Article

OBJECTIVE: To test the effectiveness of a high-dose home
exercise/telerehabilitation program for manual wheelchair users who have a spinal
cord injury (SCI) by determining whether the intervention would reduce pain and
increase function, as we hypothesized. DESIGN:
A pre-post trial with outcomes
measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24
wk). SETTING: Subjects performed an exercise program at their homes using
telerehabilitation for therapist monitoring of technique and exercise
advancement. Baseline and postintervention data were collected at a motion
analysis laboratory in a tertiary medical center. PARTICIPANTS: A convenience
sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time
in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and
mechanical impingement signs on physical examination. INTERVENTIONS: A 12-week
home exercise program of rotator cuff and scapular stabilization exercises was
given to each participant. The program included a high dose of 3 sets of 30
repetitions, 3 times weekly, and regular physical therapist supervision via
videoconferencing. MAIN OUTCOME MEASURES: Primary outcomes of pain and function
were measured with the Wheelchair User's Shoulder Pain Index (WUSPI),
Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating
Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric
strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue
test of the lower trapezius. RESULTS: Pain was reduced and function improved
after the intervention. There was a significant main effect for pain and function
between the 3 time points based on the Friedman signed-ranked test, WUSPI
(chi(2)2=5.10, P=.014), DASH Index (chi(2)2=5.41, P=.012), and SRQ
(chi(2)2=23.71, P</=.001). Wilcoxon signed-rank tests demonstrated that isometric
strength measurements of the serratus anterior and scapular retractors increased
after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003],
respectively). Muscle impulse produced by the lower trapezius during a fatigue
task also improved (t=2.2, P=.02). No differences were measured in isometric
strength for the lower trapezius, glenohumeral rotators, and abductors between
the baseline and 12-week time points. CONCLUSIONS: A high-dose scapular
stabilizer and rotator cuff strengthening program using telerehabilitation for
supervision holds promise for shoulder pain treatment in manual wheelchair users
with SCI. Additional work is needed to determine the effectiveness compared with
other interventions, as well as the potential for earlier intervention to prevent
development of shoulder pain.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS