Boninger Michael L, Cooper Rory A, Fitzgerald Shirley G, Lin Jessica, Cooper Rosemarie, Dicianno Brad, Liu Betty
Human Engineering Research Laboratories, Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pennsylvania 15206, USA.
Am J Phys Med Rehabil. 2003 Mar;82(3):197-202. doi: 10.1097/01.PHM.0000054217.17816.DD.
Despite the fact that wheelchair users are exposed to risk factors for neck and upper back pain (NP), little is known about the impact and possible diagnoses associated with NP. The purpose of this study was to examine the significance of NP in wheelchair users and to determine if a portion of the NP may be myofascial in origin.
Cross-sectional cohort study using questionnaires and physical exams to evaluate NP in a convenience sample of wheelchair users from the National Veteran's Wheelchair Games. Main outcome measures included reported NP, visual analog scale of neck complaints, Neck Disability Index, and physical examination findings of trigger points.
Sixty-six percent of subjects reported NP since becoming a wheelchair user and, 60% reported pain during the past month. Neither age nor length of time in a wheelchair was significantly different between those subjects who did and those subjects who did not report pain. Of those respondents who reported NP, 60% visited the doctor about the pain and 40% limited their daily activities due to the pain. Trigger-point palpation reproduced pain in 54% of those respondents who experienced pain in the past month (n = 34).
This study provides a first step in defining the prevalence and significance of NP among wheelchair users. Clinicians who work with this population need to ask subjects about symptoms and consider a myofascial origin for that pain when considering treatment.
尽管轮椅使用者面临颈部和上背部疼痛（NP）的风险因素，但对于NP的影响及相关可能诊断知之甚少。本研究的目的是探讨NP在轮椅使用者中的重要性，并确定部分NP是否可能起源于肌筋膜。
采用问卷调查和体格检查的横断面队列研究，对来自全国退伍军人轮椅运动会的方便样本中的轮椅使用者进行NP评估。主要结局指标包括报告的NP、颈部不适视觉模拟量表、颈部残疾指数以及触发点的体格检查结果。
66%的受试者自成为轮椅使用者后报告有NP，60%的受试者报告在过去一个月内有疼痛。报告疼痛的受试者与未报告疼痛的受试者在年龄和使用轮椅的时间方面均无显著差异。在报告有NP的受访者中，60%因疼痛去看过医生，40%因疼痛限制了日常活动。在过去一个月内经历过疼痛的受访者中（n = 34），54%的人触发点触诊可再现疼痛。
本研究为确定NP在轮椅使用者中的患病率和重要性迈出了第一步。与该人群打交道的临床医生在考虑治疗时需要询问受试者症状，并考虑疼痛的肌筋膜起源。
