Mechanical diagnosis and therapy in musculoskeletal pain of individuals with spinal cord injury

CONTEXT/OBJECTIVE

Musculoskeletal pain (MSKP) has high prevalence in individuals with spinal cord injury (SCI). Mechanical Diagnosis and Therapy (MDT) is a method focused on identifying the pain source in the musculoskeletal system and presents good results in pain relief in people without neurological impairment. However, no studies have investigated the use of MDT in SCI population. The objective was to evaluate the applicability and outcomes of MDT treatment in pain relief and independence improvement in daily activities of individuals with SCI presenting MSKP.

DESIGN

Single-arm trial.

SETTING

Rehabilitation Hospital.

PARTICIPANTS

Twenty-four individuals with SCI who presented MSKP.

INTERVENTION

MDT-certified physical therapist conducted assessments and treatments of pain according to the MDT approach.

OUTCOMES MEASURES

Numeric rating scale (NRS) was used to measure pain and Pain Disability Index (PDI) and Patient-Specific Functional Scale (PSFS) to evaluate daily activities.

RESULTS

Significant median decreases were found for NRS (from 7 to 2) and PDI (from 27 to 8) after MDT, whereas PSFS score presented a significant mean increase (from 3.2-7.7). The average decrease in pain after MDT treatment was 70.9% (5.36 on the NRS).

CONCLUSION

MDT can reduce pain and enhance independence in daily activities in individuals with SCI and MSKP.

Handgrip Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury

Objectives

To determine optimal handgrip strength (HGS) cutoff points for greater functional independence and wheelchair skills in men with spinal cord injury (SCI), and to establish predictive equations for functional independence and wheelchair ability in men with SCI, based on demographic characteristics, HGS, and functionality.

Methods

In this cross-sectional study conducted at a rehabilitation hospital, 54 men with SCI were recruited and stratified into high and low paraplegia groups. All participants performed a maximum HGS test to determine cutoff points for the Spinal Cord Independence Measure (SCIM-III) and Adapted Manual Wheelchair Circuit (AMWC). The primary outcomes were the SCIM-III, AMWC, and HGS. Demographic characteristics obtained from participants' electronic medical records were the secondary outcomes, used as predictor variables of functional independence.

Results

The SCIM-III scale, performance score, and 3-minute overground wheeling test presented significant regression equations (R = 0.45, R = 0.69, and R = 0.72). The HGS showed a cutoff point of 102.5 kilogram force (kgf) to achieve a score of 70 on the SCIM-III and a 3-minute overground wheeling distance of 270 m. The HGS cutoff point to obtain a performance score of 23.7 seconds was 93.0 kgf.

Conclusion

The HGS was a significant predictor for the SCIM-III score, AMWC performance score, and 3-minute overground wheeling test. Three significant predictive equations were established based on HGS. The cutoff points could be adopted as parameters for optimal functional independence and wheelchair skills.