title: Effectiveness of Exercise Programs for Management of Shoulder Pain in Manual Wheelchair Users With Spinal Cord Injury.
abstract: OBJECTIVE
  Shoulder pain is prevalent in manual wheelchair users (MWUs) with spinal cord injury (SCI). Therapeutic exercise has been demonstrated to be an effective, conservative approach to treating shoulder pain in able-bodied individuals. We sought to evaluate literature on the effectiveness of exercise programs on the reduction of shoulder pain in MWUs with SCI.
  
  
  METHODS
  We searched the literature, using search terms related to SCI, manual wheelchairs, and shoulder pain. Eligibility criteria included prospective study design, exercise intervention for MWUs with shoulder pain, and use of the Wheelchair User's Shoulder Pain Index as an outcome measure. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed study quality.
  
  
  RESULTS
  Three randomized control trials and 4 cohort studies met inclusion criteria. Two studies were rated as good quality and 5 as fair quality. Three interventions were evaluated in the included studies: arm ergometry, resistive strengthening with or without electromyographic biofeedback, and stretching that targeted the muscles of the shoulder girdle. Across the 7 studies, the exercise intervention was associated with reduction in shoulder pain that exceeded the estimated minimal detectable change of 5.10 points for the Wheelchair Users' Shoulder Pain Index.
  
  
  CONCLUSIONS
  Exercise is a feasible, conservative, therapeutic intervention for the treatment of shoulder pain among MWUs. Additional studies are needed to differentiate techniques for the reduction of shoulder pain, to determine the most effective duration of intervention, and to estimate the magnitude of effect associated with therapeutic exercise for shoulder pain among MWUs.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A116).
authors: Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University (K.A.C., C.E.D., T.K.H., N.R.K., B.D.M., L.M.O.), and Department of Community and Family Medicine, Duke University, and Duke Clinical Research Institute (R.R.C.), Durham, North Carolina.
authors: Kimberle A
authors: KA
authors: Cratsenberg
authors: Cassandra E
authors: CE
authors: Deitrick
authors: Taylor K
authors: TK
authors: Harrington
authors: Natasha R
authors: NR
authors: Kopecky
authors: Bradley D
authors: BD
authors: Matthews
authors: Lauren M
authors: LM
authors: Ott
authors: Remy R
authors: RR
authors: Coeytaux
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D020069:Shoulder Pain / Q000209:etiology / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D016896:Treatment Outcome; D014910:Wheelchairs / Q000009:adverse effects*