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Transfer Technique Is Associated With Shoulder Pain and Pathology in People With Spinal Cord Injury: A Cross-Sectional Investigation

  • Nathan S. Hogaboom
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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  • Lynn A. Worobey
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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  • Michael L. Boninger
    Correspondence
    Corresponding author Michael L. Boninger, MD, Human Engineering Research Laboratories, 6425 Penn Ave, Ste 400, Pittsburgh, PA 15206.
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA
    Search for articles by this author
Published:April 23, 2016DOI:https://doi.org/10.1016/j.apmr.2016.03.026

      Abstract

      Objectives

      To evaluate how transfer technique and subject characteristics relate to ultrasound measures of shoulder soft tissue pathology and self-reported shoulder pain during transfers in a sample of wheelchair users with spinal cord injury (SCI).

      Design

      Cross-sectional observational study.

      Setting

      Research laboratory, national and local veterans' wheelchair sporting events.

      Participants

      A convenience sample of wheelchair users (N=76) with nonprogressive SCI. Participants were aged >18 years, >1 year postinjury, and could complete repeated independent wheelchair transfers without the use of their leg muscles.

      Interventions

      Not applicable.

      Main Outcome Measures

      Transfer pain items from the Wheelchair User's Shoulder Pain Index; transfer technique assessed using the Transfer Assessment Instrument (TAI); and shoulder pathology markers examined using the Ultrasound Shoulder Pathology Rating Scale (USPRS).

      Results

      Better transfer technique (higher TAI) correlated with less injury (lower USPRS) (partial η2=.062, P<.05) and less pain during transfers (partial η2=.049, P<.10). Greater age was the strongest predictor of greater pathology (USPRS total: partial η2=.225, supraspinatus grade: partial η2=.174, P<.01). An interaction between technique and weight was found (P<.10): participants with lower body weights showed a decrease in pathology markers with better transfer technique (low weight: R2=.422, P<.05; middle weight: R2=.200, P<.01), while those with higher weight showed little change with technique (R2=.018, P>.05).

      Conclusions

      Participants with better transfer technique exhibited less shoulder pathology and reported less pain during transfers. The relationship between technique and pathology was strongest in lower-weight participants. While causation cannot be proven because of study design, it is possible that using a better transfer technique and optimizing body weight could reduce the incidence of shoulder pathology and pain.

      Keywords

      List of abbreviations:

      ICC (intraclass correlation coefficient), SCI (spinal cord injury), TAI (Transfer Assessment Instrument), TAI-1 (Transfer Assessment Instrument part 1), USPRS (Ultrasound Shoulder Pathology Rating Scale), WUSPI (Wheelchair User's Shoulder Pain Index)
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