Original article
Relationship Between Shoulder Pain and Kinetic and Temporal-Spatial Variability in Wheelchair Users

Presented to the Rehabilitation Engineering and Assistive Technology Society of North America, 2012
https://doi.org/10.1016/j.apmr.2013.11.005Get rights and content

Abstract

Objective

To examine intra-individual variability of kinetic and temporal-spatial parameters of wheelchair propulsion as a function of shoulder pain in manual wheelchair users (MWUs).

Design

Cohort.

Setting

University research laboratory.

Participants

Adults with physical disabilities (N=26) who use a manual wheelchair for mobility full time (>80% ambulation).

Interventions

Participants propelled their own wheelchairs with force-sensing wheels at a steady-state pace on a dynamometer at 3 speeds (self-selected, 0.7m/s, 1.1m/s) for 3 minutes. Temporal-spatial and kinetic data were recorded unilaterally at the hand rim.

Main Outcome Measures

Shoulder pain was quantified with the Wheelchair Users Shoulder Pain Index. Intra-individual mean, SD, and coefficient of variation (CV=mean/SD) with kinetic and temporal-spatial metrics were determined at the handrim.

Results

There were no differences in mean kinetic and temporal-spatial metrics as a function of pain group (P values >.016). However, individuals with pain displayed less relative variability (CV) in peak resultant force and push time than pain-free individuals (P<.016).

Conclusions

Shoulder pain had no influence on mean kinetic and temporal-spatial propulsion variables at the handrim; however, group differences were found in relative variability. These results suggest that intra-individual variability analysis is sensitive to pain. We propose that variability analysis may offer an approach for earlier identification of MWUs at risk for developing shoulder pain.

Section snippets

Participants

Twenty-six individuals (10 women, 16 men) from the Urbana-Champaign community volunteered and provided informed consent before participation in this study. All the participants were MWUs who used a wheelchair as their primary means of ambulation for more than 1 year and were between 18 and 64 years of age. People were excluded from participation if they had upper limb pain that prohibited them from propelling a manual wheelchair. The wheelchair users' diagnoses include spinal cord injury (T8

Participant demographics

The pain group had a higher total WUSPI score than the no-pain group (P=.006) (see table 1).

Velocity and perceived exertion

All participants maintained speeds very close to the targets provided in real time. Actual propulsion speed differences between groups (pain/no pain) were not significantly different (P>.05). Perceived exertion scores were low (20%–30% effort) for all speed conditions and not significantly different between groups (P>.05). On average, the magnitude of self-selected speeds fell in between the slow and

Discussion

We hypothesized that MWUs experiencing pain would propel with less variable kinetic and temporal-spatial propulsion outcome measures than those without pain. Consistent with our hypothesis, MWUs with pain displayed decreased CV in kinetic and temporal-spatial variables (see table 3). These results provide preliminary evidence that CV may serve as a unique marker of shoulder pain.

In the present study, persons reporting pain displayed reduced relative variability (CV) in both temporal-spatial and

Conclusions

The mean wheelchair propulsion values of peak force and push time were not different between pain groups. However, the variability of these biomechanical measures of wheelchair propulsion was lower in wheelchair users with shoulder pain. Future work is needed to determine whether relative variability analysis will offer an approach of earlier identification of MWUs at risk for developing shoulder pain and upper limb musculoskeletal disorders.

Suppliers

  • a.

    Three Rivers Holdings, LLC, 1826 W Broadway Rd, Ste 43, Mesa, AZ 85202.

  • b.

    The MathWorks, Inc, 3 Apple Hill Dr, Natick, MA 01760-2098.

  • c.

    SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

Acknowledgments

We thank the staff of the Illinois Simulator Laboratory where data collection occurred, and Sa Shen, PhD, for biostatistical support.

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    Supported in part by the National Institutes of Health (grant no. 1R21HD066129-01A1).

    No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

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