Harvey L.A.1, Glinsky J.V.1, Bowden J.L.1
1University of Sydney, Sydney Medical School, Sydney, Australia
Background: There are many systematic reviews and clinical practice guidelines summarising the effectiveness of physiotherapy interventions for people with spinal cord injuries (SCI). However, many include non-randomised studies which are highly vulnerable to bias or cover interventions not routinely administered in clinical practice.
Purpose: This systematic review of randomised controlled trials aimed to provide an unbiased and accessible summary of the current evidence underpinning 22 common physiotherapy interventions for people with SCI.
Methods: 22 pairs of key interventions and their primary outcome were identified prior to commencement. Each intervention and outcome pair was considered independently, resulting in 22 brief reviews within one large systematic review. Interventions investigated were hand-, wheelchair-, seated mobility-, fitness-, strength- and gait-training, electrical stimulation, passive movements, stretch, exercise, cycling, and transcutaneous electrical nerve stimulation (TENS). Interventions were compared to no or sham treatment, usual care or another physiotherapy intervention. Primary outcomes included: seated or wheelchair mobility, hand function, gait, strength, joint mobility, fitness and pain. Data were extracted to determine mean-between group differences or odds ratios (95% CI). Where possible, results were pooled in meta-analyses and the strength of evidence rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results: 147 papers were randomised controlled trials involving people with SCI and were identified as potentially eligible. After evaluation 38 randomised controlled trials met the inclusion criteria, but only 31 trials provided data suitable for analysis. Of these only 15 trials were relevant to the brief reviews selected. Four interventions were clearly effective: fitness-, hand- and wheelchair-training, and TENS. The strength of evidence however was not high. In contrast, the review of stretch interventions indicated that the treatment was ineffective. The remaining interventions were inconclusive as they failed to rule in or rule out a possible therapeutic effect.
Conclusion(s): There is initial evidence to support four commonly used physiotherapy interventions. The list of interventions and outcomes is not exhaustive, and unlike a typical systematic review we did not look at all the possible effects of any single intervention. However, this summary of the evidence is unique because of its wide scope and examination of the effectiveness of commonly administered physiotherapy interventions in one paper.
Implications: Considerable work is still needed to establish a strong evidence base for the range of physiotherapy interventions commonly used for SCI rehabilitation
Funding acknowledgements: This work was funded by Lifetime Care and Support Authority of NSW, Australia
Topic: Neurology: spinal cord injury
Ethics approval: Ethical approval was not required
All authors, affiliations and abstracts have been published as submitted.
