Quality of Life Concepts

Secondary Health Conditions

Wheelchair User's Shoulder Pain Index (WUSPI)

Description: A measure of shoulder pain in wheelchair users [1].

Format: 15 visual analogue scales consisting of 10cm lines anchored by ‘no pain’ and ‘worst pain ever experienced’. Items assess intensity of shoulder pain during transfers, activities of daily living, and mobility performed from a wheelchair.

Scoring: Participants mark an ‘X’ on the line to describe their shoulder pain intensity during that activity. Responses are measured in centimeters and summed, with a maximum total raw score of 150.

Administration and Burden: Self-administered; Interviewer-administered; Approximately 5 minutes.

Psychometrics for SCI: The WUSPI has high internal consistency (Cronbach’s alpha = 0.98) and high test-retest reliability (ranging between 0.84 and 0.99) [2].

Languages: English.

QoL Concept: The questionnaire measures Health Related Quality of Life (QoL) in relation to shoulder pain, which corresponds to Box C (achievements) of Dijker’s Model.

Permissions/Where to Obtain: Copyrighted; The WUSPI can be acquired by obtaining permission from Dr. Kathleen Curtis. Please contact Dr. Curtis directly.


  1. Curtis KA, Roach KE, Brooks Applegate E, Benbow CS, Genecco TD, Gualano J. Development of the Wheelchair User's Shoulder Pain Index (WUSPI). Paraplegia 1995;33:290-3.

  2. Curtis KA, Roach KE, Applegate EB, Amar T, Benbow CS, Genecco TD et al. Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI). Paraplegia 1995;33:595-601.


Pain SCI Studies: Seven cross-sectional surveys, one longitudinal study.

  1. Gutierrez DD, Thompson L, Kemp B, Mulroy SJ. The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia. J Spinal Cord Med 2007;30:251-5.

  2. Salisbury SK, Nitz J, Souvlis T. Shoulder pain following tetraplegia: a follow-up study 2-4 years after injury. Spinal Cord 2006;44:723-8.

  3. Curtis KA, Roach KE, Brooks Applegate E, Amar T, Behbow CS, Genecco TD, Gualano J. Development of the Wheelchair User’s Shoulder Pain Index (WUSPI). Paraplegia 1995a;33:290-3.

  4. Curtis KA, Roach KE, Applegate EB, Amar T, Benbow CS, Genecco TD, Gualano J. Reliability and validity of the Wheelchair User’s Shoulder Pain Index (WUSPI). Paraplegia 1995b;33:595-601.

  5. Curtis KA, Drysdale GA, Lanza, RD, Kolber M, Vitolo RS, West R. Shoulder pain in wheelchair users with tetraplegia and paraplegia. Arch Phys Med Rehabil 1999;80:453-7.

  6. Gironda RJ, Clark ME, Neugaard B, Nelson A. Upper limb pain in a national sample of veterans with paraplegia. The Journal of Spinal Cord Medicine 2004;27:120-7.

  7. Samuelsson KAM, Tropp H, Gerdle B. Shoulder pain and its consequences in paraplegic spinal cord-injured wheelchair users. Spinal Cord 2004;42:41-6.

  8. Nash MS, van de Ven I, van Elk N, Johnson BM. Effects of circuit resistance training on fitness attributes and upper-extremity pain in middle-aged men with paraplegia. Arch Phys Med Rehabil 2007;88:70-5.

Sensitivity to Impact: Curtis and colleagues (1995a) developed the Wheelchair User's Shoulder Pain Index (WUSPI), a shoulder pain index designed to measure the severity of should pain associated with functional activity in persons who use wheelchairs (N = 64), with whom the majority had a spinal cord injury (SCI; n = 57). An individual item analysis revealed that the participants experienced the most shoulder pain when wheeling up an incline or on outdoor surfaces, when lifting an object from an overhead shelf, when trying to sleep, when transferring from tub to wheelchair, and washing their backs. The instrument is useful for both clinical and research purposes to detect and monitor shoulder pain and accompanying loss of function by wheelchair users.

Curtis and colleagues (1995b) tested the test-retest reliability and concurrent validity of the WUSPI n persons with SCI (N = 16). Scores on the WUSPI showed high levels of reliability and internal consistency, as well as concurrent validity with loss of shoulder range of motion.

Curtis and colleagues (1999) used the WUSPI to compare the prevalence and intensity of shoulder pain experienced during daily functional activities in men with tetraplegia and paraplegia who use manual wheelchairs (N = 89). Performance-corrected WUSPI scores were found to be higher in persons with tetraplegia than in those with paraplegia.

Gutierrez and colleagues (2007) examined the relationship between self-reported shoulder pain with quality of life (QoL), physical activity, and community activities in persons with paraplegia resulting from SCI (N = 80). The main outcome measures were the WUSPI, the Subjective Quality of Life (SQoL) Scale, the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), and the Community Activities Checklist (CAC). Results showed an inverse, moderate relationship between shoulder pain intensity, as measured by the WUSPI and physical activity (measured by the PASIPD).

Salisbury and colleagues (2006) investigated the relationship between pain and functional activities, and pain and QoL using the WUSPI and a non-standardized study-specific questionnaire in patients with SCI (N = 27). Results showed that QoL was affected by pain in the majority of participants. In addition, pain was reportedly felt during daily tasks, and there was a positive correlation between pain intensity and total score on the WUSPI.

Gironda and colleagues (2004) used the WUSPI to examine the prevalence and intensity of pain and associated patient characteristics in veterans with paraplegia (N = 1,675). Shoulder pain intensity was most severe during performance of wheelchair-related mobility and transportation activities, suggesting that upper limb pain may have a significant impact on functional independence.

Samuelsson and colleagues (2004) used the WUSPI, the Constant Murley Scale (CMS), the Klein & Bell Activities of Daily Living (ADL) Index, and the Canadian Occupational Performance Measure (COPM) to describe the consequences of shoulder pain on activity and participation in persons with paraplegia (N = 56). The highest pain intensities, as assessed by the WUSPI, were found for the activities: ‘load wheelchair into a car’, followed by ‘pushing up ramps or inclines outdoor’ and ‘usual daily activities at work or school’.

Nash and colleagues (2007) examined the effects of circuit resistance exercise training on muscle strength, anaerobic power, and shoulder pain in men with paraplegia (N = 7) using the WUSPI. Results showed that pain interfered with transfers in the majority of patients. Of 10 functional activities, pain was more likely to be associated with pressure reliefs, transfers, and wheelchair mobility. Nearly a third of patients reported needing additional help for functional activities and a sense of limited independence because of their pain.

Suggestions for Use: The WUSPI is a reliable and valid measure sensitive to the impact of shoulder pain in persons with SCI.

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