Natural History of Shoulder Pathology in Wheelchair Users

项目摘要/摘要 这一竞争性更新在一项前瞻性纵向研究的基础上进行了扩展，该研究定义了 手动轮椅使用者和年龄和性别匹配的健全参照组的肩部病理，2) 改进日常生活中测量的手臂使用指标，以及3)确定使用手臂的风险因素 加速肩部病理和疼痛进展，超越自然衰老。此外，这项提案 进行一项基于人群的大型回溯性队列研究，以调查合并疾病和 用于未来临床诊断肩部病理或疼痛的药物。有充分的证据表明 使用手动轮椅的脊髓损伤患者比年龄匹配的有能力的人更有可能 身体健全的人有肩袖病理和/或肩部疼痛。这个临床问题一直在接受 关注了几十年，但肩部疼痛和功能障碍仍以令人无法接受的高比率继续存在。为了保持 人们的健康和独立依赖于他们上肢的所有日常生活活动，我们的 目的是确定MWC使用者肩袖疾病的自然病史，长期目标是 推进循证指南，以减缓疾病进展。病理率 对于MWC使用者来说，进展很大程度上是未知的，特别是在疾病的早期，当非手术干预时 可能是合适的。目标1通过跟踪部分肩袖肌腱病的进展来满足这一需求 泪水和疼痛加剧，同时量化性别、脊髓损伤程度和自脊髓损伤以来的时间的影响。毋庸置疑， 手动轮椅使用者中较高的肩袖病变率可归因于肩部改变 在日常生活中发挥作用。然而，如果知道哪些外在因素是影响临床护理的主要因素，将会改善临床护理。 日常使用ARM的不同MWC患者的病理进展比以下患者更快 病理没有进展或进展较慢。AIM 2使用可穿戴传感器技术来确定 日常手臂使用(手臂姿势、重复运动和恢复)与糖尿病进展之间的关系 肩袖病理和疼痛。内在因素，包括合并症和药物使用，一直是 在健全的文献中与肌腱病理有关，但在脊髓损伤中未见研究 人口。因此，目标3将评估合并症和药物使用对发病的贡献。 一项基于人群队列的肩袖病理和疼痛研究。通过研究区分那些 有更高的病理进展率，比那些病理稳定或改善的人更快；可操作的 可以定义内在和外在的风险因素。这些步骤是为患者提供基础的基础 教育和康复战略。通过关注肩袖病理的早期阶段，这项研究是 可能导致在肩部功能障碍发生之前实施康复策略 依靠肩膀获得独立的人。

PROJECT SUMMARY/ABSTRACT This competitive renewal 1) expands on a prospective longitudinal study that defines the natural history of shoulder pathology in manual wheelchair users and an age and sex matched able-bodied referent group, 2) improves the arm use metrics measured during daily living, and 3) determines risk factors of arm use that accelerate shoulder pathology and pain progression beyond that of natural aging. Additionally, this proposal performs a large retrospective population-based cohort study to investigate the risks of comorbidities and medication to a future clinical diagnosis of shoulder pathology or pain. Abundant evidence exists that individuals with spinal cord injury who use manual wheelchairs are much more likely than age matched able- bodied individuals to have rotator cuff pathology and/or shoulder pain. This clinical problem has been receiving attention for decades, yet shoulder pain and dysfunction continues at unacceptably high rates. To maintain the health and independence of a population that relies on their upper extremities for all activities of daily living, our objective is to define the natural history of rotator cuff disease in MWC users with the long-term goal of advancing evidence-based guidelines to decelerate the disease progression. The rate of pathology progression is largely unknown for MWC users, especially early in the disease when nonsurgical interventions may be appropriate. Aim 1 addresses this need by tracking the progression of rotator cuff tendinopathy, partial tears, and pain worsening while quantifying the effect of sex, SCI lesion level, and time since SCI. Inarguably, higher rotator cuff pathology rates among manual wheelchair users is attributable to the altered shoulder function during daily living. However, clinical care would be improved if it was known which extrinsic factors of daily arm use differentiated MWC users whose pathology progression was more accelerated from those whose pathology did not progress or progressed more slowly. Aim 2 uses wearable sensor technologies to determine the association between daily arm use (arm posture, repetitive movement, and recovery) and progression of rotator cuff pathology and pain. Intrinsic factors, including comorbidities and medication use, have been associated with tendon pathology in the able-bodied literature but they are unstudied in the spinal cord injured population. Therefore, Aim 3 will evaluate the contribution of comorbidities and medication use to the onset of rotator cuff pathology and pain in a population-based cohort. By studying factors that differentiate those who have increased rates of pathology progression from those with stable or improving pathology; actionable intrinsic and extrinsic risk factors can be defined. These steps are fundamental for providing a basis for patient education and rehabilitation strategies. By focusing on the early stages of rotator cuff pathology, this study is likely to lead to rehabilitation strategies to implement prior to the development of shoulder dysfunction among individuals who rely on their shoulders for independence.