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Strong For Recommendation
Shoulder exercises should be provided to treat shoulder pain in people with SCI.
Shoulder exercises (v no intervention) on shoulder pain (treatment) in people with SCI
P
People with SCI who have shoulder pain
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Strong opinion statement FOR
Shoulder exercises should be provided to treat shoulder pain in people with SCI.
I
Shoulder exercises
C
No intervention
Consensus-based opinion statement
Strong for (81%)
O
Shoulder pain
SUMMARY
5 RCTs
Mean difference (95% CI): Pain on Wheelchair Users Shoulder Pain Index in points
Consider studies independently. Unable to pool I2=76%
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
Very serious
Imprecision
Serious
Indirectness
No serious
Publication bias
Serious
SHOULDER EXERCISES FOR SHOULDER PAIN: GRADE Evidence to Decision
PROBLEM
No
Probably no
Probably yes
Yes
Don't know
DESIRABLE EFFECTS
Trivial
Small
Moderate
Large
Don't know
UNDESIRABLE EFFECTS
Large
Moderate
Small
Trivial
Don't know
CERTAINTY OF EVIDENCE
Very low
Low
Moderate
High
No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME
Important uncertainty or variability
Possibly important uncertainty or variability
Probably no important uncertainty or variability
No important uncertainty or variability
BALANCE OF EFFECTS
Favours the Control
Probably favours the Control
Does not favour either the intervention (I) or the comparison (C)
Probably favours the I
Favours the I
Don't know
RESOURCES REQUIRED
Large costs
Moderate costs
Negligible costs and savings
Moderate savings
Large savings
Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES
Very low
Low
Moderate
High
No included studies
COST EFFECTIVENESS
Favours the comparison
Probably favours the comparison
Does not favour either the intervention or the comparison
Probably favours the intervention
Favours the intervention
No included studies
EQUITY
Reduced
Probably reduced
Probably no impact
Probably increased
Increased
Don't know
ACCEPTABILITY
No
Probably no
Probably yes
Yes
Don't know
FEASIBILITY
No
Probably no
Probably yes
Yes
Don't know
SHOULDER EXERCISES FOR SHOULDER PAIN Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
CARDENAS 2019
Shoulder home exercise
programme
V
Control
(education)
3 x per week for 12 weeks based on Mulroy 2011
People with SCI and shoulder pain (all levels)
11/8
Wheelchair users Shoulder Pain Index (WUSPI)
High Risk of Bias
PEDro = 6/10
CURTIS 2011/b>
Shoulder exercises
V
No intervention
5 exercises twice daily for 6 months
C6 or lower SCI
17/18
WUSPI
Some Concerns of
Risk of Bias
PEDro = 4/10
DONDAL 2015
Shoulder strengthening and stretching exercises
V
No intervention
3 x per week for 4 weeks
Below T1 SCI
15/15
WUSPI
High Risk of Bias
PEDro = 6/10
MULROY 2011
Home-based shoulder exercise programme
V
Control (education)
3 x per week for 12 weeks
T2 to T7 SCI with shoulder pain
26/32
WUSPI
High Risk of Bias
PEDro = 7/10
NIGHTINGALE 2018
Arm cranking (portable desktop ergometer)
V
No intervention
4 x per week for 6 weeks (moderate intensity)
Below T2 SCI
13/8
WUSPI
Some Concerns of
Risk of Bias
PEDro = 5/10
The Australian and NZ SCI Physiotherapy guideline committee recommends shoulder exercises to treat shoulder pain in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts even though there is five randomised controlled trials related to this topic. However, the result of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Shoulder exercises should be provided to treat shoulder pain in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. The results of five randomised controlled trials were also taken into consideration. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend shoulder exercises to treat shoulder pain in people with SCI based on opinion. To learn more about the research related to this intervention go to the research summary on the website.
Cardenas DD, Felix ER, Cowan R, et al. Effects of Home Exercises on Shoulder Pain and Pathology in Chronic Spinal Cord Injury: A Randomized Controlled Trial. American journal of physical medicine & rehabilitation 2020; 99: 504-513.
Curtis KA, Tyner TM, Zachary L, et al. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users. Spinal cord 1999; 37: 421-429.
Dondal K, Kulkarni V, Patole R, et al. Effect of Shoulder Exercises on Functional Performance in Paraplegic Wheelchair users having Shoulder Pain. Indian Journal of Physiotherapy & Occupational Therapy 2015; 9: 83-86.
Mulroy SJ, Thompson L, Kemp B, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Physical therapy 2011; 91: 305-324.
Nightingale TE, Rouse PC, Walhin JP, et al. Home-based exercise enhances health-related quality of life in persons with spinal cord injury: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2018 Oct;99(10):1998-2006.
