Manual Therapy for the Treatment of Shoulder Pain for Overuse Syndrome Wheelchair Dependent Persons
Condition: Spinal Cord Injuries; Pain; Musculoskeletal Manipulations
MeSH terms: Shoulder Pain; Spinal Cord Injuries; Cumulative Trauma Disorders
Study type: Interventional

Summary: 
      Shoulder pain is a common, debilitating problem for persons with Spinal cord injuries (SCI).
      Shoulder pain affects approximately 40-50% of the total population of persons with paraplegia
      (those with SCI with full use of their upper extremities and no or limited use of their lower
      extremities). Among the etiologies of shoulder pain in persons with paraplegia, overuse
      syndrome is the most common. Shoulder overuse syndrome in a person with paraplegia is the
      result of high activity demands and high mechanical load on the upper extremity during
      activities such as wheelchair propulsion, transferring with the arms, and performing
      activities of daily living from a wheelchair height, resulting in increased overhead
      activity. The pain as a result of overuse syndrome can limit the patient's participation in
      occupational and physical therapy as well as limit performance of activities of daily living
      and participation in usual life activities. An alternative treatment for shoulder pain with
      evidence to support efficacy in the able bodied population is Manual Therapy (MT).
      Unfortunately, there have been no prior research studies published examining the therapeutic
      efficacy of MT for overuse injuries of the shoulder in patients with paraplegia. This study
      will determine if MT, is efficacious to reduce pain in this population. A total of 20
      patients with paraplegia identified in the outpatient clinic at Craig Hospital with overuse
      syndrome of the shoulder will be enrolled in the study.
    

Detailed description: 
      Shoulder pain is a common, debilitating problem for persons with Spinal cord injuries (SCI).
      Shoulder pain affects approximately 40-50% of the total population of persons with paraplegia
      (those with SCI with full use of their upper extremities and no or limited use of their lower
      extremities). Among the etiologies of shoulder pain in persons with paraplegia, overuse
      syndrome is the most common. Shoulder overuse syndrome in a person with paraplegia is the
      result of high activity demands and high mechanical load on the upper extremity during
      activities such as wheelchair propulsion, transferring with the arms, and performing
      activities of daily living from a wheelchair height, resulting in increased overhead
      activity. The pain as a result of overuse syndrome can limit the patient's participation in
      occupational and physical therapy as well as limit performance of activities of daily living
      and participation in usual life activities.

      In the able bodied population, the most common recommendation for overuse syndrome is resting
      the affected joint. In persons with paraplegia and wheelchair dependence, this recommendation
      is unrealistic and would lead to non-use of the person's primary means of mobility (the
      wheelchair). Often, patients require pharmacologic intervention to help alleviate the pain in
      order to participate in therapy sessions and activities of daily living. Current treatment
      options for overuse syndrome include oral medication including narcotic pain medication and
      anti-inflammatory medication, modalities, injections, and surgery. Despite these treatment
      options, pain from overuse syndrome remains a prevalent problem with no treatment option
      proven superior and no gold standard of treatment identified. An alternative treatment for
      shoulder pain with evidence to support efficacy in the able bodied population is Manual
      Therapy (MT). Unfortunately, there have been no prior research studies published examining
      the therapeutic efficacy of MT for overuse injuries of the shoulder in patients with
      paraplegia. This study will determine if MT, is efficacious to reduce pain in this
      population. A total of 20 patients with paraplegia identified in the outpatient clinic at
      Craig Hospital with overuse syndrome of the shoulder will be enrolled in the study. Ten of
      the participants will be randomized to the control group and receive no MT and ten
      participants will be randomized to the treatment group and receive MT for three days per week
      x 2weeks. The treatment will be provided by a Doctor of Osteopathic Medicine (D.O.),
      physical, or occupational therapists trained to perform MT. During this study, the subject's
      pain and function will be measured by a 10 point questionnaire, the Numeric Pain Rating Scale
      (NPRS) and the Wheelchair Users Shoulder Pain Index (WUSPI). The NPRS and WUSPI are included
      in Appendix 1 and 2. The NPRS has been validated as a ratio scale for pain. The WUSPI has
      been validated as a scale for assessment of baseline shoulder dysfunction and for periodic
      measurement in longitudinal studies of musculoskeletal complications in wheelchair users.
      Data gathered from these outcome measures will be accumulated and statistically analyzed to
      examine the potential benefit of MT in the target population. This investigation will be one
      of the first to examine the relationship between MT and reduction in shoulder pain for
      treatment of overuse syndrome in persons with paraplegia. It will also examine if decreased
      pain secondary to MT will result in a decrease in pain during functional activity in these
      individuals. The results of this pilot study may result in publication in peer reviewed
      journals, presentations at national symposiums and application for funding for Complementary
      Medicine grant by the National Institute of Health or other available grant for larger study.
    

Intervention name(s): Manual Therapy
Intervention type(s): Other
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment