Physical disability – the impact on the shoulder and possibilities for adapted training

Forfattere

Camilla M. Larsen ^1-3,5, Helene Nikolajsen ^1,4,5, Birgit Juul-Kristensen ^1,5

¹Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, DK

² Health Sciences Research Centre, UCL University College, Odense, DK

³ Department of Physiotherapy, UCL University College, Odense, DK

⁴ Department of Physiotherapy, Institute of Health Studies, University College South Denmark, Esbjerg-Haderslev, DK

⁵ Center for Research in Adapted Physical Activity, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, DK

Wheelchair use and shoulder pain

The shoulder is one of the most common sites of chronic musculoskeletal pain in people with spinal cord injury (SCI) (1, 2), and shoulder pain can reduce independent function and quality of life (3, 4). Individuals using a manual wheelchair as their primary form of mobility rely heavily on their upper limbs to maintain independence. Although shoulder pain has a multifactorial aetiology in people with SCI, increased biomechanical load imposed on their upper limbs may be an important factor (5). At the Center for Research in Adapted Physical Activity, University of Southern Denmark, Odense, two reviews, a systematic review and a scoping review are currently being conducted with specific foci on; Which exercises should wheelchair users with SCI perform to treat and/or prevent shoulder pain, and how does the context influence when individuals dependent on a wheelchair or another assistive device train.

 How to treat and/or prevent shoulder pain?

Physiotherapy interventions are recommended as preferable to medical interventions when treating shoulder pain in people with SCI (6). Therapeutically administered exercise has shown to decrease shoulder pain, improve function and improve quality of life in manual wheelchair users (7, 8). However, to date, the effectiveness of physiotherapy interventions in treatment of shoulder pain in manual wheelchair users have been insufficiently explored. Knowlegde about prevention strategies for shoulder pain in people with SCI is also limited.

This systematic review with meta-analysis on active exercises and prevention strategies of shoulder pain in people with SCI is being performed in an international collaboration with researchers from Curtin University in Perth, Western Australia, and will address the specific questions “What is the efficacy of active physiotherapy interventions in comparison with no or passive interventions in treating shoulder pain, decreased  function and quality of life in manual wheelchair users with spinal cord injury?, and “ What is the efficacy of active physiotherapy interventions in comparison with no or passive interventions in preventing shoulder pain and decreased function in manual wheelchair users with spinal cord injury?” Informed clinicians will be able to more effectively assist people in reducing and preventing shoulder pain, in addition to improving function and quality of life (PROSPERO 2019 CRD42019136693 Available from: (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019136693)

Where to train with a physical disability?

Individuals with a physical disability are in risk of dying earlier than the normal population (9), with the primary cause being cardiovascular disease (10). Also a higher risk of common lifestyle diseases, such as myocardial infarct, overweight, hypertension, diabetes are reported for people especially with SCI and being wheelchair bound. At the same time this group has the lowest level of physical activity (11). With the knowledge that physical training may reduce the risk of several lifestyle diseases (12), and even improve shoulder function and quality of life and prevent shoulder pain (13), fitness centres have been suggested to be the place for this training. However, currently people with physical disabilities are often excluded from fitness centres due to inaccessible buildings, unsuitable fitness environments, lack of knowledge about exercising or stigmatising.

The Danish PhD project “Fitness for all – fitness for people with physical disabilities” is a project of how to build or rebuild fitness centres to make them more accessible and usable for people with physical disabilities and is scheduled to deliver a thesis in 2020. One project objective is to identify and summarize the evidence on barriers and facilitators for fitness centre participation among adult people with or without physical disabilities. The research question addressed in the scoping review is; “Which factors influence fitness centre participation for adult people with or without physical disabilities?” (ZENDO 10.5281/zenodo.1409586. Available from: (https://doi.org/10.5281/zenodo.1409587).

Knowledge about the possibilities or lack of possibilities for training in fitness centres, may be a key factor for increasing physical activity in people with and without physical disability, as a means of maintaining highest possible level of physical capacity, and hopefully reducing lifestyle diseases.

References

1. Patel RM, Gelber JD, Schickendantz MS. The weight-bearing shoulder. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2018;26(1):3-13.
2. Dyson-Hudson TA, Kirshblum SC. Shoulder pain in chronic spinal cord injury, Part I: Epidemiology, etiology, and pathomechanics. The journal of spinal cord medicine. 2003;27(1):4-17.
3. Gutierrez DD, Thompson L, Kemp B, Mulroy SJ. The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia. The journal of spinal cord medicine. 2007;30(3):251-5.
4. Silvestri J. Effects of chronic shoulder pain on quality of life and occupational engagement in the population with chronic spinal cord injury: preparing for the best outcomes with occupational therapy. Disabil Rehabil. 2017;39(1):82-90.
5. Figoni SF. Overuse shoulder problems after spinal cord injury: a conceptual model of risk and protective factors. Clinical Kinesiology (Online). 2009;63(2):12.
6. Van Straaten MG, Cloud BA, Zhao KD, Fortune E, Morrow MM. Maintaining shoulder health after spinal cord injury: a guide to understanding treatments for shoulder pain. Arch Phys Med Rehabil. 2017;98(5):1061-3.
7. Kemp BJ, Bateham AL, Mulroy SJ, Thompson L, Augmentin Adkins RH, Kahan JS. Effects of reduction in shoulder pain on quality of life and community activities among people living long-term with SCI paraplegia: a randomized control trial. J Spinal Cord Med. 2011;34(3):278-84.
8. Lins C, Castro A, Medina GI, Azevedo ER, Donato BS, Chagas MS, et al. Alternative scapular stabilization exercises to target strength, endurance and function of shoulders in tetraplegia: A prospective non-controlled intervention study. The journal of spinal cord medicine. 2019;42(1):65-76.
9. Organization WH, Society ISC. International perspectives on spinal cord injury: World Health Organization; 2013.
10. Chamberlain JD, Meier S, Mader L, Von Groote PM, Brinkhof MW. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology. 2015;44(3):182-98.
11. Dearwater SR, LaPorte RE, Cauley JA, Brenes G. Assessment of physical activity in inactive populations. Med Sci Sports Exerc. 1985;17(6):651-5.
12. Liou K, Ho S, Fildes J, Ooi S-Y. High intensity interval versus moderate intensity continuous training in patients with coronary artery disease: a meta-analysis of physiological and clinical parameters. Heart, Lung and Circulation. 2016;25(2):166-74.
13. Aravind N, Harvey LA, Glinsky JV. Physiotherapy interventions for increasing muscle strength in people with spinal cord injuries: a systematic review. Spinal Cord. 2019.