Self-reported shoulder pain assessment in adults with spinal cord injury who use a manual wheelchair: A scoping review

Context: For individuals living with spinal cord injury (SCI), a deep understanding of their shoulder pain experience is crucial to guide equipment prescription/design, mobility training, exercise, recreation, and pain education. Standardization in pain assessment methods is necessary for cross-study comparisons and meta-analyses. No previous studies describe the spectrum of shoulder pain assessment measures applied to adults with SCI who use MWCs for mobility. Objective: This scoping review aimed to determine the measurement instruments and methods of shoulder pain assessment used in peer-reviewed, published literature in studies focused on individuals with SCI who use MWCs. Methods: A literature search was performed using multiple databases on February 23, 2023. Data extraction elements included study design type, inclusion/exclusion criteria, sample size, and pain measurement instrument. Participant characteristics were also extracted including age, sex, time since SCI, level of SCI, and MWC use. Results: This scoping review identified over 20 instruments used in 133 studies that focused on reported shoulder pain in studies of this population. Thirty percent of the studies performed shoulder pain assessment for more than one purpose (screening, baseline, outcome), and 56% used more than one assessment measurement. The Wheelchair Users Shoulder Pain Index was the most commonly used instrument. Conclusion: An in-depth understanding of pain requires measurement within a biopsychosocial framework and likely involves multiple instruments. Overall, investigators are challenged to select valid, reliable instruments that fulfill the demands of study design and questions of interest. Guiding questions are provided to assist investigators in their choice of pain instruments.