An exercise trial targeting posterior shoulder strength in manual wheelchair users: pilot results and lessons learned

Wheelchair-modified ergometer rowing exercise in individuals with spinal cord injury: a feasibility, acceptability, and preliminary efficacy study

STUDY DESIGN

Exploratory clinical investigation.

OBJECTIVES

To assess the feasibility, acceptability, and preliminary efficacy of upper-body rowing exercise adapted to wheelchair users with spinal cord injury (SCI).

SETTING

University exercise laboratory.

METHODS

Eight individuals with SCI exercised on a rowing ergometer modified for wheelchair users (REMW), three times weekly, for up to 30 min per session. Participants completed feasibility and acceptability questionnaire (1-5 Likert scale), and the Wheelchair Users Shoulder Pain Index (WUSPI) before and after six weeks of exercise. Average power output (PO_AVG), distance rowed, percent peak heart rate (%HR_peak), and rating of perceived exertion (RPE) (6-20 scale) were monitored throughout the 18 exercise sessions and analyzed to evaluate preliminary efficacy of the exercise modality.

RESULTS

All eight participants completed the study (97% adherence). Participants rated the exercise high on the feasibility and acceptability scale; median (interquartile range) = 5.0 (4.0-5.0), where higher numbers indicated greater feasibility. Shoulder pain was reduced by 21% yet not significantly different from baseline (p = 0.899). Physiological measures (%HR_peak = 80-83%; RPE = 15.0-16.0) indicated a high cardiovascular training load. From week 1 to week 6, PO_AVG and distance rowed increased by 37 and 36%, respectively (both p ≤ 0.001).

CONCLUSIONS

Data from six weeks of exercise on the REMW suggests that upper-body rowing is a feasible and acceptable exercise modality for wheelchair users with SCI. Session data on %HR_peak, RPE, and shoulder pain indicate that REMW evoked moderate to vigorous intensity exercise without exacerbation of shoulder pain. Future research is required to quantify potential training-induced changes in cardiorespiratory fitness.

Reliability of Upper-Extremity Muscle Activity and Kinematics During Adaptive Rowing

CONTEXT

The purpose of this study was to determine test-retest reliability of upper-extremity muscle activity and kinematics during submaximal adapted rowing.

DESIGN

A repeated-measures design was used.

METHODS

Data were collected on 10 individuals (7 male and 3 female) with mobility impairment. Surface electromyography of muscles of the dominant arm (upper, middle, and lower trapezius, anterior and posterior deltoid, latissimus dorsi, and infraspinatus) was acquired. Muscle activity was analyzed using the area under the curve, peak amplitude, and mean amplitude. Kinematic analysis determined joint motions for shoulder plane and angle of elevation, and trunk flexion/extension, and rotation at the catch (0%) and finish (100%) of the stroke. Three submaximal rowing trials (20 strokes each) were completed with the middle 10 strokes of each trial averaged for analysis.

RESULTS

An interclass correlation coefficient (3, 10) determined test-retest reliability across trials (interclass correlation coefficient defined as poor < .5; moderate .5-.75; and good .75-.9). Moderate to excellent reliability existed across all muscles for the area under the curve, peak amplitude, and mean amplitude. Excellent reliability was seen for all kinematic measures.

CONCLUSION

Results indicate upper-extremity muscle activity and kinematics of the adapted rowing stroke are reliable in a diverse group of individuals with mobility impairment.

Musculoskeletal Pain Due to Wheelchair Use: A Systematic Review and Meta-Analysis

INTRODUCTION

Wheelchair users are at a high risk of experiencing non-neuropathic pain of musculoskeletal origin as a result of being wheelchair-bound. The aim of this systematic review was to establish the prevalence of musculoskeletal pain in wheelchair users that is attributable to wheelchair use, and to describe the different pain syndromes and discuss risk factors and management options.

METHODS

After a systematic MEDLINE search, we identified 40 papers eligible for inclusion.

RESULTS

The pooled prevalence of musculoskeletal pain at any location was 50% (95% CI 33-67%). The most common pain syndrome was shoulder pain (pooled prevalence 44%, 95% CI 36-52%). Wheelchair users were 5.8 times as likely to suffer from shoulder pain as controls (95% CI 2.7-12.2, p < 0.0001). Other pain syndromes included neck, elbow, wrist, hand and low back pain. Older age and increased duration of wheelchair use were the most significant determinants of pain in wheelchair users.

CONCLUSIONS

Musculoskeletal pain as a result of wheelchair use is very common amongst wheelchair users. Management of pain should follow national and international guidelines. Optimal adjustment of seating position may prevent pain, and is important to be taken into consideration.

Effect of wheelchair-modified rowing exercise on cardiometabolic risk factors in spinal cord injured wheelchair users: protocol for a randomised controlled trial

INTRODUCTION

Cardiovascular and metabolic diseases are a growing concern for individuals with spinal cord injury (SCI). Physical inactivity contributes to cardiometabolic morbidity and mortality in the SCI population. However, previous studies have shown mixed results regarding the effects of exercise on cardiometabolic risk factors in individuals with SCI. This discrepancy could be influenced by insufficient exercise stimuli. Recent guidelines recommend 30 min of moderate-to-vigorous intensity aerobic exercise, three times per week, for improvement in cardiometabolic health in individuals with SCI. However, to date, no studies have implemented an exercise intervention matching the new recommendations to examine the effects on cardiometabolic risk factors. Therefore, the primary objective of this study is to determine the effects of 12 weeks of wheelchair user-modified upper-body rowing exercise on both traditional (constituents of the metabolic syndrome) and novel (eg, vascular structure and function) cardiometabolic risk factors in manual wheelchair users with SCI.

METHODS AND ANALYSIS

A randomised controlled trial will compare 12 weeks of upper-body rowing exercise, 30 min three times per week, with a control group continuing their normal lifestyle. Outcome measurements will be performed immediately before (baseline), after 6 weeks (halfway), 12 weeks of training (post) and 6 months after the termination of the intervention period (follow-up). Outcomes will include inflammatory (eg, C reactive protein) and metabolic biomarkers determined from venous blood (with serum fasting insulin as primary outcome), body composition, arterial blood pressure, cardiorespiratory fitness level, brachial artery vascular structure and function and autonomic nervous system function.

ETHICS AND DISSEMINATION

This trial is reported to the Danish Data Protection Agency (J.nr. 2019-899/10-0406) and approved by the Committees on Health Research Ethics in The North Denmark Region on 12 December 2019 (J.nr. N-20190053). The principal investigator will collect written informed consent from all participants prior to inclusion. Irrespective of study outcomes, the results will be submitted to peer-reviewed scientific journals for publication.

TRIAL REGISTRATION NUMBER

NCT04390087.

Posterior Instability of the Shoulder: A Systematic Review and Meta-analysis of Clinical Outcomes

BACKGROUND

To date, there are no reports in the literature of a systematic review and meta-analysis for posterior instability of the shoulder.

PURPOSE

The primary objective was to systematically capture, critically evaluate, and perform a meta-analysis of all available literature on arthroscopic clinical outcomes to provide insight and clinical recommendations for unilateral posterior shoulder instability. The secondary objective was to use the same means to assess clinical outcome literature for open treatment, of which a subset of highly reported outcome measures were used to determine superiority of arthroscopic versus open procedures for unilateral posterior shoulder.

STUDY DESIGN

Systematic review, meta-analysis.

METHODS

A systematic search to obtain every available, published, level of evidence study reporting patient data for unidirectional posterior shoulder instability was performed by use of the Cochrane Database of Systematic Reviews, PubMed/Medline database, manual searches of high impact factor journals and conference proceedings, and secondary references appraised for studies meeting inclusion criteria.

RESULTS

The systematic search captured a total of 1035 publications. After initial exclusion criteria were applied, 607 abstracts were assessed for eligibility. Full-text articles were obtained for 324 articles, and a total of 53 unique publications (27 arthroscopic studies, 26 open studies) reporting clinical outcomes for unidirectional posterior shoulder instability met inclusion criteria and were included in the systematic review and meta-analysis.

CONCLUSION

Well-defined and uniform shoulder outcome measures to assess posterior shoulder instability are lacking throughout the literature. However, arthroscopic procedures are shown to be an effective and reliable treatment for unidirectional posterior glenohumeral instability with respect to outcome scores, patient satisfaction, and return to play. Despite similar results of outcome measures to the overall athletic population, throwing athletes are less likely to return to their preinjury levels of sport compared with contact athletes or the overall athletic population. Evidence also indicates that arthroscopic stabilization procedures using suture anchors result in fewer recurrences and revisions than anchorless repairs in young adults engaging in highly demanding physical activity. Furthermore, the literature suggests that patients treated arthroscopically have superior outcomes compared with patients who undergo open procedures with respect to stability, recurrence of instability, patient satisfaction, return to sport, and return to previous level of play.