The influence of shoulder pain and fear of falling on level and non-level transfer technique

Background: Level and non-level transfers are essential tasks of daily living for wheelchair users. Minimal research has examined the role of shoulder pain and fear of falling on transfer quality. The purpose of this study is to (1) examine the association between shoulder pain, fear of falling (FoF) and transfer quality and (2) explore the feasibility of assessing non-level transfers to-and-from the floor. Methods: Cross-sectional design was used to explore shoulder pain, FoF, and transfer quality in 30 manual wheelchair users (aged 18-42; 15 males). Participant demographic information (age, sex, race, disability, and years using wheelchair), Spinal Cord Injury-Fall Concern Scale (SCI-FCS), and Wheelchair User Shoulder Pain Index (WUSPI) was collected. Three types of transfers: (1) level, (2) uphill, and (3) floor-to-table were graded by a trained researcher using the Transfer Assessment Instrument (TAI) 3.0. Kruskal–Wallis test was used to determine differences in transfer quality based on condition. Spearman correlation was used to determine associations between demographic data, WUSPI, SCI-FCS, and transfer quality scores. Results: All participants safely completed the uphill non-level transfer; 27 safely completed the floor-to-table non-level transfer. Statistical analysis revealed no difference in TAI score across transfer conditions. Spearman correlation revealed a significant correlation between WUSPI and SCI-FCS scores (r =.68, P=.01) and WUSPI and uphill TAI scores (r = -.45, P=.01). Conclusion: Increases in shoulder pain are related to decreased uphill transfer quality and increased FoF. Non-level transfers to-and-from the floor are feasible within clinical or laboratory settings.