PICO Questions

Selection of PICO questions and outcomes of interest

The questions addressed in this guideline are presented in the PICO format, namely, Participant, Intervention, Comparison and Outcome. The PICO questions were determined prior to commencing the guideline reviews.

Decisions about interventions that are routine clinical practice within the Australian and New Zealand context were made by an expert committee of physiotherapists within the Guideline Development Committee. This Committee met to discuss and formulate the PICO questions. During this process the drafted PICO questions were adopted, rejected, or changed.

A list of PICO questions was approved by the Guideline Development Committee and completed prior to commencement of the guideline reviews. Additional PICO questions were added at the request of the committee during the development and guideline review process.

PICO questions focused on impairment and activity-based physical outcomes rather than global health concerns with reference to culture or race, cultural practice or world views. As such, other outcomes that contribute or reflect participation and well-being (part of the Māori models of health) have not been included in these guidelines.

The PICO questions considered in this review

Questions are as follows:

Respiratory muscle training v no intervention on respiratory muscle strength in people with SCI who have respiratory muscle weakness.
Abdominal binders in sitting v no intervention on lung volumes in people with SCI who have respiratory muscle weakness.
Supine v sitting on lung volumes in people with SCI who have abdominal muscle paralysis (full or partial)
Intermittent application of positive pressure devices v no intervention on lung volume in non-ventilated people with acute SCI who have respiratory muscle weakness.
Additional application of positive pressure devices v no intervention on lung volume in ventilated people SCI
Deep breathing exercises v no intervention on lung volumes in people with SCI who have respiratory muscle weakness.
Air stacking v no intervention on lung volumes in people with SCI who have respiratory muscle weakness.
Abdominal FES v no intervention on lung volumes in people with SCI who have respiratory muscle weakness.
Postural drainage v no intervention on secretion clearance in people with SCI who have respiratory muscle weakness
Manually assisted cough v no intervention on secretion clearance in people with SCI who have abdominal muscle paralysis (full or partial)
Mechanically assisted cough (insufflation/exsufflation) v no intervention on secretion clearance in people with SCI who have respiratory muscle weakness
Mechanically assisted cough (insufflation/exsufflation) plus manually assisted cough v no intervention on secretion clearance in people with SCI who have abdominal muscle paralysis (full or partial)
Percussion and vibration v no intervention on secretion clearance in people with SCI who have respiratory muscle weakness
Abdominal binders v no intervention to improve cough in people with SCI who have abdominal muscle paralysis (full or partial)
Abdominal FES v no intervention on stimulated cough in people with SCI who have abdominal paralysis (partial or full).
Positive expiratory pressure devices v no intervention on secretion clearance in people with SCI who have expiratory muscle weakness.
Abdominal binders v no intervention on postural hypotension in people with SCI
Manual wheelchair skills training v no intervention on wheelchair skills in people with SCI
Virtual reality sitting training v no intervention on ability to sit in people with SCI
Power wheelchair skills training v no intervention on power wheelchair skills in people with SCI who are dependent on a power wheelchair for mobility
Bed mobility v no intervention on ability to move in bed in people with SCI
Sitting training v no intervention on ability to sit in people with SCI and motor function in the lower limbs
Sitting training v no intervention on ability to sit in people with SCI and paralysis of the lower limbs/trunk
Transfer training v no intervention on ability to transfer in people with SCI
Vertical transfer training v no intervention on ability to vertically transfer in people with SCI who are wheelchair dependent
Sit to stand training v no intervention on ability to move from sit to stand in people with SCI and motor function in the lower limbs
Standing training v no intervention on ability to stand in people with SCI and motor function in the lower limbs
Stair training v no intervention to improve the ability to climb stairs in people with SCI and motor function in the lower limbs
Hand function training v no intervention to improve hand function in people with tetraplegia
Robotic Upper limb training v no intervention to improve upper limb function in people with tetraplegia
Walking training vs no intervention to improve walking in people with SCI and motor function in the lower limbs. Walking training can include:
- - Overground gait training
  - Treadmill gait training (+/- body weight support)
  - Treadmill gait training with electrical stimulation (+/- body weight support)
  - Overground gait training and electrical stimulation
  - Robotic overground gait training
  - Robotic treadmill gait training
  - Conventional therapy (package of interventions including gait training)
  - Gait training with orthotics
Conventional therapy (package of interventions including gait training) vs treadmill gait training (with or without body weight support) to improve walking in people with SCI and motor function in the lower limbs
Upper limb training, Hand function training and FES v no intervention to improve hand function in people with tetraplegia
Upper limb virtual reality v no intervention to improve hand function in people with tetraplegia
Tenodesis splinting v no intervention to improve a tenodesis grip in people with C6 or C7 tetraplegia
Overground gait training v Robotic gait training to improve walking in people with SCI and potential for upright mobility
Overground gait training vs Treadmill gait training (with or without body weight support) to improve walking in people with SCI and motor function in the lower limbs
Treadmill gait training (with or without body weight support) vs Robotic gait training to improve walking in people with SCI and motor function in the lower limbs
Hydrotherapy v land therapy to improve mobility for people with SCI
Gait training (any type) v no intervention to improve walking for people with no motor function in the lower limbs
TENS v no intervention to treat pain in people with SCI
Education to avoid overuse and trauma v no intervention to prevent and treat shoulder pain in people with SCI
Shoulder exercises v no intervention to treat shoulder pain in people with SCI
Massage vs no intervention to treat pain in people with SCI
Positioning v no intervention to prevent shoulder pain in people with SCI
Passive movements v no intervention to prevent or treat shoulder pain
Equipment to support the shoulder v no intervention to prevent shoulder subluxation in people with SCI at risk of shoulder subluxation
Neuromuscular electrical stimulation v no intervention to prevent shoulder subluxation in people with SCI at risk of shoulder subluxation
Shoulder support devices/braces v no intervention to prevent shoulder subluxation in people with SCI
Neuromuscular electrical stimulation v no intervention to treat shoulder subluxation in people with SCI
Shoulder support devices/braces v no intervention to treat shoulder subluxation in people with SCI
Long duration stretch v no intervention on joint mobility in people with SCI
Active Assisted Exercise v no intervention on prevention of loss of joint mobility in people with SCI who are at risk of contracture
Active Assisted Exercise v no intervention on treatment of loss of joint mobility in people with SCI
Passive standing v no intervention on joint mobility in people with SCI and paralysed lower limbs
Serial casting v no intervention on joint mobility in people with SCI
Hand splinting versus no intervention on prevention of hand contractures in people with tetraplegia
Hand splinting versus no intervention on treatment of hand contractures in people with tetraplegia
Upper and lower limb splinting versus no intervention on prevention of contractures in people with SCI who are at risk of contracture
Passive range of motion exercises v no intervention on joint mobility in people with SCI
Passive range of motion exercises v no intervention on spasticity in people with SCI
Passive standing v no intervention on spasticity in people with SCI
FES cycling v no intervention on spasticity in people with SCI
Vibration v no intervention on spasticity in people with SCI
Passive standing v no intervention on bone mineral density
Elevation v no intervention on swelling in people with SCI
Neuromuscular electrical stimulation v no intervention on swelling
Lymphatic massage v no intervention on swelling
ES cycling v no intervention on swelling
Strength training v no intervention to improve voluntary strength of non-paralysed muscles in people with SCI
Strength training v no intervention on voluntary strength of partially paralysed muscles
FES cycling v no intervention to decrease atrophy in people with SCI and paralysis of the lower limbs
Electrical stimulation alone v no intervention on voluntary strength of partially paralysed muscles in people with SCI
Strength training combined with electrical stimulation v no intervention on voluntary strength of partially paralysed muscles in people with SCI
Whole body vibration v no intervention on voluntary strength in people with SCI
Arm cranking v no intervention on cardiorespiratory fitness in people with SCI
Hand Cycling v no intervention on cardiorespiratory fitness in people with SCI
Circuit training v no intervention on cardiorespiratory fitness in people with SCI
FES cycling v no intervention to improve cardiorespiratory fitness in people with SCI
Individual or team sports v no intervention to improve cardiovascular health in people with SCI
Wheelchair pushing v no intervention on cardiorespiratory fitness in people with SCI who are wheelchair dependent

The Australian and New Zealand Physiotherapy Guidelines for people with SCI was funded by icare NSW, National Injury Insurance Scheme Queensland, Transport Accident Commission Victoria, and Lifetime Support Authority South Australia.

Acknowledgement of Country – The Australian and New Zealand Clinical Practice Guidelines team acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

Honouring Te Tiriti – Ethical approval, including Māori consultation through University of Otago, Christchurch, Te Komiti Whakarite (Canterbury District Health Board), and through Māori consultation (Counties Manukau District Health Board) was obtained for Phase 1 of the study. In developing these guidelines, we were committed to meeting our obligations under Te Tiriti and reflect the principles of tino rangatiratanga, equity, active protection, options, and partnership.