Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI)

Abstract

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.

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

“…Prior to analysis the intra-rater, interrater reliability, speci®city and face validity of the measures were tested in a Pilot Study undertaken with a sample of 10 persons with paraplegia in the inpatient facility at the Burwood SIU. The results were analyzed in view of the extensive analysis of the psychometric properties undertaken on the WUSPI 23 and MFA. 24 This pre-testing of the instruments also assisted with determining the functional relevance, language difficulties and completion time.…”

Preserving transfer independence among individuals with spinal cord injury

“…12, 13 Subbarao et al 14 in comparing individuals with SCI who were either with or without shoulder pain, reported that time from SCI onset was the only variable that di erentiated the two groups. Curtis et al 15,16 reported a strong relationship between age and the Wheelchair User's Shoulder Pain Index (WUSPI) score and a somewhat weaker relationship between years of wheelchair use and the WUSPI score. Although shoulder pain prevalence increases with age and years of wheelchair use, the age of the individual with SCI had the greater in¯uence, particularly among extremely young or older subjects.…”

“…Although shoulder pain prevalence increases with age and years of wheelchair use, the age of the individual with SCI had the greater in¯uence, particularly among extremely young or older subjects. 16 Gellman et al 6 in an UE evaluation of 84 individuals with paraplegia reported that shoulder pain frequency during transfers increased with the length of time from SCI onset with Interface between subject-wheelchair Seelen and Vuurman 17 reported that the complex sensorimotor impairments associated with SCI limit the dynamic control of sitting posture and task performance while sitting, likely serving as the precursor to the development of compensatory UE and trunk motor control mechanisms. Hobson et al 18 reported that decreased trunk stability necessitated individuals with paraplegia to assume a biomechanically abnormal sitting posture characterized by a`C' shaped thoracic spine kyphosis, an extended cervical spine, a¯attened lumbar spine, and a posteriorly tilted pelvis (approximately 158 more tilt than non-impaired subjects).…”

“…They reported that 32% of subjects with paraplegia had UE pain at 1-year following SCI and 66% had symptoms of CTS. 7 Curtis et al 15,16 designed a 15-item Wheelchair User's Shoulder Pain Index (WUSPI) to assess shoulder pain associated with the functional activities common to wheelchair users including transfers, postural stability, self-care, and wheelchair propulsion, reporting excellent measurement reliability. They advised that multiple factors including shoulder ROM and muscle strength de®ciencies or imbalances, subacromial impingement positioning during ADL, overuse, and de-conditioning may also in¯uence WUSPI scores.…”

“…They advised that multiple factors including shoulder ROM and muscle strength de®ciencies or imbalances, subacromial impingement positioning during ADL, overuse, and de-conditioning may also in¯uence WUSPI scores. 16 The WUSPI was considered better able to quantify the in¯uence of shoulder pain on the daily function of wheelchair users than conventional clinical shoulder dysfunction measurement methods. 16 In studying 64 long-term wheelchair users with SCI, Curtis et al 15 reported that shoulder pain was most intense during activities requiring high levels of UE strength such as transfers to non-level surfaces, ascending a ramp in a wheelchair, overhead reaching, and washing their backs.…”