OBJECTIVE: The purpose of this study was to replicate findings that a home exercise program (HEP) intervention improved shoulder pain and function, and to assess changes in supraspinatus tendon pathology associated with the HEP in persons with chronic spinal cord injury (SCI). DESIGN: Single-blind randomized controlled trial. Individuals with SCI of at least 1 year and chronic shoulder pain of moderate or greater average intensity were enrolled. Participants were randomized to a 12-week HEP consisting of strengthening and stretching exercises or to an education-only control group (CON), with immediate post-intervention and 4-week post-intervention (16 weeks) follow-ups. The main outcome measures were self-report measures of shoulder pain and impairment, and the Physical Examination of the Shoulder Scale (PESS), quantitative ultrasound (QUS) metrics of the supraspinatus tendon, and the Ultrasound Shoulder Pathology Rating Scale (USPRS). RESULTS: 32 participants were randomized to HEP or CON. Average age was 44.8 +/- 12.5; 81.3% were male; 65.6% had motor complete paraplegia. Using a per-protocol, within-group analysis method, significant differences were observed between baseline and post-intervention for the HEP group for the least pain intensity (p = 0.02), number of days with shoulder pain (p = 0.042), PESS scores (dominant side, p = 0.036; non-dominant side, p = 0.008), the DASH (p = 0.028), and the Patient Global Impression of Change (p = 0.015). The CON group demonstrated significant changes in average unpleasantness of shoulder pain after the intervention period (p = 0.049). Comparisons in changes from baseline between groups showed that the HEP group had greater improvements in non-dominant side PESS scores and global impression of change, whereas the CON group had greater improvements in depressive symptoms. For QUS measures, no significant changes were found with within-group analyses for the HEP group, though the CON group demonstrated a decrease in tendon width in the non-dominant side supraspinatus tendon (p = 0.036). Comparison of changes between groups suggest that the CON group had a greater increase in dominant shoulder supraspinatus tendon US contrast at the end of the study. CONCLUSION: Changes in several measures of shoulder pain and function occurred after the HEP intervention, though the magnitude of changes were only significantly greater than those of the CON group for two measures. Significant changes in supraspinatus pathology were not detected with QUS metrics.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher