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RehabMeasures Instrument

Wheelchair User’s Shoulder Pain Index

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Purpose

The WUSPI is a self-report measure of shoulder pain in wheelchair users during functional activities.

Acronym WUSPI

Area of Assessment

Upper Extremity Function
Pain

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Key Descriptions

  • The WUSPI is composed of 15 items in the areas of:
    1) Transfers: bed-wheelchair, car-wheelchair, tub/shower-wheelchair, load wheelchair in car
    2) Wheelchair mobility: > 10 minute duration, ramp/uneven
    3) Self-Care: lift object from overhead, put on pants, put on T-shirt, put on button-down shirt, wash back
    4) General Activities: work/school activities, driving, household chores, sleeping
  • Each item is self-rated on a 10 cm visual analog scale (VAS) anchored with “no pain” and “worst pain ever experienced."

  • The ratings on each of the 15 items are added together for a total score ranging from 0-150.
  • Some studies have used a “Performance Corrected Wheelchair User’s Shoulder Pain Index (PC-WUSPI)” in cases where one or more items were not applicable (Curtis et al., 1999a; Curtis et al., 1999b; Dyson-Hudson et al., 2001; Gutierrez et al., 2007; Nawoczenski et al., 2006; Yildirim et al., 2010).
  • The PC-WUSPI score is calculated by dividing the raw total WUSPI score by the number of activities performed and then multiplying by 15. However, the psychometric properties of the PC-WUSPI have not been validated.
  • Instrument is available by contacting the original author, Kathleen Curtis, PT, PhD by email at kacurtis@utep.edu or by phone at 915-747-7201

    Description of the WUSPI is also available in Appendix 1 of Nawoczenski et al., 2006.

Number of Items

15

Time to Administer

5-10 minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by Rachel Tappan, PT, NCS, Eileen Tseng, PT, DPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in  3/2012.

ICF Domain

Body Function

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

LS

LS

R

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

R

R

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

Yes

Not reported

Considerations

  • People with limitations in hand function may have difficulty completing the VAS accurately. Use of 0-10 Numeric Rating Scale (NRS) may be considered in this situation, though the WUSPI has not been validated with a NRS.

 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Wheelchair Usage

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Standard Error of Measurement (SEM)

Long-term Wheelchair Users:

(Curtis et al, 1995a; = 16; mean age = 38.1 (12.2) years; mean time of wheelchair use = 15.0 (10.0) years; 11 subjects with SCI, 5 subjects with other disorders; calculated)

  • SEM = 1.84 points

Minimal Detectable Change (MDC)

Long-term Wheelchair Users:

(Curtis et al, 1995a; calculated)

  • MDC = 5.10 points

Test/Retest Reliability

Long-term Wheelchair Users:

(Curtis et al, 1995a) 

  • Excellent test-retest reliability (ICC = 0.99)

Internal Consistency

Long-term Wheelchair Users:

(Curtis et al, 1995b; n = 64; mean age= 42.8 (11.0) years; mean time of wheelchair use = 14.3 (8.6) years; 57 subjects with SCI, 7 subjects with polio, amputation, CVA or MS)

  • Excellent internal consistency (Cronbach’s alpha = 0.97)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Long-term Wheelchair Users:

(Curtis et al, 1995b)

  • Adequate correlation with active range of motion measurements for shoulder abduction (r = -0.49), shoulder flexion (r = -0.48)
  • Poor correlation with active shoulder extension range of motion (r = -0.30) 

Content Validity

Long-term Wheelchair Users:

(Curtis et al, 1995b)

  • A group of long-term wheelchair users reviewed the developers’ list of wheelchair activities and suggested additional activities associated with shoulder pain.

Face Validity

See Content Validity

Spinal Injuries

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Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Chronic SCI:

(Brose et al, 2008; n = 49; mean age = 44.8 (9.2) years; mean time post SCI = 16.35 (9.3) years; primary manual wheelchair users)

  • Subjects with presence of untreated shoulder pain that limited activity level had higher WUSPI scores compared to subjects without untreated pain that limited activity (mean = 40.7 points vs. 16.2 points, p = 0.03)

Construct Validity

Convergent Validity

Acute Cervical SCI:

(Salisbury et al, 2006; n = 27; mean age = 42.5 (19.9) years; complete and incomplete SCI; WUSPI administered over the phone)

  • WUSPI scores were positively correlated with pain intensity on a numeric rating scale (r = 0.723, p = 0.000)

Bibliography

Brose, S. W., Boninger, M. L., et al. (2008). "Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury." Archives of Physical Medicine and Rehabilitation 89(11): 2086-2093. Find it on PubMed

Curtis, K. A., Drysdale, G. A., et al. (1999). "Shoulder pain in wheelchair users with tetraplegia and paraplegia." Arch Phys Med Rehabil 80(10206610): 453-457. Find it on PubMed

Curtis, K. A., Roach, K. E., et al. (1995). "Development of the Wheelchair User's Shoulder Pain Index (WUSPI)." Paraplegia 33(5): 290-293. Find it on PubMed

Curtis, K. A., Roach, K. E., et al. (1995). "Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI)." Paraplegia 33(10): 595-601. Find it on PubMed

Curtis, K. A., Tyner, T. M., et al. (1999). "Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users." Spinal Cord 37(6): 421-429. Find it on PubMed

Dyson-Hudson, T. A., Shiflett, S. C., et al. (2001). "Acupuncture and Trager psychophysical integration in the treatment of wheelchair user's shoulder pain in individuals with spinal cord injury." Archives of Physical Medicine and Rehabilitation 82(8): 1038-1046. Find it on PubMed

Gutierrez, D. D., Thompson, L., et al. (2007). "The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia." Journal of Spinal Cord Medicine 30(3): 251. Find it on PubMed

Nawoczenski, D. A., Ritter-Soronen, J. M., et al. (2006). "Clinical trial of exercise for shoulder pain in chronic spinal injury." Physical Therapy 86(12): 1604-1618. Find it on PubMed

Salisbury, S. K., Nitz, J., et al. (2006). "Shoulder pain following tetraplegia: a follow-up study 2-4 years after injury." Spinal Cord 44(12): 723-728. Find it on PubMed

Yildirim, N. U., Comert, E., et al. (2010). "Shoulder pain: a comparison of wheelchair basketball players with trunk control and without trunk control." J Back Musculoskelet Rehabil 23(2): 55-61. Find it on PubMed

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