title: Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial.
abstract: BACKGROUND
  Shoulder pain is a common problem after spinal cord injury (SCI), with negative effects on daily activities and quality of life (QOL).
  
  
  OBJECTIVE
  The purpose of this study was to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from SCI.
  
  
  METHODS
  Design Eighty individuals with paraplegia from SCI and shoulder pain were randomly assigned to receive either an exercise/movement optimization intervention or an attention control intervention. The exercise/movement optimization intervention consisted of a 12-week home-based program of shoulder strengthening and stretching exercises, along with recommendations on how to optimize the movement technique of transfers, raises, and wheelchair propulsion. The attention control group viewed a 1-hour educational video. Outcome measures of shoulder pain, muscle strength (force-generating capacity), activity, and QOL were assessed at baseline, immediately after intervention, and 4 weeks later.
  
  
  RESULTS
  Shoulder pain, as measured with the Wheelchair User's Shoulder Pain Index, decreased to one third of baseline levels after the intervention in the exercise/movement optimization group, but remained unchanged in the attention control group. Shoulder torques, most 36-Item Short-Form Health Survey questionnaire (SF-36) subscale scores, and QOL scores also were improved in the exercise/movement optimization group, but not in the attention control group. Improvements were maintained at the 4-week follow-up assessment. Limitations Many of the outcome measures were self-reported, and the participant dropout rate was high in both groups. Additional studies are needed to determine whether the results of this study can be generalized to individuals with tetraplegia.
  
  
  CONCLUSIONS
  This home-based intervention was effective in reducing long-standing shoulder pain in people with SCI. The reduction in pain was associated with improvements in muscle strength and health-related and overall QOL.
authors.affiliation: Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E Imperial Hwy, Bldg 800, Room 33, Downey, CA 90242, USA. smulroy@dhs.lacounty.gov
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Mulroy
authors.forename: Lilli
authors.initials: L
authors.lastname: Thompson
authors.forename: Bryan
authors.initials: B
authors.lastname: Kemp
authors.forename: Patricia Pate
authors.initials: PP
authors.lastname: Hatchett
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Newsam
authors.forename: Dee Gutierrez
authors.initials: DG
authors.lastname: Lupold
authors.forename: Lisa Lighthall
authors.initials: LL
authors.lastname: Haubert
authors.forename: Valerie
authors.initials: V
authors.lastname: Eberly
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Ge
authors.forename: Stanley P
authors.initials: SP
authors.lastname: Azen
authors.forename: Carolee J
authors.initials: CJ
authors.lastname: Winstein
authors.forename: James
authors.initials: J
authors.lastname: Gordon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D020069:Shoulder Pain / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014910:Wheelchairs