- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02135978
Maintenance of Shoulder Health and Function After Spinal Cord Injury
Southern California Spinal Cord Injury Model System: A Randomized Clinical Trial to Evaluate Two Prevention Programs for Maintenance of Shoulder Health and Function After Spinal Cord Injury
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
All persons are at risk for shoulder pain from a shoulder injury or rotator cuff injury. Persons with SCI are at a greater risk because of the increased use of their shoulders. Lifestyle changes following SCI place a large demand on an individual's shoulders. Pushing a wheelchair, transferring, and performing pressure relief raises are three common activities that put added strain on the shoulders. In addition to these activities, reaching from a wheelchair can put strain on the shoulder because many environments are not ideally set up for wheelchair users. These new stressors are believed by the medical community to lead to shoulder pain. The prevalence of shoulder pain for persons with spinal cord injury is 30-70%. Untreated, shoulder pain may lead to additional losses in function and community mobility.
Previous research shows that shoulder exercises along with education on how to improve one's technique for wheelchair propulsion, transfers, and weight relief raises can significantly reduce chronic shoulder pain and improve quality of life. The investigators aim to not only reduce existing shoulder pain, but also to prevent the onset of new pain.
The current study will teach the same 4 simple shoulder strengthening exercises performed in the prior study to patients with healthy shoulders. Half of the patients will receive 2 sessions of one-to-one training with a physical therapist, and the other half will receive 4 sessions of training combined with an interactive education program on techniques to protect their shoulder in a class format led by a physical therapist and a peer mentor with a spinal cord injury. Patients will be followed for 3 years to learn if they develop shoulder pain.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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California
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Downey, California, United States, 90242
- Rancho Los Amigos National Rehabilitaiton Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- spinal cord injury
- at least 2 years duration post spinal cord injury and no greater than 20 years duration post spinal cord injury
- at least 18 years of age
- free of shoulder pain that interferes with daily activities or requires medical intervention at the time of enrollment in the study
- a total score on the "Wheelchair User's Shoulder Pain Index" of 10 or less
- adequate arm strength and movement to perform the shoulder exercise program
Exclusion Criteria:
- positive shoulder impingement signs (positive Hawkins-Kennedy test and painful arc in shoulder abduction or flexion)
- biceps tendonitis (positive Speed's test)
- adhesive capsulitis, or cervical radiculopathy
- a history of shoulder injury or surgery or orthopedic or neurologic disorders (other than SCI) that would impact arm function
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: One-to-one training group for shoulder home exercise program
Patients will attend two sessions of one-to-one training with a physical therapist to learn the shoulder home exercise program.
The sessions are 4 weeks apart.
They will also review a handout on techniques to protect their shoulder during wheelchair propulsion and transfers.
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Patients receive instruction and practice on the shoulder home exercise program, receive a notebook with handouts including pictures and written instructions on how to perform the program, and receive a kit containing the exercise equipment.
Patients are asked to perform the exercises at home 3 days a week over the next 3 years.
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Active Comparator: Enhanced training group for shoulder home exercise program
Patients will attend four classes held each week for 4 consecutive weeks.
The classes are led by a physical therapist and a peer mentor (with a spinal cord injury).
Two to four research patients are in each class.
Classes begin with an interactive education presentation on techniques and recommendations to protect the shoulder during transfers, wheelchair propulsion, raises and activities of daily living.
This is followed by performance of the home exercise program.
Patients will be called every 3 to 6 months by a peer mentor to receive encouragement, praise, and/or problem solve barriers to exercise.
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Patients receive instruction and practice on the shoulder home exercise program, receive a notebook with handouts including pictures and written instructions on how to perform the program, and receive a kit containing the exercise equipment.
Patients are asked to perform the exercises at home 3 days a week over the next 3 years.
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No Intervention: Historical control group
Historical control group has received no intervention.
Eligibility criteria, outcome measures and study duration for historical control group is matched for the experimental group and active comparator.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Presence of shoulder pain
Time Frame: 36 month (3 year) evaluation time point
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Presence of shoulder pain will be measured using the "Wheelchair User's Shoulder Pain Index".
This questionnaire uses a visual analog scale to rate level of shoulder pain during the previous week while performing 15 common daily activities such as transferring from the bed to a wheelchair or pushing a wheelchair > 10 minutes.
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36 month (3 year) evaluation time point
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Activity levels
Time Frame: Baseline and every 2-3 months over the 3 year study
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Patients will be called every 2-3 months to report the frequency and intensity of their shoulder exercise program.
Patients will be asked questions about their arm use specific to their functional abilities during the previous 1 to 3 days, such as the number of transfers performed, number of depression raises performed, how often they use their arms for chores or use their arms to help with walking (if applicable).
All patients with a manual wheelchair will have an odometer installed on their wheelchair and will report their distance and speed of wheelchair propulsion.
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Baseline and every 2-3 months over the 3 year study
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Shoulder torque
Time Frame: Baseline, 18 month, and 36 month evaluation time points
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Shoulder torque testing will be performed using either a Biodex machine or a handheld dynamometer for the motions of isometric shoulder abduction, adduction, flexion, extension, internal rotation and external rotation.
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Baseline, 18 month, and 36 month evaluation time points
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Self-Efficacy
Time Frame: Baseline, 18 month and 36 month evaluation time points
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Patients will complete a questionnaire rating their confidence or self-efficacy in regards to exercise.
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Baseline, 18 month and 36 month evaluation time points
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Community Participation
Time Frame: Baseline, 18 month and 36 month evaluation time points
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Patients will asked to complete the questionnaire, "Reintegration To Normal Living Index".
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Baseline, 18 month and 36 month evaluation time points
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Sara J Mulroy, PhD, PT, Rancho Research Institute and Rancho Los Amigos National Rehabilitation Center
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- H133N110018
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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