Correlations between pain, functioning, and quality of life in manual wheelchair users with spinal cord injury

Abstract

BACKGROUND : Pain after spinal cord injury (SCI) is one of the most important contributors to poor rehabilitation outcomes, reduced quality of life (QOL) as well as poorer physical, social, and psychological functioning. OBJECTIVE : To determine the correlation of overall and shoulder pain on functioning and QOL in community-dwelling people with SCI. METHODS : This quantitative correlational study included people with SCI with or without pain, who were discharged from five rehabilitation hospitals in Gauteng, South Africa. The presence of pain, wheelchair function, and QOL were investigated using the Numeric Rating Scale, Wheelchair Function Test Questionnaire, and the WHOQOL-BREF questionnaire. Pectoralis minor muscle (PMm) length was measured using a Vernier caliper and the Scapular Dyskinesis test was used to observe for scapular dyskinesis. Descriptive statistics; Independent t-tests, ANOVA tests, and Fisher's exact tests were performed using the SPSS v27 at a 0.05 level of significance. RESULTS : 85% of the 122 participants reported overall pain, mainly burning (32.7%) and below the level of injury (39.4%), with only 14.8% reporting shoulder pain. There was no overall difference in QOL between participants with and without pain, however, pain prevented individuals from doing what they needed to do (p < 0.05). Pain severity was negatively correlated with QOL (p < 0.001) and sleep satisfaction (p < 0.05). There were no correlations found between shoulder pain and PMm length, as well as scapular dyskinesis. However, there was a negative correlation between shoulder pain and wheelchair function in those who reported shoulder pain (p < 0.01). CONCLUSION : Pain is problematic after SCI and although shoulder pain is not as prominent, it has the potential to negatively impact an individual's ability to use their wheelchair effectively. CONTRIBUTION : Findings from this study emphasise the negative role of pain on life satisfaction and QOL. Stakeholders involved in SCI rehabilitation can consider including comprehensive pain management within the interprofessional model of care.