Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury

This study was conducted to test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users with a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized. A 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing. Primary outcomes of pain and function were measured with the Wheelchair User’s Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius. Pain was decreased and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ(2)2=5.10, P=.014), DASH Index (χ(2)2=5.41, P=.012), and SRQ (χ(2)2=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were observed in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points.

The study found a high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision to have potential for shoulder pain treatment in manual wheelchair users with SCI. Additional work is necessary to determine the effectiveness in comparison to other interventions, in addition to the possiblity for earlier intervention to prevent development of shoulder pain.