Treatment of shoulder pain in people with spinal cord injury who use manual wheelchairs: a systematic review and meta-analysis

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.