3%) did not. Sixty-nine (49.3%) did not present any type of shoulder injury as determined by nuclear magnetic resonance, whereas 71 (50.7%) had pathological signs. Patients with the seat at a straight angle developed 1.86 times (P<0.01) more shoulder pain and 1.73 times (P<0.001) more structural injuries than those with seats at an acute angle. Patients with structural abnormalities suffered 6.3-fold greater shoulder pain (P<0.001) than those without abnormalities. Wheelchair seats positioned parallel to the ground may be a risk factor for pain and shoulder injury. Patients with structural injuries in their shoulders have a greater risk of shoulder pain.

Effects of reduction in shoulder pain on quality of life and community activities among people living long-term with SCI paraplegia: a randomized control trial

Objective/backgroundPeople with spinal cord injury (SCI) paraplegia can develop shoulder problems over time, which may also cause pain. Shoulder pain may complicate or interfere with a person's daily activities, social events, and their overall quality of life (QOL). The purpose of this study was to examine changes in social interaction and QOL after an exercise treatment for shoulder pain in people with SCI paraplegia.DesignFifty-eight participants with SCI paraplegia who were also experiencing shoulder pain were selected and randomized to either an exercise treatment or a control group. Participants in the treatment group participated in a 12-week, at-home, exercise and movement optimization program designed to strengthen shoulder muscles and modify movements related to upper extremity weight bearing.MethodsParticipants filled out self-report measures at baseline, 12 weeks later at the end of treatment, and at a 4-week follow-up.Outcome measuresThe Wheelchair User's Shoulder Pain Index (WUSPI), the Social Interaction Inventory (SII), and the Subjective Quality of Life Scale.ResultsFrom the baseline to the end of treatment, repeated-measures analysis of variance revealed a significant interaction between WUSPI and SII scores, P < 0.001, and between WUSPI and QOL scores, P < 0.001.ConclusionReductions in shoulder pain were related to significant increases in social participation and improvements in QOL. However, increases in social participation did not significantly affect improvements in QOL.

Shoulder Ultrasound Abnormalities, Physical Examination Findings, and Pain in Manual Wheelchair Users With Spinal Cord Injury

Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, Dyson-Hudson TA. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury. Objectives To investigate the presence of ultrasound (US) abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight. Design Case series. Setting National Veterans' Wheelchair Games 2005 and 2006. Participants Volunteer sample of manual wheelchair users with SCI participating in the National Veterans' Wheelchair Games. Interventions Not applicable. Main Outcome Measures Presence of relationships between US findings, PE findings, pain, and subject characteristics. Results The USPRS correlated with age, duration of SCI, and weight (all P<.01), and showed a positive trend with the total Wheelchair User's Shoulder Pain Index (WUSPI) score ( r=.258, P=.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI ( r=.679, P<.001) and duration of SCI ( P<.05). The presence of untreated shoulder pain that curtailed activity was noted in 24.5% of subjects, and this was related to increased WUSPI scores ( P=.002). Conclusions PE and US abnormalities are common in manual wheelchair users with SCI. The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is indicated.

Shoulder pain in persons with thoracic spinal cord injury: Prevalence and characteristics

To document the prevalence of shoulder pain, associated patient characteristics, and intensity and interference with shoulder function in activities in wheelchair users. A cross-sectional survey. Individuals with a thoracic spinal cord injury. A 3-part questionnaire on patient characteristics, medical history, supplemental questions, and the Wheelchair Users Shoulder Pain Index was administered to 101 patients. Of the 88 subjects (87%) who completed the questionnaire, 40% reported experiencing current shoulder pain, often chronic in nature. The highest median intensity of shoulder pain was reported for pushing the wheelchair up ramps or inclines outdoors. Reports of limitations regarding the ability to use the shoulder in activities were common. Most subjects used no upper extremity assistive devices during transfer or wheelchair propulsion. Of those with current shoulder pain, 37% had not sought medical attention. Age was associated with ongoing shoulder pain. Shoulder pain is a common problem in wheelchair users with a thoracic spinal cord injury, it seems more likely to occur with increased age, and is a potential cause of activity limitations. The findings indicate a need to develop programmes of prevention, patient education, diagnosis and treatment, possibly including more frequent use of upper extremity assistive devices.

Arm Crank Ergometry and Shoulder Pain in Persons with Spinal Cord Injury

Dyson-Hudson TA, Sisto SA, Bond Q, Emmons R, Kirshblum SC. Arm crank ergometry and shoulder pain in persons with spinal cord injury. Objective To determine whether a primary fitness program utilizing arm crank ergometry would cause increased shoulder pain in persons with spinal cord injury (SCI). Design Cohort study. Setting Clinical research center. Participants People (N=23) with chronic SCI (>1y) who were participating in a weight loss study to compare the effectiveness of diet only (1000kcal/d for 12wk) versus diet with arm crank ergometry (1000kcal/d and arm crank ergometry 3 times a week for 12wk). Intervention Arm crank ergometry. Main Outcome Measure Changes in shoulder pain intensity using the Wheelchair User’s Shoulder Pain Index (WUSPI). Results After adjusting for baseline scores, there was no significant difference between the 2 groups on postintervention WUSPI scores (F 1,20=.85, P=.37, partial η 2=.04). The strength of the relationship between group assignment (diet only vs diet and arm crank ergometry) and final WUSPI score was weak, as assessed by a partial η 2, with group assignment accounting for 4% of the variance on the WUSPI. The adjusted means were lower in the diet and arm crank ergometry group (mean, 7.84) than in the diet only group (mean, 12.22); however, these differences did not appear to be clinically significant. Conclusions A primary fitness program using arm crank ergometry does not increase shoulder pain in people with SCI who use wheelchairs. Further investigation with a larger group and what constitutes clinically significant changes on the WUSPI is warranted to confirm our results.

Effect of 2-Speed Geared Manual Wheelchair Propulsion on Shoulder Pain and Function

Finley MA, Rodgers MM. Effect of 2-speed geared manual wheelchair propulsion on shoulder pain and function. Objective To investigate the impact of a manual 2-gear drive wheelchair wheel (MAGICWheels) on shoulder pain and function in manual wheelchair users. Design A single-group, repeated-measures pre- and postdesign with baseline and retention. Setting General community. Participants Full-time manual wheelchair users (N=17) currently experiencing shoulder pain (mean age, 46±14y; wheelchair use, 15±10y). Intervention Five-month trial using a 2-gear wheelchair wheel. Main Outcomes Measures The Wheelchair Users Shoulder Pain Index (WUSPI), Wheelchair Users Functional Assessment (WUFA), and timed hill climb test with rating of perceived exertion (RPE). Results There was significant reduction in shoulder pain after the intervention at week 2 ( P=.004) through week 16 ( P=.015). The difference was not found at week 20; however, 1 participant reported an increase in pain from unrelated factors during week 20. Change from baseline was calculated without this subject’s data; there was a significant reduction in shoulder pain ( P=.003). There was no difference in WUFA after using the 2-gear wheel ( P=.06). Hill climb time was longer when using the 2-gear wheel ( P=.01), but no difference in the RPE ( P=.13) resulted. Shoulder pain during the 4-week retention phase showed a trend toward increasing, as indicated by increased WUSPI scores. There was not a significant percentage increase, however, in comparison with the final week of using the MAGICWheels ( P<.05). Conclusions There were pain reductions 2 weeks after using the MAGICWheels, indicating a rapid response to the intervention. These findings indicate the potential for shoulder pain reduction with the use of a manual drive wheel during mobility, even in highly functional manual wheelchair users.

Effects of Circuit Resistance Training on Fitness Attributes and Upper-Extremity Pain in Middle-Aged Men With Paraplegia

Nash MS, van de Ven I, van Elk N, Johnson BM. Effects of circuit resistance training on fitness attributes and upper-extremity pain in middle-aged men with paraplegia. Objective To examine the effects of circuit resistance exercise (CRT) training on muscle strength, endurance, anaerobic power, and shoulder pain in middle-aged men with paraplegia. Design Repeated testing. Setting Academic medical center. Participants Seven men (age range, 39−58y) with motor-complete paraplegia from T5 to T12 and confirmed shoulder pain occurring during daily activities. Interventions Not applicable. Main Outcome Measures Subjects underwent a 4-month CRT program using alternating resistance maneuvers and high-speed, low-resistance arm exercise. One-repetition maximal force was measured before training and monthly thereafter. Pretraining and posttraining peak oxygen uptake (V o 2peak) was measured by graded arm testing. Anaerobic power was measured before and after training using a 30-second Wingate Anaerobic Test. Shoulder pain was self-evaluated by an index validated for people with spinal cord injury (Wheelchair Users Shoulder Pain Index [WUSPI]). Results Strength increases ranging from 38.6% to 59.7% were observed for all maneuvers ( P range, .005−.008). V o 2peak increased after training by 10.4% ( P=.01), and peak and average anaerobic power increased by 6% ( P=.001) and 8.6% ( P=.005), respectively. WUSPI scores ± standard deviation were lowered from 31.9±24.8 to 5.7±5.9 ( P=.008), with 3 of 7 subjects reporting complete resolution of shoulder pain. Conclusions CRT improves muscle strength, endurance, and anaerobic power of middle-aged men with paraplegia while significantly reducing their shoulder pain.

Clinical Trial of Exercise for Shoulder Pain in Chronic Spinal Injury

The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.

Shoulder pain following tetraplegia: a follow-up study 2–4 years after injury

To investigate (1) the characteristics of shoulder pain following discharge from rehabilitation for tetraplegia, (2) the relationship between pain and any associated risk factors and (3) the relationship between pain and functional activities, and pain and quality of life. Longitudinal study. Spinal Injuries Unit, Australia. Participants (n=27) were surveyed between 2 and 4 years postinjury. Prospective data on shoulder pain during rehabilitation had been collected previously and allowed comparison with the follow-up data. Data collected included pain intensity and quality, the Wheelchair User's Shoulder Pain Index (WUSPI) and perceived effect of pain on quality of life. Shoulder pain prevalence was 70%. Pain was associated with discharge motor level of C6-T1 (P=0.003). Pain was most commonly located in the shoulder joint. Pain was primarily aggravated by movement and cold weather and relieved by rest. The most painful activity was lifting an object from overhead. Quality of life was affected by pain in 68.4% of participants. Shoulder pain is common following rehabilitation for tetraplegia and is associated with injury level. Pain is reported during daily tasks and adversely affects quality of life. Areas for further research are identified.

Poster 232: Acupuncture in the Treatment of Shoulder Pain in Individuals With Spinal Cord Injury: A Placebo-Controlled Study

Objective: To determine the effectiveness of acupuncture in treating chronic shoulder pain in manual wheelchair using individuals with chronic spinal cord injury (SCI). Design: Randomized, single-blind (subject), placebo controlled clinical trial. Setting: Rehabilitation research department. Participants: Individuals with chronic SCI (>1y) and chronic shoulder pain (>3mo) who used manual wheelchairs as their primary means of mobility (>40h/wk). Intervention: Participants were randomly assigned to receive either traditional needle acupuncture or placebo acupuncture (ie, sham acupuncture; light needling of nonacupuncture points). All participants received a total of 10 treatments over a 5-week period. Main Outcome Measures: The Wheelchair User’s Shoulder Pain Index (WUSPI) was used to monitor changes in shoulder pain intensity during the treatment period in each group. A 1-way analysis of covariance was conducted. The independent variable, group assignment, included 2 levels: traditional acupuncture and placebo acupuncture. The dependent variable was the WUSPI score at the end of the treatment period and the covariate was the WUSPI score prior to the beginning of treatments. Results: In the total population analyzed (N=13), there was no significant difference between the traditional acupuncture and placebo acupuncture groups (F1,10=.212, P=.655). The strength of the relationship between the groups and final WUSPI score was low to medium, as assessed by a partial η2, with group assignment accounting for 3% of the variance on the WUSPI. The adjusted mean for the traditional acupuncture group (M=18.0) was smaller than the placebo acupuncture group (M=23.3). Conclusions: Although the difference between traditional needle acupuncture and placebo acupuncture in reducing shoulder pain was not significant, there was a small to medium effect size associated with the acupuncture treatments.

Prevalence of shoulder pain in adult- versus childhood-onset wheelchair users: A pilot study

Shoulder pain is a common overuse problem in long-term adult wheelchair users. The current study examined whether the prevalence of shoulder pain in adult wheelchair users who began using their wheelchairs during childhood (childhood-onset [CH-O] group) is similar to those who began using their wheelchairs as adults (adult-onset [AD-O] group). We compared 31 CH-O and 22 AD-O wheelchair users using the Wheelchair User's Shoulder Pain Index (WUSPI), an overall pain score (Brief Pain Inventory), and a lifestyle questionnaire to determine frequency and duration of physical activity. Shoulder pain (WUSPI) was greater in the AD-O wheelchair users compared with the CH-O group (p < 0.008), even though their general lifestyles were not different. The immature skeleton can possibly respond to the repetitive forces of wheeling better than that of those who begin using a wheelchair once their skeletal structure is completely developed.

Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders.

The study was concerned with the secondary functional compromise persons with long-term paraplegia contend with, that has been shown to be associated with wheelchair use. Of particular interest was the relationship between the level of thoracic spinal cord injury (SCI) and factors predisposing to rotator cuff disorders (RCD), one of the most common upper extremity musculoskeletal complications linked with long-term SCI. Disorders of these peri-articular structures have previously been associated with impaired trunk postural control and abnormal muscle strength ratios in both able-bodied groups and in paraplegic athletes. Despite their neurologically intact shoulder joint musculature, high-level and low-level paraplegics have different degrees of trunk and pelvic stability available to them during activities of daily living (ADL). This fundamental functional anatomical difference between high-level and low-level paraplegics had not previously been related to the diagnosis of RCD in a non-athletic long-term paraplegic population. A descriptive cross sectional study was undertaken to demonstrate the differences in the prevalence of clinically diagnosed RCD in a high-level (n=22) and a low-level (n=20) group of persons with long-term paraplegia. Any perceived differences were then related to the functional anatomical variations between the two groups. Inferences were made based on factors predisposing to RCD known to exist among both able-bodied and paraplegic athletes. The 42 subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) to establish the presence or absence of shoulder pain and the Musculoskeletal Function Assessment (MFA) instrument to determine differences in functional ability and perceived degree of difficulty within five categories of ADL. Each participant underwent a clinical examination using validated provocative clinical tests and isometric muscle strength ratio testing. There was a higher prevalence of RCD in the high-level group (P=0.009) which correlated with decreased trunk control (P=0.009). Differences in ability to perform functional tasks were not shown to be greater in the high-level group, although there was a higher degree of perceived difficulty in ADL. Muscle strength imbalances between the shoulder adductors and abductors were shown to be greater in the high-level group. The results of this study suggest that the functional anatomical differences that exist within paraplegia contribute to the propensity of high-level paraplegic persons to suffer from RCD. These findings send a clear message to service-providers that greater acknowledgement of the differences in trunk postural control specific to the level of thoracic SCI is required. This may have implications for the prescription of wheelchairs, assistive devices and instruction for alternative ADL techniques to this specific population.

Shoulder pain in female wheelchair basketball players.

Descriptive self-report survey. To assess activity level, medical history, and the prevalence and intensity of shoulder and upper extremity pain experienced during functional activities in female athletes who compete in wheelchairs. Previous studies have documented a high incidence of upper extremity soft tissue disorders in athletes who compete in wheelchairs. None of these studies have specifically focused on female athletes who use wheelchairs. Forty-six female wheelchair basketball players completed an anonymous survey that included demographic data, medical history data, and the Wheelchair User's Shoulder Pain Index (WUSPI). The WUSPI is a valid and reliable self-report measure scored from 0 to 150, with higher scores indicating a greater intensity of shoulder pain during functional activities. The average age of the respondents was 33.2 (+/- 9.1) years, with an average of 12.5 (+/- 10.2) years of wheelchair use. Their disabilities included 39% spinal cord injury, 28% various lower extremity musculoskeletal and neuromuscular disabilities, 13% postpolio paralysis, 11% spina bifida, and 9% amputations. Only 14% of the subjects reported shoulder pain prior to wheelchair use. In contrast, 72% of the subjects reported shoulder pain since wheelchair use, with 52% reporting current shoulder pain. Overall, the subjects scored an average +/- SD performance-corrected total WUSPI score of 15.6 +/- 20.5 on a scale of 0 to 150 points, with 0 representing no pain. The highest intensity of shoulder pain was reported during household chores, propulsion on ramps or inclines, lifting overhead, and while sleeping. Shoulder and upper extremity pain was a very common problem reported by over 90% of the subjects in this study. Prevention of pain and chronic disability in athletes who use wheelchairs should be addressed by coaches, players, and health care professionals.

Shoulder pain in wheelchair users with tetraplegia and paraplegia

Objective: To compare the prevalence and intensity of shoulder pain experienced during daily functional activities in individuals with tetraplegia and individuals with paraplegia who use manual wheelchairs. Design: Self-report survey. Setting: General community. Participants: Fifty-five women and 140 men, 92 subjects with tetraplegia and 103 subjects with paraplegia who met inclusion criteria of 3 hours per week of manual wheelchair use and at least 1 year since onset of spinal cord injury. Main Outcome Measures: Respondents completed a demographic and medical history questionnaire and the Wheelchair User's Shoulder Pain Index (WUSPI), a measure of pain during typical daily activities. Results: More than two thirds of the sample reported shoulder pain since beginning wheelchair use, with 59% of the subjects with tetraplegia and 42% of the subjects with paraplegia reporting current pain. Performance-corrected WUSPI scores were significantly higher in subjects with tetraplegia than in subjects with paraplegia. Conclusions: Both the prevalence and intensity of shoulder pain was significantly higher in subjects with tetraplegia than in subjects with paraplegia. Efforts to monitor and prevent shoulder pain should continue after rehabilitation.