Strength training (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	Strength training (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI
P	People with SCI (partially-paralysed muscles)	Evidence recommendation Weak for (90%)		Weak evidence recommendation FOR Strength training may be provided to improve voluntary strength of partially paralysed muscles in people with SCI.
I	Strength training	Evidence recommendation Weak for (90%)
C	No intervention	Consensus-based opinion statement No opinion statements
O	Voluntary strength
	SUMMARY	3 RCTs (see references)		Standardised Mean Difference (95% CI): 0.4 (0 to 0.9) Favours strength training
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Very serious	Imprecision Serious	Indirectness Serious	Publication bias Serious

STRENGTH TRAINING ON VOLUNTARY STRENGTH PARTIALLY PARALYSED MUSCLES: GRADE Evidence to Decision
PROBLEM	No	Probably no	Probably yes	Yes		Don't know
DESIRABLE EFFECTS	Trivial	Small	Moderate	Large		Don't know
UNDESIRABLE EFFECTS	Large	Moderate	Small	Trivial		Don't know
CERTAINTY OF EVIDENCE	Very low	Low	Moderate	High		No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME	Important uncertainty or variability	Possibly important uncertainty or variability	Probably no important uncertainty or variability	No important uncertainty or variability
BALANCE OF EFFECTS	Favours the Control	Probably favours the Control	Does not favour either the intervention (I) or the comparison (C)	Probably favours the I	Favours the I	Don't know
RESOURCES REQUIRED	Large costs	Moderate costs	Negligible costs and savings	Moderate savings	Large savings	Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES	Very low	Low	Moderate	High		No included studies
COST EFFECTIVENESS	Favours the comparison	Probably favours the comparison	Does not favour either the intervention or the comparison	Probably favours the intervention	Favours the intervention	No included studies
EQUITY	Reduced	Probably reduced	Probably no impact	Probably increased	Increased	Don't know
ACCEPTABILITY	No	Probably no	Probably yes	Yes		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes		Don't know

STRENGTH TRAINING ON VOLUNTARY STRENGTH PARTIALLY PARALYSED MUSCLES: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
BYE 2017	Strength training V No intervention	4 sets of 10RM, 3 x per week for 12 weeks	C1-S5 SCI	30/30	Maximal voluntary isometric strength in Nm	Some Concerns of Risk of Bias PEDro = 8/10
CHEN 2020	Strength training V No intervention	200 contraction per day, 6 days per week for 6 weeks	C1-S5 SCI	58/59	Strength manual muscle test	Some Concerns of Risk of Bias PEDro = 8/10
GLINSKY 2008	Strength training V No intervention	3 sets of 10RM, 3 x per week for 8 weeks	C4-C7 tetraplegia	15/16	Strength in Nm	Some Concerns of Risk of Bias PEDro = 8/10

The Australian and NZ SCI Physiotherapy guideline committee recommends strength training to improve voluntary strength of partially paralysed muscles in people with SCI. This is an evidence recommendation supported by the results of three randomised controlled trials. The guideline states:

Strength training may be provided to improve voluntary strength of partially paralysed muscles in people with SCI.

This recommendation was formed by considering the results of three randomised controlled trials alongside other factors. The trial results indicate that strength training is better than no strength training to improve muscle strength in partially paralysed muscles. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.

This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend strength training to improve voluntary strength of partially paralysed muscles in people with SCI based on evidence.

To learn more about this recommendation go to the research summary.

Bye EA, Harvey LA, Gambhir A, et al. Strength training for partially paralysed muscles in people with recent spinal cord injury: a within-participant randomised controlled trial. Spinal Cord 2017 May;55(5):460-465.
Chen LW et al. effects of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury: a randomised controlled trial. Spinal cord 2020.
Glinsky J, Harvey L, Korten M, et al. Short-term progressive resistance exercise may not be effective at increasing wrist strength in people with tetraplegia: a randomised controlled trial. Australian Journal of Physiotherapy 2008;54(2):103-108 2008.