Chen LW1,2,3, Glinsky JV2,3, Kataria C4, Islam MS5, Boswell-Ruys C6, Denis S6, Redhead J7, Gollan E8, Ben M9, Hossain MM5, Chaudhary L4, Xiong Y10, Gandevia SC11, Harvey LA2,3
1Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia, 2Sydney Medical School Northern, University of Sydney, Sydney, Australia, 3John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia, 4Indian Spinal Injuries Centre, New Delhi, India, 5Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh, 6Prince of Wales Hospital, Randwick, NSW, Australia, 7Royal Rehab, Ryde, NSW, Australia, 8Queensland Spinal Injuries Service, Metro South Health, Brisbane, Australia, 9NSW Spinal Outreach Service, Ryde, NSW, Australia, 10Guangdong Work Injury Rehabilitation Hospital, Guangdong, China, 11Neuroscience Research Australia and University of New South Wales, Randwick, NSW, Australia
Background: Physiotherapists often use repetitious contractions to increase strength in people with spinal cord injuries who are very weak. This is based on theories about neural plasticity and the need for repeated movement to prompt neural recovery. However, it is unknown whether this is an effective training paradigm for people with spinal cord injuries.
Purpose: The aim of this trial is to compare the effectiveness of repeated contractions of isolated muscles combined with usual care, versus usual care alone for increasing strength in very weak partially-paralysed muscles of people with recent SCI.
Methods: The 200-Rep Trial is a pragmatic multi-centre, assessor-blinded between participants randomised controlled trial. 120 participants will be recruited from 6 spinal units across 4 countries in Asia. Participants will be randomised to either the Treatment group or the Control group. Participants allocated to the Treatment group will perform 200 isolated contractions of the target muscle per day for 8 weeks as well as usual care. Participants allocated to the Control group will receive usual care alone. The primary outcome is strength assessed using the 13-point manual muscle test. There will be a number of secondary outcomes reflecting participants' perspectives. All outcomes will be collected at baseline and at 8 weeks by blinded assessors. The results will be analysed by intention-to-treat using regression models.
Results: To date, 103 of 120 participants have been enrolled, and 84 have completed the trial. We anticipate completion of the trial in February 2019.
Conclusion(s): This trial uses an isolated muscle model to answer an important question about the responsiveness of muscles to repetitious practice. The trial design is intentionally simple to facilitate international collaboration.
Implications: This study will not only answer a pragmatic question about the effectiveness of a widely administered strength training paradigm but it will also help clarify underlying mechanisms for more complex interventions which involve repetitious contractions of many different muscles within the context of functional training.
Keywords: Spinal Cord Injury, Rehabilitation, Physical Therapy
Funding acknowledgements: icare and The Slater and Gordon Foundation
Purpose: The aim of this trial is to compare the effectiveness of repeated contractions of isolated muscles combined with usual care, versus usual care alone for increasing strength in very weak partially-paralysed muscles of people with recent SCI.
Methods: The 200-Rep Trial is a pragmatic multi-centre, assessor-blinded between participants randomised controlled trial. 120 participants will be recruited from 6 spinal units across 4 countries in Asia. Participants will be randomised to either the Treatment group or the Control group. Participants allocated to the Treatment group will perform 200 isolated contractions of the target muscle per day for 8 weeks as well as usual care. Participants allocated to the Control group will receive usual care alone. The primary outcome is strength assessed using the 13-point manual muscle test. There will be a number of secondary outcomes reflecting participants' perspectives. All outcomes will be collected at baseline and at 8 weeks by blinded assessors. The results will be analysed by intention-to-treat using regression models.
Results: To date, 103 of 120 participants have been enrolled, and 84 have completed the trial. We anticipate completion of the trial in February 2019.
Conclusion(s): This trial uses an isolated muscle model to answer an important question about the responsiveness of muscles to repetitious practice. The trial design is intentionally simple to facilitate international collaboration.
Implications: This study will not only answer a pragmatic question about the effectiveness of a widely administered strength training paradigm but it will also help clarify underlying mechanisms for more complex interventions which involve repetitious contractions of many different muscles within the context of functional training.
Keywords: Spinal Cord Injury, Rehabilitation, Physical Therapy
Funding acknowledgements: icare and The Slater and Gordon Foundation
Topic: Neurology: spinal cord injury; Disability & rehabilitation
Ethics approval required: Yes
Institution: Northern Sydney Local Health District
Ethics committee: Northern Sydney Local Health District Human Research Ethics Committee
Ethics number: HREC/16/HAWKE/251
All authors, affiliations and abstracts have been published as submitted.
