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Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users
Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
Department of Orthopedic Surgery, Vrinnevi Hospital, Norrköping, Sweden.
Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
2004 (English)In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 42, no 1, 41-46 p.Article in journal (Refereed) Published
Abstract [en]

Study design: Cross-sectional.

Objectives: To describe the consequences of shoulder pain on activity and participation in spinal cord-injured paraplegic wheelchair users. To describe the prevalence and type of shoulder pain.

Setting: Two spinal cord injury (SCI) centres in Sweden.

Methods: All subjects with paraplegia due to an SCI of more than 1 year living in the counties of Uppsala and Linköping, Sweden were contacted by mail and asked to fill in a questionnaire (89 subjects). Those of the responding 56 subjects with current shoulder pain were asked to participate in further examination and interviews. A physiotherapist examined 13 subjects with shoulder pain in order to describe type and site of impairment. To describe consequences of shoulder pain on activity and participation, the Constant Murley Scale (CMS), the Wheelchair Users Shoulder Pain Index (WUSPI) the Klein & Bell adl-index and the Canadian Occupational Performance Measure (COPM) were used.

Results: Out of all respondents, 21 had shoulder pain (37.5%). Data from 13 of those subjects were used in the description of type and consequences of shoulder pain. Findings of muscular atrophy, pain, impingement and tendinits were described. We found no difference in ADL-performance with, respectively without, shoulder pain (P=0.08) using the Klein & Bell adl-index. No correlation was found between the various descriptions of impairment, activity limitations and participation restriction (P>0.08). All together 52 problems with occupational performance due to shoulder pain were identified using the COPM. Of these, 54% were related to self-care activities.

Conclusion: The consequences of shoulder pain in paraplegic wheelchair users are mostly related to wheelchair activities. Since the wheelchair use itself presumably cause shoulder problems, this will become a vicious circle. More research is needed in order to reduce shoulder problems in wheelchair users.

Place, publisher, year, edition, pages
2004. Vol. 42, no 1, 41-46 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-23464DOI: 10.1038/ ID: 2919OAI: diva2:243778
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-09-18Bibliographically approved
In thesis
1. Active wheelchair use in daily life: considerations for mobility and seating
Open this publication in new window or tab >>Active wheelchair use in daily life: considerations for mobility and seating
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Wheelchair fit and prescription are central in the rehabilitation process of a spinal cord injured client with an impaired walking ability. The knowledge and consequences of wheelchair use in active wheelchair users is deficient, which might lead to unnecessary problems and disabilities.

Objective: The general aim of the research underlying this thesis was to increase and deepen the knowledge of wheelchair use, considering both mobility and seating aspects.

Methods: The thesis includes five different studies, two of them with a focus on wheelchair mobility, two with a focus on secondary complications common in wheelchair users and one intervention study with a focus on wheelchair seating. Methods used to measure and describe wheelchair use from mobility and seating aspects are well-standardized, valid and reliable methods, custom-made newly developed forms and client estimations.

Results: The power output and mechanical efficiency of wheelchair propulsion was found to be low compared to arm-crank ergometry in a group of experienced wheelchair users. Another study found that it was not possible to affect this mechanical efficiency in a uniform positive way, by a change in rear-wheel position. A significant change in propulsion technique was found which, however, did not correlate to physical effort. Secondary complications such as back pain, spinal defonnities and shoulder pain were common in clients with a spinal cord injury. In the intervention study a change in seating prerequisites had a positive effect on estimated seating comfort, posture and activity.

Conclusion: Wheelchair propulsion and seating mean high physical and musculoskeletal load on the individual with a risk for secondary complications. A prescriber of hand-rim wheelchairs to clients who will spend many years in their wheelchairs has a major responsibility to understand and use available knowledge, to carefully examine the physical prerequisites of each client, and to interrelate these findings to individual needs and wishes. There is a great need for continuous development of new methods and knowledge in this area in order to avoid unnecessary complications due to wheelchair use. There is also a need for new thinking in the construction and design of new wheelchairs.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 70 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 753
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-28075 (URN)12839 (Local ID)91-7373-196-X (ISBN)12839 (Archive number)12839 (OAI)
Public defence
2002-11-15, Berzeliussalen, Hälsouniversitet, Linköping, 13:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-18Bibliographically approved

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