Abstract
Study design
Systematic review and meta-analysis
Objectives
The objective was to summarise prior research regarding the efficacy of active physiotherapy interventions and prevention strategies on shoulder pain, decreased physical function and quality of life in people with a spinal cord injury (SCI).
Methods
A systematic literature search was conducted in CENTRAL, EMBASE (via Ovid), CINAHL and MEDLINE (via Ovid). Randomised controlled trials investigating effects of active physiotherapy interventions on shoulder pain, physical function and quality of life were included. Further, prospective cohort studies investigating effects of active physiotherapy interventions in prevention of shoulder pain and reduced physical function were included. Mean difference (MD) for pain (15 items on a 0–10 scale) and standardised mean difference (SMD) for physical function were summarised in a random effects meta-analysis.
Results
Four studies on treatment (totalling 167 participants), and no studies on prevention were included. Significant and clinically meaningful improvements on shoulder pain (MD 19.06, 95% CI 5.72–32.40; I2 = 65%) (scale 0–150) and physical function (SMD 0.61, 95% CI 0.27–0.94; I2 = 0%) were found for active physiotherapy interventions. Only one study included quality of life, making meta-analysis inappropriate.
Conclusions
Evidence from a sparse number of studies supports active physiotherapy interventions to decrease shoulder pain and increase physical function in people with SCI who use a manual wheelchair. No studies met the criteria for prevention, highlighting a lack of research investigating prevention of shoulder pain and decreased physical function and quality of life.
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Data availability
We applied to the Information Department at Curtin University to receive access to R:drive, a shared drive which allowed us to store data securely, minimised the risk of data loss and was accessible by all members of the research team. Data will be available upon request to the authors.
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Acknowledgements
Acknowledgement to Curtin University for providing funding for the purchase of Covidence, to Curtin University librarian Diana Blackwood for assistance with search terms and sourcing of full text articles, to Cindy Davis for assistance with screening and Gretta Adolph for assistance with search terms and administration.
Funding
All facilities and resources were provided by Curtin University, including funding for the purchase of Covidence at a cost of $240 AUD. In addition, Camilla Marie Larsen received grant funding from the Danish Society of Polio and Accident Victims, the Danish Physiotherapy Research Foundation, the Danish Jascha Foundation, and the Danish Vanføre Foundation for the initial planning and writing of this work.
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All authors (CML, CJ, KL, BJK, LM, MH and MW) were responsible for designing the review protocol. MW and KL were responsible for conducting the initial search and screening for eligible studies by title and abstract; screening the full text paper for inclusion, with all authors providing arbitration on some of the final decisions; assessing the qualifying articles for quality; extracting and analysing the data, with all authors contributing to the analysis process and assisting to interpret the results. KL and MW wrote the report with all remaining authors contributing and providing feedback.
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Wellisch, M., Lovett, K., Harrold, M. et al. Treatment of shoulder pain in people with spinal cord injury who use manual wheelchairs: a systematic review and meta-analysis. Spinal Cord 60, 107–114 (2022). https://doi.org/10.1038/s41393-021-00673-x
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DOI: https://doi.org/10.1038/s41393-021-00673-x
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