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Bye E.1, Gambhir A.2, Harvey L.A.1, Kataria C.2, Glinsky J.1, Bowden J.1, Tranter K.3, Lam C.4, White J.5, Gollan E.6, Arora M.1, Gandevia S.7
1University of Sydney, Sydney, Australia, 2Indian Spinal Injury Centre, Delhi, India, 3Prince of Wales Hospital, Sydney, Australia, 4Royal North Shore Hospital, Sydney, Australia, 5Royal Ryde Rehabilitation Centre, Sydney, Australia, 6Princess Alexandra Hospital, Brisbane, Australia, 7Neuroscience Research Australia (NeuRA), Sydney, Australia
Background: Weakness secondary to partial paralysis is a common impairment following spinal cord injury (SCI). It impedes movement and compromises function. Strength training programs are widely used to increase strength, however their effectiveness is unclear. Some studies have suggested that partially paralysed muscles may not be as responsive to strength training as generally assumed. Therefore, the aim of this trial was to determine the effects of a 12-week strength training program in partially-paralysed muscles, as compared to usual care.
Purpose: To determine whether strength training combined with usual care increases strength in partially-paralysed muscles of people with recent SCI more than usual care alone.
Methods: An assessor-blind randomised controlled trial was conducted in five SCI units. Thirty people with recent SCI undergoing inpatient rehabilitation participated. One target muscle group was selected for each participant and randomly allocated to the strength training group. The same muscle group on the contralateral side of the body was allocated to the control group. The primary outcome was strength. Secondary outcomes were spasticity and participants perception of function and strength.
Results: Training increased strength with a mean between-group difference (95% CI) of 4.3Nm (1.9 to 6.8; pre-defined clinically meaningful treatment effect was 2.7Nm). Participants perceived that strength and function had improved with mean between-group differences (95%CI) of 2.2/10 points (1.3 to 3.0) and 2.1 (1.2 to 3.0), respectively. The mean between-group difference (95%CI) for spasticity was 0/5 points
(-0.25 to 0.32). No participants dropped out and compliance was excellent.
Conclusion(s): This is one of the first clinical trials to confirm the benefits of strength training for partially-paralysed muscles in people with recent SCI.
Implications: Physiotherapists have administered strength training to non-paralysed muscles for a long time and have assumed that this intervention is equally applicable to partially-paralysed muscles but these assumptions have not been adequately tested. The results of this study provide some of the first evidence to indicate that partially-paralysed muscles are responsive to strength training. The results are not generalisable to grade 1 or grade 2 muscles and still indicate some uncertainty about whether the size of the treatment effect is clinically meaningful.
Funding acknowledgements: Prince of Wales Hospital Foundation and National Health and Medical Research Council of Australia.
Topic: Neurology: spinal cord injury
Ethics approval: Northern Sydney Local Health District Human Research Ethics Committee and from each specific site involved in the trial.
All authors, affiliations and abstracts have been published as submitted.
