Effectiveness of Exercise Programs for Alleviation of Upper Body Pain in Patients with Spinal Cord Injury: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Planning
2.2. Literature Search
2.3. Literature Selection and Categorization
2.4. Data Extraction
- -
- Wheelchair User Shoulder Pain Index (WUSPI): Used in seven studies, the WUSPI is a self-reported measure designed to assess shoulder pain severity and its impact on the daily activities of wheelchair users. This tool includes questions on pain intensity during various movements and is highly relevant for tracking the pain dynamics in individuals with SCI.
- -
- Performance-corrected WUSPI (PC-WUSPI): A variation of the original WUSPI, the PC-WUSPI adjusts for participants’ performance capability, providing a more tailored assessment of pain related to shoulder use. Four studies utilized it.
- -
- 36-Item Short Form Survey (SF-36): This broad health survey was used in three studies to measure aspects of quality of life related to physical and mental health. In the context of SCI, the SF-36 helps delineate how pain affects general well-being.
- -
- Visual Analog Scale (VAS): Used alongside WUSPI in two studies, the VAS is a straightforward measure in which participants rate their pain intensity on a scale, typically from ‘no pain’ to ‘worst imaginable pain.’ It is a widely accepted instrument for its simplicity and effectiveness in pain assessment.
3. Results
- Positive results on shoulder impingement tests such as Neer’s impingement test, Hawkins–Kennedy test, and empty can test;
- Impact on one or more functional tasks due to unilateral or bilateral shoulder pain;
- Moderate shoulder or upper limb pain for a specified period.
4. Discussion
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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P | Participants | Patients with SCI with Upper Body Pain |
I | Intervention | Exercise |
C | Comparison | Control group |
O | Outcome | Changes in pain |
S | Study design | Experimental study |
First Author (Year) | Study Design | Study Population | N | Intervention Details | Duration of Intervention | Study Parameters (Instruments) | Outcomes |
---|---|---|---|---|---|---|---|
Kim, S.C. et al. (2018) [18] | Pre–post comparative experiment |
| 10 |
| 10 weeks, 3 times a week | (1) Shoulder pain (WUSPI) (2) Trapezius and serratus anterior activities (wireless surface ECG) | (1) Significant reduction in shoulder pain (WUSPI) p = 0.02 (<0.05) 20.9 ± 10.9 → 15.4 ± 10.46 |
Nightingale, T.E. et al. (2018) [19] | RCT |
| 21 | Experimental (n = 13):
| 6 weeks, 4 times a week | (1) HRQOL (SF-36)
(3) Fatigue (FSS) (4) Exercise Self-efficacy (ESES) | (2) Greater change in shoulder pain (PC-WUSPI) score in the experimental group
△ (90%CI) = −5 (−16.6)
△ (90%CI) = 0 (−4.4) (△: change scores) |
Gee, C.M. et al. (2022) [20] | Multi-center RCT |
| 28 | Active upper limb exercise (n = 14):
| 72 sessions, 3–5 weeks | (1) QoL (LiSAT-9, SWLS) (2) LTPA (MVPA of LTPAQ-SCI) (3) Pain (SF-36) (4) Affect (PANAS-positive/negative) (5) Self-efficacy (questionnaire) (6) Independence (SCIM-III) (7) Participation and Autonomy (IPAQ) | (3) Pain (SF-36)
|
Van Straaten, M.G. et al. (2014) [21] | Pre–post comparative clinical trial |
| 16 |
| 12 weeks, 3 times a week | (1) Shoulder pain (WUSPI) (2) Upper extremity function (DASH, SRQ) | (1) Shoulder pain (WUSPI)
|
Mulroy, S.J. et al. (2011) [22] | RCT |
| 58 | Experimental (n = 26):
| 12 weeks, 3 times a week | (1) Shoulder pain (WUSPI, VAS) (2) Muscle strength (shoulder torque) (3) Activity (PASIPD, wheelchair propulsion speed) (4) QoL (SII, SQOL, SF-36) | (1-1) Shoulder pain (WUSPI)
|
Vestergaard, M. et al. (2022) [23] | One-group pre–post comparative trial (Validation) |
| 7 |
(2) arm exercise (3) Leg + arm exercise (hybrid) | 8 weeks, 3 times a week | (1) AE (2) Participant acceptability (PACES) (3) Shoulder pain (PC-WUSPI) (4) Shoulder/arm/hand pain (NRS) (5) Training intensity (% peak watts) (6) Attendance (7) Vo2peak (8) Physical activity (SCI-LTPAQ) (9) HRQOL (SF-36) (10) Fatigue (MFI-20) | (3) Shoulder pain (PC-WUSPI)
|
Hicks, A.L. et al. (2003) [12] | RCT |
| 23 | Experimental (n = 11): (1) arm ergometer exercise
| 9 months, 2 times a week | (1) Arm ergometry performance (2) Muscle strength (max load could be lifted) (3) Stress (PSS) (4) Depression (CES-D) (5) Physical self-concept (questionnaire) (6) Pain (SF-36) (7) Perceived health (SF-36) (8) QoL (PQOL) | (6) Pain (SF-36)
|
Ditor, D. S. et al. (2003) [24] | RCT Follow-up |
| 7 | Same intervention used in a previous study (AL Hicks, 2003) [12] | 3 months, 2 times a week | (1) Exercise adherence (sessions attended) (2) QoL (PQOL) (3) Pain (SF-36) (4) Stress (PSS) | (3) Pain (SF-36)
|
Cardenas, D.D. et al. (2020) [25] | Single-blinded RCT |
| 25 | Experimental (n = 13):
| 12 weeks, 3 times a week | (1) Interview about shoulder pain (NRS) (2) Shoulder pathology (PESS-dominant/non-dominant) (3) Functional limitations of upper limbs (DASH) (4) The effect of pain on ADLs (MPI-Interference) (5) Shoulder pain (WUSPI) (6) Well-being (PHQ-9) (7) Depressive symptoms (BDI) (8) Patient Global Impression of Change Scale | (5) Shoulder pain (WUSPI)
|
Kemp, B.J. et al. (2011) [3] | RCT |
| 58 | Experimental (n = 26):
| 12 weeks, 3 times a week | (1) Shoulder pain (WUSPI) (2) Activities (SII) (3) QoL (Likert-type scale) | (1) Shoulder pain (WUSPI)
|
Nash, M.S. et al. (2007) [26] | Pre–post comparative time-series |
| 7 | Circuit resistance training | 16 weeks, 3 times a week | (1) Upper limb endurance (Vo2peak by ergometer) (2) Anaerobic power (peak/mean power by ergometer) (3) Upper-extremity dynamic strength (1-RM) (4) pain (WUSPI) | (4) Shoulder pain (WUSPI)
|
Norrbrink, C. et al. (2012) [27] | Pre–post comparative experiment |
| 13 (8) |
| 10 weeks, 3 times a week | (1)
(4) Global pain-relieving effect (PGIC) (5) Pain interference (ISCOS Basic pain data set) (6) QoL (ISCOS quality of life basic data set ver1.0) | (2-1) Neuropathic pain
|
Serra-Añó, P. et al. (2012) [28] | Time series design |
| 15 (8) | Time series design: Measurement 1 → Control (8 weeks) → Measurement 2 → Experiment (8 weeks) → Measurement 3 Experimental:
| 8 weeks each, 3 times a week | (1) Isometric and isokinetic shoulder muscle strength (2) Body composition
(4) Upper-limb functionality (DASH) | (3) Shoulder pain (PC-WUSPI)
|
First Author (Year) | Type of Exercise | Targeted Area | Exercise Motions |
---|---|---|---|
Kim, S.C. et al. (2018) [18] | Bodyweight exercise |
|
|
Van Straaten, M.G. et al. (2014) [21] | Resistance exercise |
| |
Mulroy, S. J. et al. (2011) [22] | Resistance exercise | Hypertrophy exercises
| |
Hicks, A.L. et al. (2003) [12] Ditor, D.S. et al. (2003) [24] | Resistance exercise | Forearm/wrist, biceps, back, chest, abdominal, shoulder, triceps, and leg (only when suitable) |
|
Nash, M.S. et al. (2007) [26] | Resistance exercise |
| |
Serra-Añó, P. et al. (2012) [28] | Resistance exercise | Rotator cuff |
|
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Park, J.; Kim, J.; Eun, S.-D.; Kang, D. Effectiveness of Exercise Programs for Alleviation of Upper Body Pain in Patients with Spinal Cord Injury: A Systematic Review. J. Clin. Med. 2024, 13, 3066. https://doi.org/10.3390/jcm13113066
Park J, Kim J, Eun S-D, Kang D. Effectiveness of Exercise Programs for Alleviation of Upper Body Pain in Patients with Spinal Cord Injury: A Systematic Review. Journal of Clinical Medicine. 2024; 13(11):3066. https://doi.org/10.3390/jcm13113066
Chicago/Turabian StylePark, Jiyoung, Jihyun Kim, Seon-Deok Eun, and Dongheon Kang. 2024. "Effectiveness of Exercise Programs for Alleviation of Upper Body Pain in Patients with Spinal Cord Injury: A Systematic Review" Journal of Clinical Medicine 13, no. 11: 3066. https://doi.org/10.3390/jcm13113066