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

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.
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.
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.
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.
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.

对于脊髓损伤（Spinal Cord Injury, SCI）患者而言，深入了解其肩痛体验，对于指导康复设备的处方与设计、移动训练、肢体锻炼、休闲活动以及疼痛教育均至关重要。疼痛评估方法的标准化，是开展跨研究对比与元分析的必要前提。此前尚无研究对使用移动轮椅（Mobile Wheelchair, MWC）的成年脊髓损伤患者所采用的肩痛评估手段的完整范畴进行系统梳理。

本次范围综述旨在明确：在已发表的同行评议研究中，针对使用移动轮椅的脊髓损伤患者开展肩痛评估时所采用的测量工具与方法。

本研究于2023年2月23日通过多数据库开展文献检索。数据提取维度涵盖研究设计类型、纳入排除标准、样本量以及疼痛测量工具；同时提取受试者的人口学与临床特征，包括年龄、性别、脊髓损伤后时长、脊髓损伤平面以及移动轮椅使用情况。

本次范围综述共纳入133项针对该群体肩痛报告的研究，涉及20余种评估工具。其中30%的研究出于多重目的开展肩痛评估（如筛查、基线评估、结局指标评估），56%的研究采用了不止一种评估手段。轮椅使用者肩痛指数（Wheelchair Users Shoulder Pain Index, WUSPI）是最为常用的评估工具。

对疼痛的深入理解需依托生物-心理-社会框架开展测量，且往往需要结合多种评估工具。总体而言，研究人员面临的挑战在于，需筛选出契合研究设计需求与研究问题的有效、可靠的评估工具。本文提供了指导性问题，以协助研究人员选择合适的疼痛评估工具。