Curtis et al. 1999
USA
PEDro =5
RCT
N=42

Population: Mean age = 35 yrs; Gender: males = 35, females = 7; Level of injury = cervical to lumbar; Duration of wheelchair use = 24 yrs.
Treatment: The experimental group attended a 60min educational session where they were instructed in 5 shoulder exercises.
Outcome Measures: Self report questionnaire (demographic and medical info), WUSPI, and VAS used to rate intensity of pain.

1. When looking at the effect of exercise intervention on performance corrected (PC) WUSPI, a 2 factor repeated measures ANOVA showed a significant effect of time only (p=0.048).
2. There were no significant differences between control and experimental group in age, years of wheelchair use or activity levels although the control group had much lower pain scores at baseline.

Nawoczenski et al. 2006
USA
Downs & Black score=21
Prospective controlled trial
N=41

Population: Exercise group: Mean age=47.1yrs; Gender: males=15, females=6, Level of injury: C=3, T2-T7=7, T8-T12=7, L=4; Severity of injury: incomplete=13, complete=8; Control group: Mean age=38.1yrs; Gender: males=13, females=7, Level of injury: T2-T7=7, T8-T12=12, L=1; Severity of injury: incomplete=6, complete=14;
Treatment: Those in the experimental group (n=21) were given an 8-week home exercise program consisting of stretching and strengthening exercises. This program was augmented at 4 weeks (or sooner). Changes included increasing elastic band resistance, increasing repetitions, or both. The asymptomatic control group (n=20) was not given any exercises.
Outcome Measures: WUSPI; SRQ

1. SRQ and WUSPI scores significantly improved in the experimental group, pre- to post-test (p<0.001 and p=0.002, respectively).
2. Those in the asymptomatic control group did improve.
3. Over time, satisfaction scores in the intervention group significantly improved (p<0.001).

Nash et al. 2007
Netherlands
D&B=16
Pre-Post
N=7

Population: Age=39-58yrs; Level of injury=T5-T12; Severity of injury=complete.
Treatment: Seven participants volunteered to undergo 16 weeks of circuit resistance training (CRT), 3 times weekly on non-consecutive days, each session lasting 45 min. Included were: circuit resistance training, low-intensity endurance activities, military press, horizontal rows, pectoralis (horizontal row), preacher curls, wide-grip latissimus pull-downs, and seated dips.
Outcome Measures: WUSPI

1. Participants reported a reduction in pain. WUPSI scores decreased from 31.8±23.5 to 5.0±7.7 (p=0.008). 3/7 participants reported near-complete resolution of shoulder pain following treatment.
2. All completed training, with peak Vo2 values increasing from 1.64 ±0.45 to 1.81± 0.54L/min (p=0.01).
3. Anaerobic power increased significantly as a result of training; peak power increased by 6% and average power by 8.6% (p=0.005 and p=0.001, respectively).

Finley & Rogers 2007
USA
Downs & Black score=15
Pre-Post
N=17

Population: Mean age = 46 yrs; Gender: males = 9, females = 8; Mean duration of wheelchair use = 15 yrs; Type of disability: SCI = 9, spina bifida = 1, ataxia = 1, postpolio syndrome = 1, spinal stenosis = 1, Stroke = 1, rheumatoid arthritis = 1.
Treatment: 4-wk baseline phase where patients used personal wheelchairs (no intervention), followed by a 5-month phase where patients used the intervention wheelchair (MAGICWheels 2-gear wheel). There was a 4-wk retention period in which patients used their personal wheels again. Once a day patients were instructed to navigate in uneven terrain or on a hill.
Outcome Measures: WUSPI, WUFA, self-reported activities (Activities Log), and timed hill climb test with RPE.

1. Shoulder ROM, upper-extremity strength, or the occurrence of specific shoulder diagnoses did not differ after use of MAGICWheels (P<0.05).
2. Shoulder pain was significantly decreased following the treatment at wk 2 (P=0.004) through wk 16 (P=0.015).
3. At week 20, one patient reported increased pain from unrelated factor.
4. During the 4-wk retention phase, the WUSPI scores indicated a trend toward increasing shoulder pain. However, no significant increase was found compared to the last week of using the MAGICWheels (P<0.05).
5. During the MAGICWheels phase, patients encounter significantly more carpeted (P<0.01) and grass (P<0.001) surfaces in comparison to the baseline phase.
6. During the retention phase patients encountered significantly more hills (P=0.009) and gravel (P=0.03) surfaces in comparison to the baseline phase.
7. No difference was found in WUFA following the use of the 2-gear wheel (P=0.06).
8. There was significantly longer hill time during the use of the 2-gear wheel (P=0.01), however no difference was found in the RPE (P=0.013).