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Aravind N1,2, Harvey L1, Glinsky J1
1John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, Sydney, Australia, 2Prince of Wales Hospital, South Eastern Sydney Local Health District, Physiotherapy, Sydney, Australia
Background: There are many physiotherapy interventions that are being used by physiotherapists around the world to increase strength of partially paralysed muscles in people with spinal cord injury. But, there is no collated evidence to show if all these interventions are effective. It is important to better understand the effectiveness of different physiotherapy interventions to guide practice.
Purpose: The major purpose of this review was to determine the effectiveness of physiotherapy interventions for increasing muscle strength in people with spinal cord injuries (SCI).
Methods: We included randomised controlled trials of physiotherapy interventions for people
with SCI. We were interested in two comparisons: physiotherapy interventions compared with sham or no intervention, and physiotherapy interventions compared to each other. The outcome of interest was voluntary strength of muscles directly affected by SCI. All included studies were rated according to the Cochrane Risk of Bias Tool and results of similar trials were pooled with meta-analyses where possible.
Results: Twenty-six trials met the inclusion criteria and provided useable data. A statistically
significant treatment effect was found in four comparisons, namely, resistance training versus no intervention (SMD = 0.64; 95% CI, 0.22 to 1.07; p = 0.003); resistance training combined with electrical stimulation versus no intervention (MD = 14 Nm; 95% CI, 1 to 27; p = 0.03); a package of physiotherapy interventions versus no intervention (MD = 4.8/50 points on the Lower Extremity Motor Score (LEMS); 95% CI 1.9 to 7.7; p = 0.01); and robotic gait training versus overground gait training (MD = 3.1/50 points on the LEMS; 95% CI, 1.3 to 5.0; p = 0.0008).
Conclusion(s): There is evidence that a small number of physiotherapy interventions increase
strength in muscles directly affected by SCI. However, there are still many interventions that are administered for this purpose without a good evidence base. These interventions may or may not be effective.
Implications: Our systematic review showed that the following interventions improve strength in partially paralyzed muscles in people with SCI: Resistance training, resistance training combined with electrical stimulation, a package of physiotherapy interventions that included resistance training and functional training, and Robotic gait training when compared to overground training. Further work is now needed to put an evidence base to the many other interventions which are also used to increase strength.
Keywords: Spinal Cord Injury, Paralyzed muscles, Strengthening muscles
Funding acknowledgements: The Lifetime Care and Support Authority, NSW, Australia.
Purpose: The major purpose of this review was to determine the effectiveness of physiotherapy interventions for increasing muscle strength in people with spinal cord injuries (SCI).
Methods: We included randomised controlled trials of physiotherapy interventions for people
with SCI. We were interested in two comparisons: physiotherapy interventions compared with sham or no intervention, and physiotherapy interventions compared to each other. The outcome of interest was voluntary strength of muscles directly affected by SCI. All included studies were rated according to the Cochrane Risk of Bias Tool and results of similar trials were pooled with meta-analyses where possible.
Results: Twenty-six trials met the inclusion criteria and provided useable data. A statistically
significant treatment effect was found in four comparisons, namely, resistance training versus no intervention (SMD = 0.64; 95% CI, 0.22 to 1.07; p = 0.003); resistance training combined with electrical stimulation versus no intervention (MD = 14 Nm; 95% CI, 1 to 27; p = 0.03); a package of physiotherapy interventions versus no intervention (MD = 4.8/50 points on the Lower Extremity Motor Score (LEMS); 95% CI 1.9 to 7.7; p = 0.01); and robotic gait training versus overground gait training (MD = 3.1/50 points on the LEMS; 95% CI, 1.3 to 5.0; p = 0.0008).
Conclusion(s): There is evidence that a small number of physiotherapy interventions increase
strength in muscles directly affected by SCI. However, there are still many interventions that are administered for this purpose without a good evidence base. These interventions may or may not be effective.
Implications: Our systematic review showed that the following interventions improve strength in partially paralyzed muscles in people with SCI: Resistance training, resistance training combined with electrical stimulation, a package of physiotherapy interventions that included resistance training and functional training, and Robotic gait training when compared to overground training. Further work is now needed to put an evidence base to the many other interventions which are also used to increase strength.
Keywords: Spinal Cord Injury, Paralyzed muscles, Strengthening muscles
Funding acknowledgements: The Lifetime Care and Support Authority, NSW, Australia.
Topic: Neurology; Disability & rehabilitation
Ethics approval required: No
Institution: Not applicable
Ethics committee: Not applicable
Reason not required: This was a systematic review and therefore did not require Ethics approval.
All authors, affiliations and abstracts have been published as submitted.
