Managing shoulder pain in manual wheelchair users: a scoping review of conservative treatment interventions

OBJECTIVE: To review the literature that has explored conservative treatments for the management of shoulder pain in manual wheelchair users. METHODS: Five databases were systematically searched in february 2020 for terms related to shoulder pain and manual wheelchair use. Articles were screened and included if they investigated the conservative treatment of shoulder pain in wheelchair users. Participants’ physical characteristics, experimental design and primary and secondary outcome measures were extracted from studies. Studies were grouped according to treatment type to identify gaps in the literature and guide future research. RESULTS: The initial search identified 407 articles, of which 21 studies met the inclusion criteria. Exercise-based treatment interventions were most prevalent (n = 12). A variety of exercise modalities were employed such as strengthening and stretching (n = 7), ergometer training (n = 3), Pilates classes (n = 1) and functional electrical stimulation (n = 1). Only three studies supplemented exercise with an additional treatment type. The Wheelchair Users Shoulder Pain Index was used by 18 studies as the primary measure of shoulder pain. Only seven of these included an objective measure of shoulder function. Participant characteristics varied among studies, and physical activity levels were frequently not reported. CONCLUSIONS: Despite the high prevalence of shoulder pain in manual wheelchair users, the number of studies to have explored conservative treatment types is low. Exercise is the most commonly used treatment, which is encouraging as physical inactivity can exacerbate other health conditions. Few studies have adopted interdisciplinary treatment strategies or included objective secondary measures to better understand the mechanisms of pain.