Association between shoulder problems in persons with spinal cord injury at discharge from inpatient rehabilitation with activities and participation at 5 years later

The objective of this study was to examine whether musculoskeletal shoulder pain and limitations in shoulder range of motion (ROM) at discharge from first rehabilitation are associated with activities and participation restrictions five years later in persons with spinal cord injury (SCI). This was achieved through a prospective cohort study across 8 specialist centres involving 138 patients. Outcome measures included were Peak exercise performance (POpeak), Wheelchair skills test (WST), Functional Independence Measure (FIM)-Motor Score, ability to transfer, Physical activity Scale for subjects with a Disability (PASIPD), Mobility Range and Social Behavior scales of the Sickness Impact Profile 68 (SIPSOC) and employment status. Overall the mean age of the subjects at discharge was 39 years, 72% were male, 32 % suffered a tetraplegia, and in 65% the SCI was motor complete. At discharge 39% reported shoulder pain and 32% had a limited shoulder ROM. In the analyses of variance shoulder ROM limitation, but not shoulder pain was associated with all but one outcome at 5 years. In the regression analyses ROM limitations of the shoulder were negatively associated with ability to transfer (p=0.004), FIM-Motor Scores (p<0.001), and return to work (p= 0.027) 5 years after discharge. No significant associations were found with POpeak, performance of time of WST, SIPSOC, and the PASIPD.

The presence of limitations in shoulder ROM, but not shoulder pain, at discharge is associated with limitations in activities and employment status 5 years later.