An Overview of Neck Pain in Wheelchair Users: Difference between revisions
mNo edit summary |
(Additions made) |
||
| Line 1: | Line 1: | ||
This page will be discussing Neck Pain (acute, sub-acute or chronic) | This page will be discussing Neck Pain (acute, sub-acute or chronic) that has developed since becoming a wheelchair user, discussing the prevalence, aetiology and management of this area in this specific population. Neck pain is a very broad complaint and can have a wide variety of causes, however this page will focus on musculoskeletal type neck pain, which is common in wheelchair users. | ||
== Wheelchair Users as a population == | == Wheelchair Users as a population == | ||
There are approximately '''1.2million''' wheelchair users in the UK. | There are approximately '''1.2million''' wheelchair users in the UK. However within this large population there are a variety of different types of wheelchair users, such as self propelled, assistant propelled and electric powered wheelchair users and the needs of all of them can be subtly different. Usage varies from daily use to competitive use. There are also those who are ambulatory wheelchair users - users who can at times mobilise without the need for a chair but use a chair for more effective, appropriate or pain-free ways of getting around. | ||
(NHS England, 2014)<ref>NHS England. (2014). Improving Wheelchair Services. Available: <nowiki>https://www.england.nhs.uk/wheelchair-services/</nowiki>. Last accessed 22nd May 2019.</ref> | (NHS England, 2014)<ref>NHS England. (2014). Improving Wheelchair Services. Available: <nowiki>https://www.england.nhs.uk/wheelchair-services/</nowiki>. Last accessed 22nd May 2019.</ref> | ||
[[File:Neck Pain Diagram.png|thumb|<ref>http://masteringhealthhappiness.com/2017/06/27/easily-reduce-neck-pain-by-making-these-small-changes-to-your-daily-activities/</ref>]] | |||
== 'Mechanical' Neck Pain == | |||
What do we mean by mechanical neck pain? Clinical features, pain that isn't neuropathic/ inflammatory etc., and how it is assessed[[File:Neck Pain Diagram.png|thumb|<ref>http://masteringhealthhappiness.com/2017/06/27/easily-reduce-neck-pain-by-making-these-small-changes-to-your-daily-activities/</ref>]] | |||
== Prevalence of Neck Pain in Wheelchair Users == | == Prevalence of Neck Pain in Wheelchair Users == | ||
=== General Pain in Wheelchair Users === | ==== '''General Pain in Wheelchair Users''' ==== | ||
A qualitative study interviewed 64 electric powered wheelchair users about their experiences of pain: | A qualitative study interviewed 64 electric powered wheelchair users about their experiences of pain since becoming a wheelchair user: | ||
* 86% of participants experienced pain related to sitting in past or present wheelchairs | * 86% of participants experienced pain related to sitting in past or present wheelchairs | ||
* 59% felt their pain was influenced by their | * 59% felt their pain was influenced by their wheelchair | ||
* 17% reported experiencing severe pain | * 17% reported experiencing severe pain | ||
(Frank et al, 2014)<ref name=":0">Frank, A. De Souza, L. Frank, J. Neophytou, C. (2012). The pain experiences of powered wheelchair users. Disability and Rehabilitation . 34 (9), 770-778.</ref> | (Frank et al, 2014)<ref name=":0">Frank, A. De Souza, L. Frank, J. Neophytou, C. (2012). The pain experiences of powered wheelchair users. Disability and Rehabilitation . 34 (9), 770-778.</ref> | ||
=== Neck Pain in Wheelchair Users === | ==== '''Neck Pain in Wheelchair Users''' ==== | ||
A cross-sectional study with 68 participants recruited from the National Veteran's Wheelchair Games: | A cross-sectional study with 68 participants recruited from the National Veteran's Wheelchair Games: | ||
* 66% (n=45) reported neck/upper back pain at any time since they started using a wheelchair | * 66% (n=45) reported neck/upper back pain at any time since they started using a wheelchair | ||
( | (Boninger et al, 2003)<ref name=":1">Boninger, M.L., Cooper, R.A., Fitzgerald, S.G., Lin, J., Cooper, R., Dicianno, B. and Liu, B., 2003. Investigating neck pain in wheelchair users. American journal of physical medicine & rehabilitation, 82(3), pp.197-202</ref> | ||
A cross-sectional study with 750 participants conducted at 4 major Spanish hospitals offering education and training related to using a wheelchair permanently, either due to spinal cord injury or other reasons. | A cross-sectional study with 750 participants conducted at 4 major Spanish hospitals offering education and training related to using a wheelchair permanently, either due to spinal cord injury or other reasons. | ||
* 56% reported neck pain | * 56% reported neck pain | ||
(Kovacs et al, 2018)<ref name=":2">Kovacs, F.M., Seco, J., Royuela, A., Barriga, A. and Zamora, J., 2018. Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study. Spinal cord, 56(4), p.392.</ref> | (Kovacs et al, 2018)<ref name=":2">Kovacs, F.M., Seco, J., Royuela, A., Barriga, A. and Zamora, J., 2018. Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study. Spinal cord, 56(4), p.392.</ref> | ||
What is shown from these two studies, is that a 'mechanical' musculoskeletal type neck pain is a common condition affecting those in wheelchair users. Specifically, the Kovacs et al research used a robust inclusion/exclusion criteria meaning that only those with a 'mechanical' type pain as opposed to neuropathic or inflammatory type pain (that may be present in cases of rheumatoid arthritis or ankylosing spondylitis) were included and still showed a 56% prevalence of neck pain in a large sample size. Having said this, Kovacs also identifies that there is limited research pertaining to 'mechanical' spinal pain at all levels within wheelchair users as a population. | |||
== Aetiology and Risk Factors == | |||
There has been research in to potential causes of neck pain in wheelchair users, with a lot of the research focusing on a broad area of 'wheelchair ergonomics' and associating the effects of positioning and posture in wheelchair users with neck pain. There has also been research in to the effect of different terrains and neck pain and also another possible cause of neck pain in this population may be underlying conditions which may or may not have led to them becoming a wheelchair user. It is important that there is a strong consideration of the biopsychosocial model of health, when it comes to wheelchair users who require a holistic approach to their management and understanding of the challenges being in a wheelchair exposes them to. | |||
==== '''Wheelchair ergonomics''' ==== | |||
Wheelchair ergonomics relates to a wide variety of issues that ultimately may impact on the positioning of patients in a wheelchair. This may include seat heights, widths and depths, thoracic supports, lumbar supports, cervical supports, arm supports or any other adaptations that may influence positioning and subsequently the neck posture and position in patients. | |||
For example: A patient may have become a wheelchair user as a result of a neuro-degenerative condition such as multiple sclerosis and as a result have a very impaired sitting balance due to a loss of muscle strength, endurance and co-ordination. As a result they may require a variety of wheelchair supports in order to keep them in a comfortable position. All of these adaptations can influence the posture of the patient. | |||
Seat height has an impact on the neck position during function. In a 2016 study<ref>Sabari, J. Shea, M. Chen, L. Laurenceau, A. Leung, E. (2016). Impact of wheelchair seat height on neck and shoulder range of motion during functional task performance. Assistive Technology. 20 (3), 183-189.</ref>, a lower seat height was shown to cause participants to go in to greater cervical extension and shoulder abduction which was associated with repetitive overuse type injuries to shoulder complex and C-spine in wheelchair users. | |||
As a result of this it is important that when a patient becomes a wheelchair user, they are referred to 'Wheelchair Services' and are provided with a wheelchair that is best suited to their needs and is an appropriate fit when it comes to factors such as seat depth, width, height and has the required supports where needed. If conditions or symptoms change or develop as a wheelchair user and there is a concern that the wheelchair no longer is adequate, again this should require a referral to wheelchair services for an assessment and alterations to the chair made as required. | |||
| | ||
| Line 32: | Line 48: | ||
'''(Frank et al, 2014)''' - This Paper included users who had been wheelchair users for 10 years before the interviews. However, it only interviewed wheelchair users who used Electric Powered Indoor/Outdoor Chairs (EPIOC) making it difficult to apply to other varieties of wheelchairs. Additionally, interviews were done over telephone eliminating the use of non-verbal communication making difficult to gain information from some participants who had communication difficulties. Furthermore, diagnostic data about participants was provided by the participants and not professional referrals. However, the authors stated that the participants were given appropriate diagnostic information by healthcare professionals. Lastly, this paper was aware of its limitations and provided a good analysis of qualitative data. | '''(Frank et al, 2014)''' - This Paper included users who had been wheelchair users for 10 years before the interviews. However, it only interviewed wheelchair users who used Electric Powered Indoor/Outdoor Chairs (EPIOC) making it difficult to apply to other varieties of wheelchairs. Additionally, interviews were done over telephone eliminating the use of non-verbal communication making difficult to gain information from some participants who had communication difficulties. Furthermore, diagnostic data about participants was provided by the participants and not professional referrals. However, the authors stated that the participants were given appropriate diagnostic information by healthcare professionals. Lastly, this paper was aware of its limitations and provided a good analysis of qualitative data. | ||
'''( | '''(Boninger et al, 2003)''' - Crit App: Limited Sample size, not enough literature looking at neck pain with wheelchair users, included no inclusion or exclusion criteria | ||
'''(Kovacs et al, 2018)''' - Inclusion criteria, age >18 and permanent wheelchair user for more than >1 year. Exclusion | '''(Kovacs et al, 2018)''' - Inclusion criteria, age >18 and permanent wheelchair user for more than >1 year. Exclusion criteria sitting in a wheelchair intermittently or temporarily, suffering from physical or mental inability, which made it impossible to respond to the interviewer’s questions (e.g., pentaplegia or senile dementia), reporting being unable to distinguish neuropathic from mechanical pain, presenting fever, and having been diagnosed (or being in the diagnostic process) of cancer, systemic infection, or any inflammatory diseases such as spondylitis or rheumatoid arthritis. Crit appraisal: strong robust methology, well defined exclusion and inclusion criteria | ||
Revision as of 20:25, 26 May 2019
This page will be discussing Neck Pain (acute, sub-acute or chronic) that has developed since becoming a wheelchair user, discussing the prevalence, aetiology and management of this area in this specific population. Neck pain is a very broad complaint and can have a wide variety of causes, however this page will focus on musculoskeletal type neck pain, which is common in wheelchair users.
Wheelchair Users as a population[edit | edit source]
There are approximately 1.2million wheelchair users in the UK. However within this large population there are a variety of different types of wheelchair users, such as self propelled, assistant propelled and electric powered wheelchair users and the needs of all of them can be subtly different. Usage varies from daily use to competitive use. There are also those who are ambulatory wheelchair users - users who can at times mobilise without the need for a chair but use a chair for more effective, appropriate or pain-free ways of getting around. (NHS England, 2014)[1]
'Mechanical' Neck Pain[edit | edit source]
What do we mean by mechanical neck pain? Clinical features, pain that isn't neuropathic/ inflammatory etc., and how it is assessed
Prevalence of Neck Pain in Wheelchair Users[edit | edit source]
General Pain in Wheelchair Users[edit | edit source]
A qualitative study interviewed 64 electric powered wheelchair users about their experiences of pain since becoming a wheelchair user:
- 86% of participants experienced pain related to sitting in past or present wheelchairs
- 59% felt their pain was influenced by their wheelchair
- 17% reported experiencing severe pain
(Frank et al, 2014)[3]
Neck Pain in Wheelchair Users[edit | edit source]
A cross-sectional study with 68 participants recruited from the National Veteran's Wheelchair Games:
- 66% (n=45) reported neck/upper back pain at any time since they started using a wheelchair
(Boninger et al, 2003)[4]
A cross-sectional study with 750 participants conducted at 4 major Spanish hospitals offering education and training related to using a wheelchair permanently, either due to spinal cord injury or other reasons.
- 56% reported neck pain
(Kovacs et al, 2018)[5]
What is shown from these two studies, is that a 'mechanical' musculoskeletal type neck pain is a common condition affecting those in wheelchair users. Specifically, the Kovacs et al research used a robust inclusion/exclusion criteria meaning that only those with a 'mechanical' type pain as opposed to neuropathic or inflammatory type pain (that may be present in cases of rheumatoid arthritis or ankylosing spondylitis) were included and still showed a 56% prevalence of neck pain in a large sample size. Having said this, Kovacs also identifies that there is limited research pertaining to 'mechanical' spinal pain at all levels within wheelchair users as a population.
Aetiology and Risk Factors[edit | edit source]
There has been research in to potential causes of neck pain in wheelchair users, with a lot of the research focusing on a broad area of 'wheelchair ergonomics' and associating the effects of positioning and posture in wheelchair users with neck pain. There has also been research in to the effect of different terrains and neck pain and also another possible cause of neck pain in this population may be underlying conditions which may or may not have led to them becoming a wheelchair user. It is important that there is a strong consideration of the biopsychosocial model of health, when it comes to wheelchair users who require a holistic approach to their management and understanding of the challenges being in a wheelchair exposes them to.
Wheelchair ergonomics[edit | edit source]
Wheelchair ergonomics relates to a wide variety of issues that ultimately may impact on the positioning of patients in a wheelchair. This may include seat heights, widths and depths, thoracic supports, lumbar supports, cervical supports, arm supports or any other adaptations that may influence positioning and subsequently the neck posture and position in patients.
For example: A patient may have become a wheelchair user as a result of a neuro-degenerative condition such as multiple sclerosis and as a result have a very impaired sitting balance due to a loss of muscle strength, endurance and co-ordination. As a result they may require a variety of wheelchair supports in order to keep them in a comfortable position. All of these adaptations can influence the posture of the patient.
Seat height has an impact on the neck position during function. In a 2016 study[6], a lower seat height was shown to cause participants to go in to greater cervical extension and shoulder abduction which was associated with repetitive overuse type injuries to shoulder complex and C-spine in wheelchair users.
As a result of this it is important that when a patient becomes a wheelchair user, they are referred to 'Wheelchair Services' and are provided with a wheelchair that is best suited to their needs and is an appropriate fit when it comes to factors such as seat depth, width, height and has the required supports where needed. If conditions or symptoms change or develop as a wheelchair user and there is a concern that the wheelchair no longer is adequate, again this should require a referral to wheelchair services for an assessment and alterations to the chair made as required.
References[edit | edit source]
- ↑ NHS England. (2014). Improving Wheelchair Services. Available: https://www.england.nhs.uk/wheelchair-services/. Last accessed 22nd May 2019.
- ↑ http://masteringhealthhappiness.com/2017/06/27/easily-reduce-neck-pain-by-making-these-small-changes-to-your-daily-activities/
- ↑ Frank, A. De Souza, L. Frank, J. Neophytou, C. (2012). The pain experiences of powered wheelchair users. Disability and Rehabilitation . 34 (9), 770-778.
- ↑ Boninger, M.L., Cooper, R.A., Fitzgerald, S.G., Lin, J., Cooper, R., Dicianno, B. and Liu, B., 2003. Investigating neck pain in wheelchair users. American journal of physical medicine & rehabilitation, 82(3), pp.197-202
- ↑ Kovacs, F.M., Seco, J., Royuela, A., Barriga, A. and Zamora, J., 2018. Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study. Spinal cord, 56(4), p.392.
- ↑ Sabari, J. Shea, M. Chen, L. Laurenceau, A. Leung, E. (2016). Impact of wheelchair seat height on neck and shoulder range of motion during functional task performance. Assistive Technology. 20 (3), 183-189.
Critical Appraisal[edit | edit source]
(Frank et al, 2014) - This Paper included users who had been wheelchair users for 10 years before the interviews. However, it only interviewed wheelchair users who used Electric Powered Indoor/Outdoor Chairs (EPIOC) making it difficult to apply to other varieties of wheelchairs. Additionally, interviews were done over telephone eliminating the use of non-verbal communication making difficult to gain information from some participants who had communication difficulties. Furthermore, diagnostic data about participants was provided by the participants and not professional referrals. However, the authors stated that the participants were given appropriate diagnostic information by healthcare professionals. Lastly, this paper was aware of its limitations and provided a good analysis of qualitative data.
(Boninger et al, 2003) - Crit App: Limited Sample size, not enough literature looking at neck pain with wheelchair users, included no inclusion or exclusion criteria
(Kovacs et al, 2018) - Inclusion criteria, age >18 and permanent wheelchair user for more than >1 year. Exclusion criteria sitting in a wheelchair intermittently or temporarily, suffering from physical or mental inability, which made it impossible to respond to the interviewer’s questions (e.g., pentaplegia or senile dementia), reporting being unable to distinguish neuropathic from mechanical pain, presenting fever, and having been diagnosed (or being in the diagnostic process) of cancer, systemic infection, or any inflammatory diseases such as spondylitis or rheumatoid arthritis. Crit appraisal: strong robust methology, well defined exclusion and inclusion criteria
