The effectiveness of physical interventions for people with spinal cord injuries: A systematic review
Harvey, Al., Lin, C., Glinsky, J. V. & Wolf, A. De. (2009). The effectiveness of physical interventions for people with spinal cord injuries: A systematic review. Spinal Cord, 47, 184195.
Abstract written by Jenny Carlton, Information Specialist, NCPAD
People with spinal cord injuries (SCI) experience a wide range of secondary health conditions, including poor strength, joint problems, muscle extensibility, bone density loss, pain, and muscle spasticity. These health conditions can cause physical impairments relating to activity limitations affecting walking, fine motor skills, and attending to personal self-care. Interventions by medical practitioners, exercise physiologists, and occupational and physical therapists show that people with SCI can improve these activity limitations. Therapists and clinicians want and need to know the most effective interventions in order to provide the best therapy options for their SCI clients. Researchers state that the best way to determine interventions' effectiveness comes from high-quality, randomized, controlled trials. This study attempted to provide a quantitative analysis of all randomized controlled trials designed to determine the effectiveness of physical interventions for people with SCI.
A literature search was performed on articles that fit the criteria of using randomized controlled trials involving physical interventions for people with SCI. More specifically, the inclusion criteria included: type of trials, type of participants, type of interventions, type of comparisons, and type of outcomes. Two reviewers independently performed the task of finding the articles that fit the criteria by using the Physiotherapy Evidence Database (PEDro), the search strategy for identifying randomized controlled trials. In order to retrieve specific information on subjects and fit within the criteria inclusion, the reviewers used the International Standards for the Classification of SCI. Once the results were collected, they were put into three categories: clearly important between-group difference, inconclusive, and ineffective.
Researchers examined 4,543 abstracts and, out of those, only 31 papers met the inclusion criteria. From all of the trials, researchers calculated a total of 770 participants including those with incomplete SCI, paraplegia, and tetraplegia. Dropout was a common occurrence among participants and occurred throughout the majority of the studies. The 31 trials that met the inclusion criteria were grouped into 7 categories. fitness and strength training (seven trials investigated the effectiveness of arm or leg exercise); gait training (five trials assessed the effectiveness of gait training either with weight-supported systems or with orthoses); hand therapy (three trials compared biofeedback or somatosensory stimulation of the hand with conventional hand therapy); stretch (four trials examined the effectiveness of different stretch-based interventions on range of motion and shoulder pain); acupuncture (three trials examined the effect of acupuncture); hand splinting (two trials examined the effect of hand splints on people with tetraplegia); other related therapies (seven trials examined a range of different therapies, including effect of shoulder exercises or massage for mobility and depression; electrical stimulation or biofeedback for function; hippotherapy for spasticity; upper-limb exercise with graded tilting for postural hypotension; ultrasound for bone loss and stretches; and strengthening exercises for shoulder pain).
In general, the physical interventions mentioned in the trials did provide some evidence that they reduced physical limitations for people with spinal cord injuries. For strength and fitness training interventions, findings provided some promising evidence in their effectiveness, both with and without electrical stimulation. As for gait training, the results were similar to that of strength and fitness training programs. The physical intervention that seemed to have a bigger impact on strength and sensation was acupuncture. However, as most of the results from the reviewed trials were inconclusive, it was unclear from the majority of trials whether the treatments were effective. Although this systematic review did not provide substantial evidence, it did, however, show that the significance of treatment effects on impairments does increase when it is accompanied by evidence about treatment effects on activity limitations and participation restrictions. Research with a stronger emphasis on high-quality studies is the best way to ensure high-quality physical interventions for people with spinal cord injuries.