Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users.

PURPOSE: To analyze the effectiveness of a 6-month exercise protocol on shoulder pain experienced by wheelchair users during functional activities. SUBJECTS: Forty-two wheelchair users, 35 males and seven females: average age of 35 years and an average duration of wheelchair use of 14 years. METHODS: Subjects were randomly assigned to treatment (n=21) and control (n=21) groups. The treatment group received instruction in five shoulder exercises which they performed daily for 6 months. The exercise protocol included two exercises for stretching anterior shoulder musculature and three exercises for strengthening posterior shoulder musculature. OUTCOME MEASURES: All subjects completed a self-report questionnaire and the Wheelchair Users Shoulder Pain Index (WUSPI) initially and at bimonthly intervals during the 6-month intervention. RESULTS: Seventy-five per cent of the subjects reported a history of shoulder pain since beginning wheelchair use. The average initial performance-corrected (PC-WUSPI) score of the 42 subjects was 17.7 (+/-21.3) with a range of 0-103.2 points. Over 83% of the subjects (35 of 42) completed the 6-month study. Subjects in the treatment group decreased their PC-WUSPI score by an average of 39.9%, compared to decreases of only 2.5% in the control group. CONCLUSIONS: These findings supported the effectiveness of this exercise protocol in decreasing the intensity of shoulder pain which interferes with functional activity in wheelchair users.

Shoulder pain in female wheelchair basketball players.

STUDY DESIGN: Descriptive self-report survey. OBJECTIVES: To assess activity level, medical history, and the prevalence and intensity of shoulder and upper extremity pain experienced during functional activities in female athletes who compete in wheelchairs. BACKGROUND: Previous studies have documented a high incidence of upper extremity soft tissue disorders in athletes who compete in wheelchairs. None of these studies have specifically focused on female athletes who use wheelchairs. METHODS AND MEASURES: Forty-six female wheelchair basketball players completed an anonymous survey that included demographic data, medical history data, and the Wheelchair User's Shoulder Pain Index (WUSPI). The WUSPI is a valid and reliable self-report measure scored from 0 to 150, with higher scores indicating a greater intensity of shoulder pain during functional activities. RESULTS: The average age of the respondents was 33.2 (+/- 9.1) years, with an average of 12.5 (+/- 10.2) years of wheelchair use. Their disabilities included 39% spinal cord injury, 28% various lower extremity musculoskeletal and neuromuscular disabilities, 13% postpolio paralysis, 11% spina bifida, and 9% amputations. Only 14% of the subjects reported shoulder pain prior to wheelchair use. In contrast, 72% of the subjects reported shoulder pain since wheelchair use, with 52% reporting current shoulder pain. Overall, the subjects scored an average +/- SD performance-corrected total WUSPI score of 15.6 +/- 20.5 on a scale of 0 to 150 points, with 0 representing no pain. The highest intensity of shoulder pain was reported during household chores, propulsion on ramps or inclines, lifting overhead, and while sleeping. CONCLUSIONS: Shoulder and upper extremity pain was a very common problem reported by over 90% of the subjects in this study. Prevention of pain and chronic disability in athletes who use wheelchairs should be addressed by coaches, players, and health care professionals.

Shoulder pain in wheelchair users with tetraplegia and paraplegia.

OBJECTIVE: To compare the prevalence and intensity of shoulder pain experienced during daily functional activities in individuals with tetraplegia and individuals with paraplegia who use manual wheelchairs. DESIGN: Self-report survey. SETTING: General community. PARTICIPANTS: Fifty-five women and 140 men, 92 subjects with tetraplegia and 103 subjects with paraplegia who met inclusion criteria of 3 hours per week of manual wheelchair use and at least 1 year since onset of spinal cord injury. MAIN OUTCOME MEASURES: Respondents completed a demographic and medical history questionnaire and the Wheelchair User's Shoulder Pain Index (WUSPI), a measure of pain during typical daily activities. RESULTS: More than two thirds of the sample reported shoulder pain since beginning wheelchair use, with 59% of the subjects with tetraplegia and 42% of the subjects with paraplegia reporting current pain. Performance-corrected WUSPI scores were significantly higher in subjects with tetraplegia than in subjects with paraplegia. CONCLUSIONS: Both the prevalence and intensity of shoulder pain was significantly higher in subjects with tetraplegia than in subjects with paraplegia. Efforts to monitor and prevent shoulder pain should continue after rehabilitation.

The relationship between duration of physical therapy services in the acute care setting and change in functional status in patients with lower-extremity orthopedic problems.

BACKGROUND AND PURPOSE: This study examined the relationship between the duration of physical therapy and functional status at discharge. SUBJECTS: The subjects were 173 inpatients, with a mean age of 67.9 years (SD = 20.5, range = 18-101), referred to physical therapy with lower-extremity orthopedic problems. METHODS: For this retrospective cohort study, medical and physical therapy quality assurance records were used. Functional status, at initiation of and discharge from physical therapy, was measured using the Acute Care Index of Function (ACIF). The ACIF scores, which ranged from 0 to 100, were obtained from quality assurance records. The duration of physical therapy was the number of minutes of physical therapy billed to each patient, as determined from billing records. RESULTS: Subjects received an average of 238.5 minutes of physical therapy (SD = 153.6, range = 15-1,110). Function improved an average of 15.4 points (SD = 17.0, range = -27.4 to 64.9), and the duration of physical therapy was an important predictor of functional status at discharge after controlling for age, length of hospitalization, number of diagnoses, and initial functional status. CONCLUSION AND DISCUSSION: This study provides evidence that the amount of physical therapy that patients with some types of orthopedic problems receive is directly related to the functional improvement that occurs during hospitalization in an acute care setting.

Early family experiences and helping behaviors of physical therapists.

BACKGROUND AND PURPOSE: Ineffective or excessive helping behavior may encourage helpee dependence and overextension of helper resources. Early family experiences and perceptions of the helpee's situation both contribute to the expression of helping behavior in health professionals. The purpose of this study was to determine how early family experiences and variations in perceived patient responsibility influence physical therapist helping behavior. SUBJECTS AND METHODS: Five hundred physical therapists were surveyed by mail, resulting in a final sample of 221 (44%) respondents who completed the Family of Origin Scale (FOS), measuring the nature of their early family experiences, and a Helping Questionnaire, measuring their helping behavior, perceptions of replaceability, and feelings of compassion for four hypothetical patients. The four patients represented Brickman's models of helping and coping, varying in high and low responsibility for the problem and high and low responsibility for the solution to the problem. RESULTS: Subjects who scored in the dysfunctional or neutral ranges on the FOS had lower scores on their willingness to help and feelings of compassion than did subjects who scored in the functional range on the FOS. Regardless of early family experiences, subjects' scores were higher for willingness to help and feelings of compassion and lower in their perceptions of replaceability for patients who were not thought to be responsible for their medical problem (medical and compensatory models). In contrast, subjects' scores were lower for their willingness to help and feelings of compassion and higher in their perceptions of replaceability when patients were felt to be responsible for their medical problem (enlightenment and moral models). CONCLUSION AND DISCUSSION: All subjects, regardless of early family experience, showed helping responses that linked feelings of compassion with greater tendencies to help. Variations in perceived patient responsibility for the medical problem, rather than early family experience, appears to be a major determinant in motivating both compassion and helping behavior. Thus, helpers may be more likely to overextend themselves or create patient dependence when patients are perceived to be not responsible for the cause of their problem. [Curtis KA, Davis CM, Trimble TK, Papoulidis DK. Early family experiences and helping behaviors of physical therapists.

Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI).

Many long term wheelchair users develop shoulder pain. The purpose of this study was to examine the reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI), an instrument which measures shoulder pain associated with the functional activities of wheelchair users. This 15-item functional index was developed to access shoulder pain during transfers, self care, wheelchair mobility and general activities. To establish test-retest reliability, the index was administered twice in the same day to 16 long term wheelchair users and their scores for the two administrations were compared by intraclass correlation. To establish concurrent validity, the index was administered to 64 long term wheelchair users and index scores were compared to shoulder range of motion measurements. Results showed that intraclass correlation for test-retest reliability of the total index score was 0.99. There were statistically significant negative correlations of total index scores to range of motion measurements of shoulder abduction (r = -0.485), flexion (r = -0.479) and shoulder extension (r = -0.304), indicating that there is a significant relationship of total index score to loss of shoulder range of motion in this sample. The Wheelchair User's Shoulder Pain Index shows high levels of reliability and internal consistency, as well as concurrent validity with loss of shoulder range of motion. As a valid and reliable instrument, this tool may be useful to both clinicians and researchers in documenting baseline shoulder dysfunction and for periodic measurement in longitudinal studies of musculoskeletal complications in wheelchair users.

Development of the Wheelchair User's Shoulder Pain Index (WUSPI).

Chronic shoulder pain is a frequently reported phenomenon in individuals who use wheelchairs as their primary means of mobility. No indices are currently available which detect difficulties in performing daily activities due to shoulder discomfort in a largely independent population of wheelchair users. The Wheelchair User's Shoulder Pain Index (WUSPI) was designed to measure shoulder pain in individuals who use wheelchairs. A pilot index was created to measure shoulder pain and related difficulty during basic and instrumental activities of daily living. The instrument was administered to 64 wheelchair users at an athletic event. Analyses of internal consistency and interitem correlations were used to revise and refine the original instrument. Individual item analysis revealed that the subjects in this study experienced the most shoulder pain when wheeling up an incline or on outdoor surfaces, when lifting an object from an overhead shelf, when trying to sleep, when transferring from tub to wheelchair and when washing their backs. The final 15-item index shows high internal consistency. This instrument is useful for both clinical and research purposes to detect and monitor shoulder pain and accompanying loss of function by wheelchair users.

Functional reach in wheelchair users: the effects of trunk and lower extremity stabilization.

Our purpose was to compare the effects of using wheelchair trunk and lower extremity stabilization on sitting trunk mobility and functional reach of wheelchair users. Seven subjects with paraplegia who averaged 35.6 years of age and nine able-bodied control subjects with an average age of 26.0 years participated in this study. Each subject's functional reach in the transverse and sagittal planes was video-recorded in each of three conditions, randomized in order: (1) without a belt; (2) with a neoprene chest belt; and (3) with a webbing thigh belt. The area circumscribed by each subject's functional reach under each condition was processed using the Motion Analysis Expert Vision Flextrak program. Functional reach in each belting condition was compared within each subject and between able-bodied controls and subjects with high and low thoracic levels of paraplegia. This study showed that in the sagittal plane, subjects with both high and low thoracic levels of paraplegia were able to substantially increase the area of their functional reach when using a chest belt when compared with the thigh belt or no-belt condition. The mean area of their sagittal plane functional reach increased by over 50% by stabilizing the chest to the wheelchair using a neoprene belt. However, in the transverse plane, only those individuals with lower thoracic paraplegia (T8 to L1) gained substantial benefit from chest strapping, increasing the area of their functional reach by a mean of 24%. In contrast, able-bodied control subjects gained no benefit in functional reach from either belting condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Attributional analysis of interprofessional role conflict.

Interprofessional role conflict is often a source of job dissatisfaction for health professionals. Attributional analysis provides a methodology to better understand the health care provider's perceptions of the causes of interprofessional conflict and the influence of these causal perceptions on future behavior. This paper reports a study in which 86 physical therapists reported the attributions (perceived causes) they held for situations in which they had compromised (failure) and other instances in which they had supported (success) their best professional judgment following incidents of interprofessional conflict with physicians. Comparison of reported incidents showed that there were significant differences in subject perceptions of the nature of the causes and their future expectations following success and following failure. Therapists tended to ascribe their successes to internal, stable and controllable causes, such as their personality, effort, assertiveness or the strategies they used and held high expectations for future success. Following failure, therapists ascribed the causes of their failures to more external and uncontrollable causes such as influence of the supervisor or the receptivity of the physician. Therapist causal ascriptions for failure to external and uncontrollable sources strongly correlated with high future expectations of failure. Patterns of causal thinking following incidents of interprofessional conflict clearly influence one's future expectations to avoid, withdraw or to seek a productive resolution to role conflict.

Perceptions of acute care physical therapy practice: issues for physical therapist preparation.

BACKGROUND AND PURPOSE: Acute care physical therapists have experienced the effects of dramatic changes in health care reimbursement systems and population demographics. Acute care hospitals now serve a patient population of much older, chronically ill patients who are hospitalized for shorter periods of time in a practice environment in which physical therapy staffing resources are often inadequate. The purposes of this study were to document common experiences in the practice of acute care physical therapy and to identify differences in the perceptions of physical therapists with varying levels of experience and in various sizes of acute care facilities. SUBJECTS AND METHODS: A survey questionnaire was mailed to 500 randomly selected physical therapists employed in acute care facilities. The therapists answered questions regarding the frequency of various physical therapy evaluation and treatment practices, problems encountered in delivering physical therapy services, coordination of the discharge planning process, and perceptions of staffing trends in the acute care setting. The responses of 188 physical therapists who completed the survey were compared by their experience levels and the size of the institutions in which they practiced. RESULTS: Subjects reported that patient factors, such as medical complications and cooperation; organizational factors, such as staffing shortages and large caseloads; and health care system constraints, such as difficulty changing orders and limited time in which to work with the patient interfered with patients reaching physical therapy goals. CONCLUSION AND DISCUSSION: Inadequate skills for successful acute care practice and maladaptive therapist beliefs about acute care career possibilities may adversely affect physical therapist career longevity in the acute care setting.

Health, vocational, and functional status in spinal cord injured athletes and nonathletes.

The relationship of sports involvement to medical complications, functional independence, and vocational status was studied in 67 individuals from 2 to 24 years after spinal cord injury (SCI). Sports participation ranged from none to 30 (means 7.6) hours/wk. No significant correlation was found between time spent in sports participation and number of medical complications, rehospitalizations, functional status, or employment. Subsequently, subgroups of SCI wheelchair basketball players (n = 19) and SCI nonathletes (n = 19) were compared in medical, functional, and vocational status. The athlete group showed significantly more average time per week of sports participation (p less than 0.03), as expected. Fewer physician visits (p less than 0.01) occurred in the athlete group. Trends toward fewer medical complications and fewer rehospitalizations were seen in the athletic group, but this did not reach statistical significance. Sports participation was not associated with increased risk of medical complications and did not limit available time for vocational pursuits. The positive benefits of sports involvement on the community reintegration process and the acquisition of functional skills for the newly disabled warrant further study. The long-term impact of sports involvement on prevention of cardiovascular disease, obesity, and other associated risks of a sedentary existence demands attention in our aging SCI population.

Spinal cord injury community follow-up. Role of the physical therapist.

This study was conducted over a 14-month period to assess the physical therapy intervention needs of 201 patients who attended monthly spinal cord injury (SCI) outpatient clinics conducted in three outlying local communities of northern California. Methods to identify and provide appropriate physical therapy services for the patients were explored. An experienced physical therapist from a regional SCI center and other clinic staff members screened the patients and identified 66 patients (33%) who needed physical therapy services, including evaluation (82%), patient education (62%), and referrals to appropriate local health care professionals or equipment vendors (52%). Losses of joint range of motion, changes in sitting posture as a result of increased muscle tone or contracture, and malaligned or misfitting lower extremity orthoses were identified as problem areas not commonly recognized in routine follow-up examinations. Recommendations based on our study findings included the use of a screening form for physical therapy needs at each clinic, improved patient education about the role of the physical therapist as a resource person during follow-up care, coverage for each of the three clinics on a biannual basis, and continued study of the mechanisms used by other SCI centers to fulfill the outpatient needs of their patients. Physical therapy involvement in SCI follow-up services can maximize efficient use of our health care resources and provide early identification and management of specific postdischarge needs.

Survey of wheelchair athletic injuries: common patterns and prevention.

Twelve hundred wheelchair athletes were surveyed to determine commonly experienced athletic injuries, sports participation and training patterns associated with injuries. Soft tissue trauma, blisters, lacerations, decubiti and joint disorders were the most commonly reported injuries of the 128 respondents. Over 70 per cent of all reported injuries occurred during wheelchair track, road racing and basketball. Common mechanisms of injury were also identified. A significantly higher number of reported injuries were associated with increased sports participation (p less than 001), with the 21-30 year-old age group (p less than .01), and with a high number of training hours per week (p less than .05). There was no significant relationship between number of reported injuries and disability type, National Wheelchair Athletic Association classification, or sex. Decubitus ulcers and temperature regulation disorders were identified as particular risks for the spinal cord injury population. Educating the athlete and coach in means to prevent injury is necessary to promote optimal performance and safe participation.

Physical therapist role satisfaction in the treatment of the spinal cord-injured person.

The purpose of this article is to discuss role satisfaction and role deprivation experienced by the physical therapist during rehabilitation of the spinal cord-injured person. Physical therapist goals to promote patient independence may be in conflict with the therapist experiencing role satisfaction. The patient-therapist relationship is examined and recommendations for therapist behaviors that foster a positive and productive interaction are given.

Wheelchair sports medicine.

Wheelchair sports medicine involves the assessment of recreational and competitive sport capacities of physically disabled individuals, medical classification to allow fair competition among athletes with various types and degrees of disability, the prevention, diagnosis, and treatment of athletic injuries, and research into the biomechanics and physiology of wheelchair athletics. Involvement in wheelchair sports medicine activities increases professional awareness and provides a valuable referral source for organized sports activities.