title: Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation.
abstract: OBJECTIVE
  To test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized.
  
  
  METHODS
  A pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk).
  
  
  METHODS
  Subjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center.
  
  
  METHODS
  A convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination.
  
  
  METHODS
  A 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing.
  
  
  METHODS
  Primary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius.
  
  
  RESULTS
  Pain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ(2)2=5.10, P=.014), DASH Index (χ(2)2=5.41, P=.012), and SRQ (χ(2)2=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points.
  
  
  CONCLUSIONS
  A high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain.
authors.affiliation: Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN.
authors.forename: Meegan G
authors.initials: MG
authors.lastname: Van Straaten
authors.affiliation: Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN; Mayo Graduate School, Mayo Clinic College of Medicine, Center for Clinical and Translational Science, Rochester, MN.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Cloud
authors.affiliation: Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Morrow
authors.affiliation: Program in Rehabilitation Science, University of Minnesota, Minneapolis, MN.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Ludewig
authors.affiliation: Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Electronic address: zhao.kristin@mayo.edu.
authors.forename: Kristin D
authors.initials: KD
authors.lastname: Zhao
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007537:Isometric Contraction; D008297:Male; D008875:Middle Aged; D018763:Muscle Fatigue; D053580:Muscle Strength; D010147:Pain Measurement; D010349:Patient Compliance; D017006:Rotator Cuff / Q000503:physiopathology; D012782:Shoulder / Q000503:physiopathology; D019534:Shoulder Impingement Syndrome / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology; D064171:Superficial Back Muscles / Q000503:physiopathology; D011795:Surveys and Questionnaires; D017216:Telemedicine; D049269:Videoconferencing; D014910:Wheelchairs / Q000009:adverse effects*
keywords: Exercise therapy; Rehabilitation; Shoulder impingement syndrome; Spinal cord diseases; Telemedicine