Strengthening and Optimal Movements for Painful Shoulders - Essay Example

?Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in Chronic Spinal Cord Injury: A Randomized Controlled Trial... This article can be found at this link: http://www.rancho.org/Research/Stomps.pdf Introduction This article that I chose is about the effectiveness of Strengthening and Optimal Movements for Painful Shoulders or STOMPS therapy for patients who have had chronic spinal cord injuries. This was the article I chose because as a future physical therapist assistant, I feel that it is part of my duty to know about exercises such as these that are aimed at increasing the patient’s quality of life even if he has a disability. It interested me because this is an exercise focused on strengthening the upper extremities needed by paraplegics that can be done at home, without having to go to a physical therapy clinic, or having to use large setups or expensive equipment. Shoulder pain is common in people who have had chronic spinal cord injuries. Using the upper extremities as weight-bearing limbs for prolonged amounts of time can be stressful to the muscles of those extremities, resulting in severe pain that could limit the capabilities of the patient to perform even everyday tasks. This article determines the effectiveness of this exercise program in optimizing the performance of upper-extremity tasks on shoulder pain in paraplegics from spinal cord injuries. Previous research done by Lundquist and colleagues, and Gutierrez et al. have both come to the conclusion that shoulder pain is a definitive factor in the lower quality of life scores in patients with spinal cord injuries. This prompts researchers to look for ways to mend this problem. Previous studies have shown that strengthening workout tailor fit to suit the needs of paraplegics can help reduce pain as effectively as surgery, without the tremendous cost. This trial is the first to record the efficacy of the STOMP exercise program, putting it as an important source of information on the matter. Even though this study succeeded, it needs more studies to see if the same treatment can also help patients with tetraplagia. The author’s purpose for this study was “to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from spinal cord injury” (Mulroy et al., 2011, p. 305). There were also secondary purposes for this trial wherein they wanted to “determine the impact of the intervention on physical activity and participation, including health-related and overall self-reported quality of living,” and “to identify whether improvements in pain or function would be maintained for 4 weeks after the end of the intervention” (Mulroy et al., 2011, p. 307). Methods Participants and Procedure The participants for this trial were volunteers who responded to flyers posted at outpatient clinics at Rancho Los Amigos National Rehabilitation Center. The inclusion criteria included: (1) post pubescent onset of paraplegia at age 14 years or older, (2) had a Spinal Cord Injury of at least 5 years’ duration, (3) were between 19 and 75 years of age, (4) had unilateral or bilateral shoulder pain that interfered with at least one functional task, (5) used a manual wheelchair for mobility at least 50% of the time, and (6) had the ability to understand informed consent (Mulroy et al., 2011, p. 307). Some of the participants were also excluded from the study because of the following criteria: (1) hospitalization within the previous month; (2) cortisone injection to the shoulder within the previous 4 months; (3) fracture within the previous year; (4) shoulder surgery to the painful side within the previous year; (5) diagnosis of complete rotator cuff tear, rheumatoid arthritis, adhesive capsulitis at the shoulder, or complex regional pain syndrome; (6) positive ?ndings on all 3 clinical tests for full-thickness rotator cuff tear; (7) any serious medical conditions; (8) major depression; or (9) alcohol abuse (Mulroy et al., 2011, p. 307). Participants were recruited from the RLANRC in Downey, California from March 2004 to December 2005. Among the 127 individuals screened for eligibility, a total of 80 participants were eligible for randomization into two groups: the exercise optimization group and the attention control group. The 71% of the participants were men and the average age was 45 years. The most common form of spinal cord injury in both groups was subacromial impingement, which afflicted 83% of the participants. Materials/Measures: Participants in the exercise optimization group were given instructions by a physical therapist in a 12-week shoulder home exercise program and in strategies to optimize transfers, depression raises and wheelchair propulsion technique. They were also given written instructions and picture illustrations for all the exercises, as well as an elastic band and a dumbbell. They were told to input their progress on a Physical Activity Calendar. This was different from what was given to the attention control group who were given an instructional video about shoulder anatomy, mechanisms of injury and general concepts in managing shoulder pain. They were also given a handout and a brochure about general shoulder care. All participants were assessed by blinded physical therapists before and after the 12-week intervention and at week 16, four weeks after the intervention. The assessment included the Wheelchair User’s Shoulder Pain Index (WUSPI). This questionnaire uses visual analog scales (VASs) with 10-cm lines indicating between “no pain” to “worst pain ever experienced,” with a total score of 150 to assess shoulder pain as the primary outcome measure. Muscle strength was assessed using the Micro-FET handheld dynamometer; Self-selected wheelchair propulsion speed over a 25-m distance was also measured; and the Physical Activity Scale for Individuals with Physical Disabilities (PASIPID) measured how physically active a person had been in the previous week; The Social Interaction Intervention (SII) measured community involvement and Quality of Life using the 36-Item Short-form Health Survey (SF-36) questionnaire, and the Subjective Quality of Life Scale (SQOL). The SQOL has a seven point scale with 1 being a low rating meaning “Life is very distressing,” 7 being “Life is great,” and “Life is so-so” in the middle. Results Even though some participants withdrew or were not able to finish the study due to various reasons, the results show that shoulder pain, as measured by the Wheelchair User’s Shoulder Pain Index, was reduced to one third of baseline levels after the intervention done to the exercise optimization group while it remained unchanged in the attention control group. There were also improvements to shoulder torques, and quality of life scores in the exercise optimization group, but not in the attention control group. These results were still seen at the 16-week mark, four weeks after intervention. Discussion There were two limitations to the study reported by the authors. Most of the outcome measures were self-reported, and many participants withdrew in both groups. My own limitations would be that the information is mostly subjective. What is painful or tiring to one individual might be tolerable to another. There are cultural and psychological factors that would affect a person’s tolerance of pain and fatigue. Also, the age range was quite wide. Between 19-75 years of age, people of those ages have different capacities, and a 30 year old person who has been on a wheelchair since he was 15 would have had more time to get used to using his upper extremities, as opposed to a 20 year old who had a spinal cord injury 5 years ago. Aside from the fact that the intervention worked, I also learned that simple and cost-effective therapy at home can be as effective as outpatient Physical Therapy sessions at the clinic; I learned that strength training is very important physical therapy for paraplegics since their upper extremities will have to make up for the loss of function in his lower extremities; Also, I learned that different people have different tolerances to the therapy, thus, the necessity of having instruction to optimize movement performance techniques. Reference Mulroy, S., Thompson, L., Kemp, B., Hatchett, P., Newsam, C., Lupold, D., Haubert, L., Eberly, V., Ge, T., Azen, S., Winstein, C., & Gordon, J. (2011). Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in chronic spinal cord injury: A randomized trial. Physical Therapy, 91 (3), 305-324. Retrieved from http://www.rancho.org/Research/Stomps.pdf Read More