PREVALENCE OF SHOULDER PAIN AMONG LONG-TERM MANUAL WHEELCHAIR USERS: A CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.71000/z0rypq68Keywords:
Cross-Sectional Studies; Disabled Persons; Musculoskeletal Pain; Prevalence; Rehabilitation; Shoulder Pain; Wheelchairs.Abstract
Background: Shoulder pain is a common musculoskeletal problem among manual wheelchair users because the upper limbs are repeatedly used for propulsion, transfers, pressure relief, and daily mobility. Continuous loading of the shoulder joint may lead to pain, disability, and reduced independence over time. In local rehabilitation settings, limited evidence is available regarding the burden of shoulder pain among long-term manual wheelchair users, making this issue important for clinical screening and preventive care.
Objective: To determine the prevalence of shoulder pain among long-term manual wheelchair users and to assess its association with the duration of wheelchair use.
Methods: An observational cross-sectional study was conducted among 159 manual wheelchair users recruited from Mayo Hospital, Ghurki Hospital, Sheikh Zayed Hospital, and Services Hospital, Lahore. Participants were selected through a non-probability convenience sampling technique. Male and female participants aged 20–40 years who had used a manual wheelchair as their primary means of mobility for at least one year were included. Shoulder pain and disability were assessed using the Shoulder Pain and Disability Index. Data were analyzed using SPSS version 29.0. Frequencies and percentages were calculated for categorical variables, while mean and standard deviation were used for continuous variables. Chi-square test was applied to determine the association between duration of wheelchair use and shoulder pain severity, with p < 0.05 considered statistically significant.
Results: The mean age of participants was 30.0 ± 5.5 years. Among 159 participants, 85 (53.5%) were male and 74 (46.5%) were female. Shoulder pain was reported by 132 (83.0%) participants, while 27 (17.0%) had no shoulder pain. Mild pain was reported by 40 (25.2%) participants, moderate pain by 60 (37.7%), and severe pain by 32 (20.1%). A statistically significant association was found between duration of wheelchair use and shoulder pain severity (χ² = 26.06, p = 0.002).
Conclusion: Shoulder pain was highly prevalent among long-term manual wheelchair users and was significantly associated with duration of wheelchair use. Routine screening, early rehabilitation, ergonomic wheelchair training, and preventive shoulder care may help reduce pain and preserve functional independence.
Keywords: Cross-Sectional Studies; Disabled Persons; Musculoskeletal Pain; Prevalence; Rehabilitation; Shoulder Pain; Wheelchairs.
References
Hodgetts C, Walker B. Epidemiology, common diagnoses, treatments and prognosis of shoulder pain: A narrative review. International Journal of Osteopathic Medicine. 2021;42:11-9.
Lucas J, Van Doorn P, Hegedus E, Lewis J, Van Der Windt D. A systematic review of the global prevalence and incidence of shoulder pain. BMC musculoskeletal disorders. 2022;23(1):1073.
Lili L, Sunnerhagen KS, Rekand T, Alt Murphy M. Independence and upper extremity functioning after spinal cord injury: a cross-sectional study. Scientific Reports. 2023;13(1):3148.
Willig RM, Garcia I, da Silva NSL, Corredeira R, Carvalho J. The effectiveness of community-based upper body exercise programs in persons with chronic paraplegia and manual wheelchair users: A systematic review. The Journal of Spinal Cord Medicine. 2022;45(1):24-32.
McCann A, Kerr D, Hannon-Fletcher MP. Prevalence of Upper Limb Pain in Spinal Cord Injury: A Systematic Review. Paraplegia-New Insights. 2022.
Muhammad AS, Amjad F, Arslan SA, Hashim A, Hameed M, Habib RH, et al. Prevalence of shoulder pain and disability in adult using manual wheelchair, a cross sectional study: Shoulder Pain and Disability in Adults Using Manual Wheelchair. Pakistan BioMedical Journal. 2022:237-40.
Pozzi F, Sousa CO, Plummer HA, Andrade B, Awokuse D, Kono N, et al. Development of shoulder pain with job-related repetitive load: mechanisms of tendon pathology and anxiety. Journal of shoulder and elbow surgery. 2022;31(2):225-34.
Wołoszyn N, Wiśniowska-Szurlej A, Grzegorczyk J, Kwolek A. The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes–a randomized control trial. BMC geriatrics. 2021;21(1):423.
Andreasson E, Söverstad J, Löfvenmark I. Shoulder problems after spinal cord injury. Part one: self-assessment by questionnaires. J Rehabil Med. 2025;57:jrm43631.
Longatelli V, Antonietti A, Biffi E, Diella E, D’Angelo MG, Rossini M, et al. User-centred assistive SystEm for arm Functions in neUromuscuLar subjects (USEFUL): a randomized controlled study. Journal of neuroengineering and rehabilitation. 2021;18(1):4.
Goodwin BM, Jahanian O, Cain SM, Van Straaten MG, Fortune E, Morrow MM. Duration of static and dynamic periods of the upper arm during daily life of manual wheelchair users and matched able-bodied participants: a preliminary report. Frontiers in sports and active living. 2021;3:603020.
Finley MA, Euiler E. Association of musculoskeletal pain, fear-avoidance factors, and quality of life in active manual wheelchair users with SCI: A pilot study. The journal of spinal cord medicine. 2020;43(4):497-504.
Nie Q, Rice LA, Sosnoff JJ, Shen S, Rogers WA. Understanding wheelchair use in older adults from the National Health and Aging Trends Study. Archives of physical medicine and rehabilitation. 2024;105(3):514-24.
Mashola MK, Korkie E, Mothabeng DJ. Correlations between pain, functioning, and quality of life in manual wheelchair users with spinal cord injury. PLoS One. 2025;20(5):e0324850.
Soo Hoo JA, Kim H, Fram J, Lin YS, Page C, Easthausen I, et al. Shoulder pain and ultrasound findings: A comparison study of wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users. PM&R. 2022;14(5):551-60.
Liampas A, Neophytou P, Sokratous M, Varrassi G, Ioannou C, Hadjigeorgiou GM, et al. Musculoskeletal pain due to wheelchair use: a systematic review and meta-analysis. Pain and therapy. 2021;10(2):973-84.
Karabay D, Yildiz M, Caliskan N, Ozer Kaya D. Comparisons and associations of psychological factors and the number of painful sites in wheelchair basketball athletes with and without shoulder pain: A cross-sectional case-control study. The Journal of Spinal Cord Medicine. 2025;48(6):1100-11.
Venturin D, Giannotta G, Pellicciari L, Rossi A, Pennella D, Goffredo M, et al. Reliability and validity of the Shoulder Pain and Disability Index in a sample of patients with frozen shoulder. BMC Musculoskeletal Disorders. 2023;24(1):212.
Mohamed EK, El-Naser Ghareeb MA, Abdelhaleem MD, Elshinnawy AM, Eraky ZS, Aly SM, et al. Correlation between low back pain and disability among physical therapy students at Horus University, Egypt: Across-sectional study.
Rider JV, Linford RE, Lin WJ. Shoulder pain in wheelchair rugby athletes: Athlete characteristics, training behaviors, and rehabilitation implications. Assistive Technology. 2026;38(3):256-64.
Kassam F, MacRae F, Lechner L, Dow H, Boissonnault È, Huang F, et al. Early Intervention of Hemiplegic Shoulder Pain in the Context of Post-Stroke Shoulder Spasticity: A Canadian Cross-Sectional Survey. Toxins. 2026;18(5):228.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ayesha Asghar , Iqra Waseem, Nibaat Hafeez , Erum Naz (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
