No abstract

Chronic shoulder pain is a frequently reported phenomenon in individuals who use wheelchairs as their primary means of mobility. No indices are currently available which detect difficulties in performing daily activities due to shoulder discomfort in a largely independent population of wheelchair users. The Wheelchair User's Shoulder Pain Index (WUSPI) was designed to measure shoulder pain in individuals who use wheelchairs. A pilot index was created to measure shoulder pain and related difficulty during basic and instrumental activities of daily living. The instrument was administered to 64 wheelchair users at an athletic event. Analyses of internal consistency and interitem correlations were used to revise and refine the original instrument. Individual item analysis revealed that th.e subjects in this study experienced the most shoulder pain when wheeling up an inclir.c or on outdoor surfaces, when lifting an object from an overhead shelf, when trying to sleep, when transferring from tub to wheelchair and when washing their backs. The final 15-item index shows high internal consistency. This instrument is useful for both clinical and research purposes to detect and monitor shoulder pain and accompanying loss of function by wheelchair users.

Purpose: To analyze the eectiveness of a 6-month exercise protocol on shoulder pain experienced by wheelchair users during functional activities. Subjects: Forty-two wheelchair users, 35 males and seven females: average age of 35 years and an average duration of wheelchair use of 14 years. Methods: Subjects were randomly assigned to treatment (n=21) and control (n=21) groups.The treatment group received instruction in ®ve shoulder exercises which they performed daily for 6 months. The exercise protocol included two exercises for stretching anterior shoulder musculature and three exercises for strengthening posterior shoulder musculature. Outcome measures: All subjects completed a self-report questionnaire and the Wheelchair Users Shoulder Pain Index (WUSPI) initially and at bimonthly intervals during the 6-month intervention. Results: Seventy-®ve per cent of the subjects reported a history of shoulder pain since beginning wheelchair use. The average initial performance-corrected (PC-WUSPI) score of the 42 subjects was 17.7 (+21.3) with a range of 0 ± 103.2 points. Over 83% of the subjects (35 of 42) completed the 6-month study. Subjects in the treatment group decreased their PC-WUSPI score by an average of 39.9%, compared to decreases of only 2.5% in the control group. Conclusions: These ®ndings supported the eectiveness of this exercise protocol in decreasing the intensity of shoulder pain which interferes with functional activity in wheelchair users.

Many long term wheelchair users develop shoulder pain. The purpose of this study was to examine the reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI), an instrument which measures shoulder pain associated with the functional activities of wheelchair users. This 15-item functional index was developed to assess shoulder pain during transfers, self care, wheelchair mobility and general activities. To establish test-retest reliability, the index was administered twice in the same day to 16 long term wheelchair users and their scores for the two administrations were compared by intraclass correlation. To establish concurrent validity, the index was administered to 64 long term wheelchair users and index scores were compared to shoulder range of motion measurements. Results showed that intraclass correlation for test-retest reliability of the total index score was 0.99. There were statistically significant negative correlations of total index scores to range of motion measurements of shoulder abduction (r = -0.485), flexion (r = -0.479) and shoulder extension (r = -0.304), indicating that there is a significant relationship of total index score to loss of shoulder range of motion in this sample. The Wheelchair User's Shoulder Pain Index shows high levels of reliability and internal consistency, as well as concurrent validity with loss of shoulder range of motion. As a valid and reliable instrument, this tool may be useful to both clinicians and researchers in documenting baseline shoulder dysfunction and for periodic measurement in longitudinal studies of musculoskeletal complications in wheelchair users.

Study Design: Descriptive self-report survey. Objectives: 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. Background: 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.Methods and Measures: Forty-six female wheelchair basketball players completed an anonymous survey that included demographic data, medical history data, and the Wheelchair User' s Shoulder k i n Index (WUSPI). The WUSPl is a valid and reliable selfreport measure scored from 0 to 150, with higher scores indicating a greater intensity of shoulder pain during functional activities. Results: The average age of the respondents was 33.2 ( 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 5 SD performancecorrected total WUSPl 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, liking overhead, and while sleeping. Conclusions: 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. 1 Orthop Sports Phys Ther l999;29:225-23 1.