Arm cranking (v no intervention) on cardiorespiratory fitness in people with SCI
evidence: Weak For Recommendation
Arm cranking may be provided to improve cardiorespiratory fitness in people with SCI.
Arm cranking for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse.
| Arm cranking (v no intervention) on cardiorespiratory fitness in people with SCI |
|||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Weak for (81%) | Weak evidence recommendation FOR Arm cranking may be provided to improve cardiorespiratory fitness in people with SCI. Clinical note: Arm cranking for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse. |
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| I | Arm cranking | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
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| O | Cardiorespiratory Fitness | ||||||
| SUMMARY | 3 RCTs (see references) | Mean difference (95% CI): Cardiorespiratory fitness expressed as Vo2 Peak 4.7 (1.4 to 8.0) Favours arm cranking |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency No serious | Imprecision No serious | Indirectness Serious | Publication bias Serious |
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 |
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| ARM CRANKING ON CARDIORESPIRATORY FITNESS: 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 | |
| ARM CRANKING ON CARDIORESPIRATORY FITNESS: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| AKKURT 2017 | Arm cranking (plus usual care) V Usual care | 3 days per week, 1.5 hours/week 50-70% pVO2 (A borg scale score of lightly hard-moderately hard | C7-L5 SCI | 17/16 | Vo2 peak | High Risk of Bias PEDro = 6/10 |
| NIGHTINGALE 2018 | Arm cranking (portable desktop ergometer) V No intervention | 4 x per week for 6 weeks (moderate intensity) | Below T2 SCI | 13/8 | Vo2 peak | Some Concerns of Risk of Bias PEDro = 5/10 |
| TAYLOR 1986 | Arm cranking V No intervention | 30 minutes, 5 x per week for 8 consecutive weeks (50rev/min) | paraplegia | 5/5 | Vo2 peak | High Risk of Bias PEDro = 5/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends arm cranking to improve cardiorespiratory fitness in people with spinal cord injury. This is an evidence recommendation supported by the results of 3 randomised controlled trials. The guideline states:
Arm cranking may be provided to improve cardiorespiratory fitness in people with SCI.
This recommendation was formed by considering the results of three randomised controlled trials alongside other factors. The combined trial results indicate that arm cranking is better than no arm cranking in people with SCI. 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 arm cranking for cardiorespiratory fitness in people with SCI based on the evidence.
To learn more about this recommendation go to the research summary.
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Nightingale TE, Rouse PC, Walhin JP, et al. Home-based exercise enhances health-related quality of life in persons with spinal cord injury: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2018 Oct;99(10):1998-2006.
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Akkurt H, Karapolat HU, Kirazli Y, Kose T. The effects of upper extremity aerobic exercise in patients with spinal cord injury: a randomized controlled study. Eur J Phys Rehabil Med. 2017 Apr;53(2):219-227.
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Taylor AW, E M and L B (1986) The effects of an arm ergometer training programme on wheelchair subjects. Paraplegia. 24:105-114.
Manual wheelchair skills training (v no intervention) on wheelchair skills in people with SCI
evidence: Weak For Recommendation
Manual wheelchair skills training may be provided to improve manual wheelchair skills in people with SCI.
| Manual wheelchair skills training (v no intervention) on wheelchair skills in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Weak for (95%) | Weak evidence recommendation FOR Evidence recommendation: manual wheelchair skills training may be provided to improve manual wheelchair skills in people with SCI. |
||||
| I | Manual wheelchair skills training | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Wheelchair skills | ||||||
| SUMMARY | 4 RCTs (see references) | Standardised Mean difference (95% CI): 0.7 (0 to 1.4) Favours wheelchair skills training |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Serious | Inconsistency Very serious | Imprecision Very serious | Indirectness Serious | Publication bias Serious |
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 |
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| MANUAL WHEELCHAIR TRAINING FOR WHEELCHAIR SKILLS: 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 | |
| MANUAL WHEELCHAIR SKILLS TRAINING FOR WHEELCHAIR SKILLS: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| KIRBY 2016 | Wheelchair skills training V Educational Control | Intervention: Five individual training sessions Control: Five education sessions | People with SCI living in community | 47/49 | Wheelchair skills test | Some concerns about Risk of Bias PEDro = 7/10 |
| RICE 2013 | Wheelchair skills training V No Intervention | 3 visits of real time feedback from a Smart wheel while pushing | People with SCI living in community SCI<2 years | 6/9 | Stroke frequency | Some concerns about Risk of Bias PEDro = 4/10 |
| WOROBEY 2016 | Wheelchair skills training V Control | Between 2-8, 60–80-minute group training sessions | People with SCI living in community | 36/43 | Wheelchair skills test | High Risk of Bias PEDro = 7 |
| YEO 2018 | Wheelchair skills training V No Intervention | 1 hour per day, 3 days/week for 8 weeks | People with tetraplegia living in community | 13/11 | Wheelchair skills test | Some concerns about Risk of Bias PEDro = 4 |
The Australian and NZ SCI Physiotherapy guideline committee recommends manual wheelchair skills training to improve manual wheelchair skills in people with SCI. This is an evidence recommendation supported by the results of four randomised controlled trials. The guideline states:
Manual wheelchair skills training may be provided to improve manual wheelchair skills in people with SCI.
This recommendation was formed by considering the results of four randomised controlled trials alongside other factors. The combined trial results indicate that manual wheelchair skills training is better than no manual wheelchair skills training to improve manual wheelchair skills. 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 manual wheelchair skills training to improve manual wheelchair skills in people with SCI. To learn more about this recommendation go to the research summary.
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Kirby RL, Mitchell D, Sabharwal S, et al. Manual wheelchair skills training for community-dwelling veterans with spinal cord injury: a randomized controlled trial. PLoS ONE 2016 Dec;11(12):e0168330.
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Rice LA, Smith I, Kelleher AR, et al. Impact of the clinical practice guideline for preservation of upper limb function on transfer skills of persons with acute spinal cord injury. Archives of Physical Medicine and Rehabilitation 2013 Jul;94(7):1230-1246.
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Yeo SS, Kwon JW. Wheelchair Skills Training for Functional Activity in Adults with Cervical Spinal Cord Injury. International journal of sports medicine 2018; 39: 924-928.
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Worobey LA, Kirby RL, Heinemann AW et al Effectiveness of Group Wheelchair Skills Training for People With Spinal Cord Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2016 Oct;97(10):1777-1784.
Virtual reality sitting training (v no intervention) on ability to sit in people with SCI
evidence: Weak For Recommendation
Virtual Reality sitting training may be provided to improve ability in sitting in people with SCI.
| Virtual reality sitting training (v no intervention) on ability to sit in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Weak for (95%) | Weak evidence recommendation FOR Virtual Reality sitting training may be provided to improve ability in sitting in people with SCI. |
||||
| I | Virtual reality (VR) sitting training | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Ability to sit | ||||||
| SUMMARY | 1 RCT (see reference) | Mean difference (95% CI): Seated reach in mm 63 (38 to 89) Favours VR sitting training |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Serious | Inconsistency Serious | Imprecision Serious | Indirectness Serious | Publication bias Serious |
||
 |
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| VIRTUAL REALITY SITTING TRAINING FOR FUNCTIONAL ABILITY TO SIT: 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 | |
| VIRTUAL REALITY SITTING TRAINING FOR ABILITY TO SIT: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| TAK 2015 | Game based virtual reality sitting training (plus usual care) V Usual care | 6 weeks, 30 minutes ×3 sessions per week of Nintendo Wii- based VR balance training | AIS A or B SCI (cervical and thoracic) | 13/13 | Modified functional reach test (front) | Some concerns of Risk of Bias PEDro = 7/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends virtual reality sitting training to improve sitting in people with SCI. This is an evidence recommendation supported by the results of one randomised controlled trial. The guideline states:
Virtual Reality sitting training may be provided to improve ability in sitting in people with SCI.
This recommendation was formed by considering the results of one randomised controlled trials alongside other factors. The trial results indicate that virtual reality sitting training is better than no virtual reality sitting training to improve sitting. 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 Virtual Reality sitting training to improve ability in sitting in people with SCI based on evidence.
To learn more about this recommendation go to the research summary.
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Tak S, Choi W and Lee S. Game-based virtual reality training improves sitting balance after spinal cord injury: a single-blinded, randomized controlled trial. Medical Science Technology 2015 Jun 26;56:53-59.
Abdominal binders in sitting (v no intervention) on lung volumes in people with SCI who have abdominal muscle weakness or paralysis
evidence: Weak For Recommendation
Abdominal binders in sitting may be provided to improve lung volume in people with SCI who have abdominal muscle weakness or paralysis.
Abdominal binders (to improve lung volumes) are provided in people with respiratory compromise and abdominal muscle paralysis (full or partial). Abdominal binders may not be suitable for people with significant abdominal distension, central adiposity, or large abdomens. Abdominal binders may also be provided for purposes other than improving lung volume.
| Abdominal binders in sitting (v no intervention) on lung volumes in people with SCI who have abdominal muscle weakness or paralysis | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who have abdominal muscle weakness or paralysis | Evidence recommendation Weak for (100%) | Weak evidence recommendation FOR Abdominal binders in sitting may be provided to improve lung volume in people with SCI who have abdominal muscle weakness or paralysis. Clinical note: Abdominal binders (to improve lung volumes) are provided in people with respiratory compromise and abdominal muscle paralysis (full or partial). Abdominal binders may not be suitable for people with significant abdominal distension, central adiposity, or large abdomens. Abdominal binders may also be provided for purposes other than improving lung volume. |
||||
| I | Abdominal binders | ||||||
| C | No abdominal binder | Consensus-based opinion statement No opinion statements |
|||||
| O | Lung volume | ||||||
| SUMMARY | 5 RCTs (see references) | Mean difference (95% CI): Lung volume in litres 0.3 (0.1 to 0.5) Favours abdominal binders |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency Not serious | Imprecision Not serious | Indirectness Serious | Publication bias Serious |
||
 |
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| ABDOMINAL BINDERS FOR LUNG VOLUME: 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 | |
| ABDOMINAL BINDERS FOR LUNG VOLUME: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| GOLDMAN 1996 | Sitting with abdominal binder V Sitting without abdominal binder | Elastic binder | C5-C7 Complete SCI >3 months post injury | 7/7 | Lung volume Vital Capacity (VC) | High Risk of Bias PEDro = 5/10 |
| BOAVENTURA 2003 | Sitting with abdominal binder V Sitting without abdominal binder | Elastic binder | C4-C7 Complete SCI 1 year post injury | 10/10 | Lung volume Forced Vital Capacity (FVC) | Some Concerns of Risk of bias PEDro = 6/10 |
| BODIN 2005 | Sitting with abdominal binder V Sitting without abdominal binder | Elastic binder | C5-C8 SCI At least 1 year post injury | 20/20 | Lung volume (VC) | High Risk of Bias PEDro = 4/10 |
| HART 2005 | Sitting with abdominal binder V Sitting without abdominal binder | Combination elastic and non-elastic binder | C5-T6 AIS A SCI | 10/10 | Lung volume (FVC) | High Risk of Bias PEDro = 4/10 |
| WADSWORTH 2012 | Sitting with abdominal binder V Sitting without abdominal binder | Elastic binder | C3-T5 AIS A or AIS B SCI Acute | 14/14 | Lung volume (FVC) | High Risk of Bias PEDro = 4/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends abdominal binders in sitting may be provided to improve lung volume in people with SCI who have abdominal muscle weakness or paralysis. This is an evidence recommendation supported by the results of five randomised controlled trials. The guideline states:
Abdominal binders in sitting may be provided to improve lung volume in people with SCI who have abdominal muscle weakness or paralysis.
This recommendation was formed by considering the results of five randomised controlled trials alongside other factors. The combined trial results indicate that abdominal binders in sitting are better than no abdominal binders for improving lung volume. 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 abdominal binders in sitting may be provided to improve lung volume in people with SCI who have abdominal muscle weakness or paralysis based on the evidence.
To learn more about this recommendation go to the research summary.
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Boaventura, C. D.Gastaldi, A. C.Silveira, J. M.Santos, P R.Guimaraes, R. C.De, L. L. C. Effect of an abdominal binder on the efficacy of respiratory muscles in seated and supine tetraplegic patients. Physiotherapy 2003 May;89(5):290-295.
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Wadsworth, B. M. Haines, T. P. Cornwell, P. L. Rodwell, L. T. Paratz, J. D. An abdominal binder improves lung volumes and voice in people with tetraplegic spinal cord injury. Archives of Physical Medicine and Rehabilitation 2012 Dec;93(12):2189-2197.
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Hart, N. Laffont, I.de la Sota, A. P.Lejaille, M.Macadou, G.Polkey, M. I.Denys, P.Lofaso, F. Respiratory effects of combined truncal and abdominal support in patients with spinal cord injury. Archives of Physical Medicine and Rehabilitation 2005 Jul;86(7):1447-1451
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Bodin P, Fagevik Olsen M, Bake B, Kreuter M. Effects of abdominal binding on breathing patterns during breathing exercises in persons with tetraplegia. Spinal Cord 2005; 43: 117–122.
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Goldman JM, Rose LS, Williams SJ, Silver JR, Denison DM. Effect of abdominal binders on breathing in tetraplegic patients. Thorax 1986; 41: 940–945.
Respiratory muscle training (v no intervention) on inspiratory respiratory muscle strength in people with SCI who have respiratory muscle weakness
evidence: Weak For Recommendation
Respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness.
Respiratory muscle training most commonly involves inspiratory muscle training but can also include expiratory muscle training.
| Respiratory muscle training (v no intervention) on respiratory muscle strength in people with SCI who have respiratory muscle weakness | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who have respiratory muscle weakness | Evidence recommendation Weak for (100%) | Weak evidence recommendation FOR Respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness. Clinical note: Respiratory muscle training most commonly involves inspiratory muscle training but can also include expiratory muscle training |
||||
| I | Respiratory muscle training | ||||||
| C | No intervention | Opinion statement No opinion statements |
|||||
| O | Muscle strength (mean inspiratory pressure) | ||||||
| SUMMARY | 10 RCTs (see references) | Mean difference (95% CI): Muscle strength in Mean Inspiratory Pressure -13 (-17 to -9) Favours respiratory muscle training |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Serious | Inconsistency Serious | Imprecision Not serious | Indirectness Not serious | Publication bias Serious |
||
 |
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| RESPIRATORY MUSCLE TRAINING FOR RESPIRATORY MUSCLE STRENGTH: 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 | |
| RESPIRATORY MUSCLE TRAINING FOR RESPIRATORY MUSCLE STRENGTH: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BOSWELL-RUYS 2020 | Resistive Inspiratory muscle training (RMT) V Sham RMT | 3-5 sets 12 breaths 2 x day 5 days per week for 6 weeks @ > 30% MIP | C4-C8 SCI AIS A, B, C > 4 weeks post-injury | 29/31 | Maximal Inspiratory pressure (MIP) | Very low Risk of Bias PEDro = 10/10 |
| Liaw 2000 | Inspiratory muscle training (& usual care) V Usual care | 15-20 minutes 2 x day; 7 days per week for 6/52 | C4-C7 complete SCI < 6 months post-injury | 10/10 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 4/10 |
| LITCHKE 2008 | Respiratory resistance training V No intervention | 1 set of exercises 2-3 x per day daily for 10 weeks | >80% participants with SCI C5-T12 SCI > 6 months post-injury | 4/5 | Maximal Inspiratory pressure (MIP) | Some Concerns about Risk of Bias PEDro = 5/10 |
| LITCHKE 2011 | Concurrent flow resistance V No intervention | 10 breaths 3 different x per day daily for 9 weeks | >80% participants with SCI C5-C7 SCI | 5/7 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 3/10 |
| LOVERIDGE 1989 | Concurrent flow resistance V No intervention | 85% of sustained inspiratory pressure 2 x day for 15 minutes 5 days per week for 8 weeks | C6-C7 complete SCI >1 year post-injury | 6/6 | Maximal Inspiratory pressure (MIP) | Some Concerns about Risk of Bias PEDro = 4/10 |
| MUELLER 2013 | Inspiratory resistance training V placebo | 90 breaths @ > 80% max inspiratory power 4 x per week for 8 weeks | C6-C7 complete SCI >1 year post-injury | 8/8 | Maximal Inspiratory pressure (MIP) | Some Concerns about Risk of Bias PEDro = 4/10 |
| POSTMA 2014 | Resistive Inspiratory muscle training (& usual care) V Usual care | 90 breaths @ > 80% max inspiratory power 4 x per week for 8 weeks | T12 and above SCI AIS A-D initial rehab FEV1 <80% predicted | 19/21 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 7/10 |
| ROTH 2010 | Expiratory muscle training V Sham | Exp muscle resistive training 10 reps, twice a day, 5 x per week for 6 weeks | T1 and above motor complete SCI | 16/13 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 4/10 |
| SOUMYASHREE 2018 | Inspiratory muscle training V Breathing exercises | 15 minutes @ 40 MIP 5 x per week for 4 weeks | T1-12 SCI AIS A-D | 15/12 | Maximal Inspiratory pressure (MIP) | Some Concerns of Risk of bias PEDro = 7/10 |
| WEST 2014 | Inspiratory muscle training V Sham | 30 breaths at 50-60% Pimax 2 x day 5 days per week for 6 weeks | C5-C7 SCI AIS A or B ≥3 years post-injury | 5/5 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 4/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness. This is an evidence recommendation supported by the results of ten randomised controlled trials. The guideline states:
Respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness.
This recommendation was formed by considering the results of ten randomised controlled trials alongside other factors. The combined trial results indicate that respiratory muscle training is better than no respiratory muscle training in people with SCI. 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 respiratory muscle training for respiratory muscle strength in people with SCI (who have respiratory muscle weakness) based on the evidence.
To learn more about this recommendation go to the research summary.
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Liaw MY, Lin MC, Cheng PT, et al. Resistive inspiratory muscle training: its effectiveness in patients with acute complete cervical cord injury. Archives of Physical Medicine and Rehabilitation 2000 Jun;81(6):752-756.
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Litchke L, Lloyd L, Schmidt E, et al. Comparison of two concurrent respiratory resistance devices on pulmonary function and time trial performance of wheelchair athletes. Therapeutic Recreation Journal 2011;45(2):147-159.
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Litchke LG, Russian CJ, Lloyd LK, et al. Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes. The Journal of Spinal Cord Medicine 2008;31(1):65-71.
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Loveridge B, Badour M, Dubbo H. Ventilatory Muscle Endurance Training in Quadriplegics; effects on breathing pattern. Paraplegia 1989; 27: 329-339.
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Mueller G, Hopman MTE and Perret C. Comparison of respiratory muscle training methods in individuals with motor complete tetraplegia. Topics in Spinal Cord Injury Rehabilitation 2012;18(2):118-121.
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Postma K, Haisma JA, Hopman MTE, et al. Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial. Physical Therapy 2014 ;94(12):1709-1719 2014.
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Soumyashree S, Kaur J. Effect of inspiratory muscle training (IMT) on aerobic capacity, respiratory muscle strength and rate of perceived exertion in paraplegics. Journal of spinal cord medicine 2018: 1-7.
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West CR, CR, Taylor BJ, Campbell IG, Romer LM. Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury. Scandinavian journal of medicine & science in sports 2014; 24: 764.
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Boswell-Ruys CL, Lewis CRH, Wijeysuriya NS, et al. Impact of respiratory muscle training on respiratory muscle strength, respiratory function and quality of life in individuals with tetraplegia: a randomised clinical trial. Thorax 2020;75:279-288.
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Roth EJ, Stenson KW, Powley S, Oken J, Primack S, Nussbaum SB, Berkowitz M. Expiratory muscle training in spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil. 2010 Jun;91(6):857-61.
TENS (v no intervention) on pain in people with SCI
evidence: Weak For Recommendation
TENS may be provided for pain in people with SCI.
| TENS (v no intervention) on pain in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Weak for (95%) | Weak evidence recommendation FOR Evidence recommendation: TENS may be provided for pain in people with SCI. |
||||
| I | TENS | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Pain | ||||||
| SUMMARY | 2 RCTs (see references) | Mean difference (95% CI): Pain (VAS) -2 (-3 to -1) Favours TENS |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency Serious | Imprecision No serious | Indirectness Serious | Publication bias Serious |
||
 |
|||||||
| TENS FOR PAIN: 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 | |
| TENS FOR PAIN: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BI 2015 | TENS V Sham TENS | TENS 20 minutes, 3 x per week for 12 weeks | People with SCI | 24/24 | Visual Analogue Pain scale | Some Concerns of Risk of Bias PEDro = 7/10 |
| CELIK 2013 | TENS V Sham TENS | 30 mins per day for 10 days | People with SCI | 17/16 | Visual Analogue Pain scale | High Risk of Bias PEDro = 4/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends TENS may be provided for pain in people with SCI. This is an evidence recommendation supported by the results of 2 randomised controlled trials. The guideline states:
TENS may be provided for pain in people with SCI.
This recommendation was formed by considering the results of two randomised controlled trials alongside other factors. The combined trial results indicate that TENS is better than no TENS for pain in people with SCI. 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 TENS for pain in people with SCI based on the evidence.
To learn more about this recommendation go to the research summary.
-
Bi X, Lv H, Chen B-L, Li X, Wang X-Q. Effects of transcutaneous electrical nerve stimulation on pain in patients with spinal cord injury: a randomized controlled trial. Journal of Physical Therapy Science 2015; 27: 23-25.
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Celik EC, Erhan B, Gunduz B, Lakse E. The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury. Spinal cord 2013; 51: 334.
Long duration stretch (v no intervention) on joint mobility in people with SCI
evidence: Weak For Recommendation
Long duration stretch may be provided to prevent and treat loss of joint mobility in people with SCI.
| Long duration stretch (v no intervention) on joint mobility in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Weak for (95%) | Weak evidence recommendation FOR Long duration stretch may be provided to prevent and treat loss of joint mobility in people with SCI. |
||||
| I | Long duration stretch | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Joint mobility | ||||||
| SUMMARY | 3 RCTs (see references) | Mean difference (95% CI): Joint mobility in degrees 2 (1 to 4) Favours long duration stretch Favours stretch |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Serious | Inconsistency Serious | Imprecision No serious | Indirectness Serious | Publication bias Serious |
||
 |
|||||||
| LONG DURATION STRETCH ON JOINT MOBILITY: 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 | |
| LONG DURATION STRETCH ON JOINT MOBILITY: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BEN 2005 | Long duration stretch V No intervention | 30 minutes, 3 x per week for 12 weeks of standing on TT | People with SCI and LL paralysis | 20/20 | Ankle mobility (degrees) | Some Concerns of Risk of Bias PEDro = 8/10 |
| HARVEY 2000 | Long duration stretch V No intervention | 30 mins, 5 x per week for 4 weeks | People with SCI and LL paralysis | 7/7 | Ankle mobility (degrees) | Some Concerns of Risk of Bias PEDro = 8/10 |
| HARVEY 2003 | Long duration stretch V No intervention | 30 mins, 5 x per week for 4 weeks | People with SCI and LL paralysis | 16/16 | Joint mobility/Hamstring length (degrees) | Some Concerns of Risk of Bias PEDro = 7/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends long duration stretch to prevent and treat loss of joint mobility in people with SCI. This is an evidence recommendation supported by the results of 3 randomised controlled trials. The guideline states:
Long duration stretch may be provided to prevent and treat loss of joint mobility 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 long duration stretch is better than no long duration stretch to improve joint mobility. 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 long duration stretch to prevent and treat loss of joint mobility in people with SCI based on evidence. To learn more about this recommendation go to the research summary.
-
Ben M, Harvey L, Denis S, et al. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries? Australian journal of physiotherapy 2005;51:251.
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Harvey LA, Batty J, Crosbie J, et al. A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries. Arch Phys Med Rehabil 2000; 81:1340-1347.
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Harvey LA, Byak AJ, Ostrovskaya M, et al. Randomised trial of the effects of four weeks of daily stretch on extensibility of hamstring muscles in peoplewith spinal cord injuries. Aust J Physiotherapy 2003; 49:176-181.
Strength training (v no intervention) on voluntary strength of non-paralysed muscles in people with SCI
evidence: Weak For Recommendation
Strength training may be provided to improve voluntary strength of non-paralysed muscles in people with SCI.
| Strength training (v no intervention) on voluntary strength of non-paralysed muscles in people with SCI |
|||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI (non- paralysed muscles) | Evidence recommendation Weak for (91%) | Weak evidence recommendation FOR Strength training may be provided to improve voluntary strength of non-paralysed muscles in people with SCI. |
||||
| I | Strength training | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Voluntary strength | ||||||
| SUMMARY | 3 RCTs (see references) | Consider studies independently. Unable to pool I2 = 78% |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency Very serious | Imprecision Serious | Indirectness No serious | Publication bias Serious |
||
 |
|||||||
| STRENGTH TRAINING ON VOLUNTARY STRENGTH INNERVATED 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 INNERVATED MUSCLES: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| HICKS 2003 | Circuit training (Pushing, arm ergometry and PRE) V Education | Supervised progressive exercise 2 x weekly for 9 months. Each session 90-120 minutes | C4-L2 SCI | 11/12 | Elbow flexion strength in kg | High Risk of Bias PEDro = 5/10 |
| MULROY 2011 | Home-based shoulder exercise programme V Education | 3 x per week for 12 weeks | T2 to T7 SCI | 26/32 | Shoulder abduction in Nm | High Risk of Bias PEDro = 7/10 |
| YILDRIM 2016 | Strength training V No intervention | Upper extremity training 5 x per week for 6 weeks | Paraplegia | 13/13 | Elbow flexion Nm/kg | Some Concerns of Risk of Bias PEDro = 4/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends strength training to improve voluntary strength of non-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 non-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 non-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 non-paralysed muscles in people with SCI based on evidence.
To learn more about this recommendation go to the research summary.
-
Mulroy SJ, Thompson L, Kemp B, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Physical therapy 2011; 91: 305-324.
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Hicks Al, Martin KA, Ditor DS, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal cord 2003; 41: 34.
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Yildirim A, Sürücü GD, Karamercan A et al Short-term effects of upper extremity circuit resistance training on muscle strength and functional independence in patients with paraplegia. J Back Musculoskelet Rehabil. 2016 Nov 21;29(4):817-823.
Strength training (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI
evidence: Weak For Recommendation
Strength training may be provided to improve voluntary strength of partially paralysed muscles in people with SCI.
| 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 | ||||||
| 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.
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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.
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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.
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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.
Hand Cycling (v no intervention) on cardiorespiratory fitness in people with SCI
evidence: Weak For Recommendation
Hand cycling may be provided to improve cardiorespiratory fitness in people with SCI.
Hand cycling for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse
| Hand Cycling (v no intervention) on cardiorespiratory fitness in people with SCI |
|||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Weak for (88%) | Weak evidence recommendation FOR Hand cycling may be provided to improve cardiorespiratory fitness in people with SCI. Clinical note: Hand cycling for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse |
||||
| I | Hand cycling | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Cardiorespiratory Fitness | ||||||
| SUMMARY | 1 RCT (see reference) | Mean difference (95% CI): Cardiorespiratory fitness expressed as Vo2 Peak 5.9 (3.7 to 8.1) Favours hand cycling |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Serious | Inconsistency Serious | Imprecision No serious | Indirectness Serious | Publication bias Serious |
||
 |
|||||||
| HAND CYCLING ON CARDIORESPIRATORY FITNESS: 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 | |
| HAND CYCLING ON CARDIORESPIRATORY FITNESS: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| KIM 2015 | Indoor hand cycling V No intervention (usual activities) | Indoor hand bike - 60 minutes per day, 3 days per week for 6 weeks | C5-T11 SCI | 8/7 | Vo2 peak | Some Concerns of Risk of Bias PEDro = 5/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends hand cycling to improve cardiorespiratory fitness in people with SCI. This is an evidence recommendation supported by the results of one randomised controlled trial. The guideline states:
Hand cycling may be provided to improve cardiorespiratory fitness in people with SCI.
This recommendation was formed by considering the results of one randomised controlled trial alongside other factors. The trial results indicate that hand cycling is better than no hand cycling to improve cardiorespiratory fitness. 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 hand cycling to improve cardiorespiratory fitness in people with SCI based on evidence.
To learn more about this recommendation go to the research summary.
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Kim D-I, Lee H, Lee B-S, et al. Effects of a 6-Week Indoor Hand-Bike Exercise Program on Health and Fitness Levels in People with Spinal Cord Injury: A Randomized Controlled Trial Study. Archives of physical medicine and rehabilitation 2015; 96: 2033-2040.e2031.
FES cycling (v no intervention) on atrophy (prevention) in people with SCI and paralysis of the lower limbs
evidence: Weak For Recommendation
FES cycling may be provided to decrease atrophy in people with SCI and paralysis of the lower limbs.
| FES cycling (v no intervention) on atrophy (prevention) in people with SCI and paralysis of the lower limbs |
|||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who have paralysis of the lower limbs | Evidence recommendation Weak for (100%) | Weak evidence recommendation FOR FES cycling may be provided to decrease atrophy in people with SCI and paralysis of the lower limbs |
||||
| I | FES cycling | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Atrophy | ||||||
| SUMMARY | 2 RCTs (see references) | Standardised Mean Difference (95% CI) 3 (2 to 4) Favours FES cycling |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency No serious | Imprecision Serious | Indirectness Serious | Publication bias Serious |
||
 |
|||||||
| FES CYCLING ON ATROPHY: 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 | |
| FES CYCLING ON ATROPHY: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BALDI 1998 | FES cycle ergometry V No intervention | FES cycle ergometer 3 x per week for 3 weeks | C5-T12 Frankel A and B SCI | 9/9 | Atrophy Total body mass (gluteal) | High Risk of Bias PEDro = 4/10 |
| DEMCHAK 2005 | FES cycle ergometry V No intervention | FES cycle ergometer 3 x per week for 13 weeks | AIS A and B SCI | 5/5 | Atrophy – Muscle fibre cross sectional area | High Risk of Bias PEDro = 5/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends FES cycling to decrease atrophy in people with SCI and paralysis of the lower limbs. This is an evidence recommendation supported by the results of two randomised controlled trials. The guideline states:
FES cycling may be provided to decrease atrophy in people with SCI and paralysis of the lower limbs.
This recommendation was formed by considering the results of two randomised controlled trials alongside other factors. The trial results indicate that FES cycling is better than no FES cycling to prevent atrophy. 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 FES cycling to decrease atrophy in people with SCI and paralysis of the lower limbs based on evidence.
To learn more about this recommendation go to the research summary.
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Demchak TJ, Linderman JK, Mysiw WJ, Jackson R, Suun J, Devor ST. Effects of functional electric stimulation cycle ergometry training on lower limb musculature in acute sci individuals. J Sport Sci Med 2005;4(3):263–71.
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Baldi JC, Jackson RD, Moraille R and Mysiw WJ. Muscle atrophy is prevented in patients with acute spinal cord injury using functional electrical stimulation. Spinal cord 1998; 36: 463.
Circuit training (v no intervention) on cardiorespiratory fitness in people with SCI
evidence: Weak For Recommendation
Circuit training may be provided to improve cardiorespiratory fitness in people with SCI.
| Circuit training (v no intervention) on cardiorespiratory fitness in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Weak for (100%) | Weak evidence recommendation FOR Circuit training may be provided to improve cardiorespiratory fitness in people with SCI. |
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| I | Circuit training | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Cardiorespiratory Fitness | ||||||
| SUMMARY | 4 RCTs (see references) | Standardised Mean Difference (95% CI) 0.5 (0 to 0.9) Favours circuit training |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Serious | Inconsistency No serious | Imprecision Very serious | Indirectness Serious | Publication bias Serious |
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 |
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| CIRCUIT TRAINING ON CARDIORESPIRATORY FITNESS: 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 | |
| CIRCUIT TRAINING ON CARDIORESPIRATORY FITNESS: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BOMBARDIER 2000 | Circuit training (telehealth) V No intervention | 16 sessions of telehealth over 6 months | People with SCI | 6/7 | Vo2 Peak | Some Concerns of Risk of Bias PEDro = 6/10 |
| HICKS 2003 | Circuit training (Pushing, arm ergometry and PRE) V Sham (education) | Supervised progressive exercise 2 x weekly for 9 months. Each session 90-120 minutes | C4-L2 SCI | 11/10 | Power output in Watts | High Risk of Bias PEDro = 5/10 |
| KIM 2019 | Circuit training (Resistance and aerobic training) V No intervention | 3 x weekly for 6 weeks. Each session was one hour | C5-T10 SCI | 11/6 | Vo2 Peak | Some Concerns of Risk of Bias PEDro = 6/10 |
| MA 2019 | Circuit training (Physical activity coaching including a programme) V No intervention | 8 sessions, 1x week for 8 weeks. Each session was 140-180 minutes | People with SCI | 14/14 | Vo2 Peak | Some Concerns of Risk of Bias PEDro = 5/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends circuit training to improve cardiorespiratory fitness in people with SCI. This is an evidence recommendation supported by the results of four randomised controlled trials. The guideline states:
Circuit training may be provided to improve cardiorespiratory fitness in people with SCI.
This recommendation was formed by considering the results of four randomised controlled trials alongside other factors. The trial results indicate that circuit training is better than no circuit training to improve cardiorespiratory fitness. 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 circuit training to improve cardiorespiratory fitness in people with SCI based on evidence.
To learn more about this recommendation go to the research summary.
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Hicks Al, Martin KA, Ditor DS, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal cord 2003; 41: 34.
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Bombardier CH, Dyer JR, Burns P, et al. A tele-health intervention to increase physical fitness in people with spinal cord injury and cardiometabolic disease or risk factors: a pilot randomized controlled trial. Spinal cord 2020.
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Kim J, Lee BS, Lee H-J, et al. Clinical efficacy of upper limb robotic therapy in people with tetraplegia: a pilot randomized controlled trial. Spinal cord 2019; 57: 49-57.
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Ma, J. K. West, C. R. Martin Ginis, K. A. The effects of a patient and provider co-developed, behavioral physical activity intervention on physical activity, psychosocial predictors, and fitness in individuals with spinal cord injury: a randomized controlled trial. Sports Medicine 2019 Jul;49(7):1117-1131.
Electrical stimulation alone (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI
evidence: Weak Against Recommendation
Electrical stimulation alone should not be provided to improve voluntary strength of partially paralysed muscles in people with SCI.
When electrical stimulation is used in partially paralysed muscles it should be combined with voluntary effort.
| Electrical stimulation alone (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI |
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|---|---|---|---|---|---|---|---|
| P | People with SCI (partially-paralysed muscles) | Evidence recommendation Weak Against (96%) | Weak evidence recommendation AGAINST Electrical stimulation alone should not be provided to improve voluntary strength of partially paralysed muscles in people with SCI. Clinical note: When electrical stimulation is used in partially paralysed muscles it should be combined with voluntary effort. |
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| I | Electrical stimulation alone | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
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| O | Voluntary strength | ||||||
| SUMMARY | 1 RCT (see reference) | Mean difference (95% CI): Strength in Nm 0 (-0.5 to 0.6) Favours electrical stimulation |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Serious | Inconsistency Serious | Imprecision No serious | Indirectness Serious | Publication bias Serious |
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| ELECTRICAL STIMULATION 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 | |
| ELECTRICAL STIMULATION ON VOLUNTARY STRENGTH PARTIALLY PARALYSED MUSCLES: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| GLINSKY 2009 | Strength training plus ES V Strength training and Sham ES | 6 sets of 10 Reps, 3 x per week for 8 weeks | C4 to C7 tetraplegia | 32/32 | Strength in Nm | Some Concerns of Risk of Bias PEDro = 9/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends against electrical stimulation alone to improve voluntary strength of partially paralysed muscles in people with SCI.This is an evidence recommendation supported by the results of one randomised controlled trial. The guideline states:
Electrical stimulation alone should not be provided to improve voluntary strength of partially paralysed muscles in people with SCI.
This recommendation was formed by considering the results of one randomised controlled trial alongside other factors. The trial results indicate that electrical stimulation alone is not better than no electrical stimulation to improve strength. 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 against electrical stimulation alone 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.
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Glinsky J, Harvey L, van Es P, et al. The addition of electrical stimulation to progressive resistance training does not enhance the wrist strength of people with tetraplegia: a randomized controlled trial. Clinical rehabilitation 2009; 23: 696-704.
FES cycling (v no intervention) on swelling in people with SCI
evidence: Weak Against Recommendation
FES cycling should not be provided to decrease swelling in people with SCI.
| FES cycling (v no intervention) on swelling in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Weak Against (86%) | Weak evidence statement AGAINST ES cycling should not be provided to decrease swelling in people with SCI. |
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| I | ES cycling | ||||||
| C | No intervention | Consensus-based opinion statement No opinion statements |
|||||
| O | Swelling | ||||||
| SUMMARY | 1 RCT (see reference) | ¬Mean difference (95% CI): Swelling in cm -0.1 (-1.5 to 1.3) Favours no intervention |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias No serious | Inconsistency Serious | Imprecision Serious | Indirectness Serious | Publication bias Serious |
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| FES CYCLING ON SWELLING: 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 | |
| FES CYCLING ON SWELLING: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| RALSTON 2013 | FES cycling V No intervention | Four x a week for two weeks (30-45 minutes) | C4 to T10 SCI | 14/14 | Swelling (cm) | Low Risk of Bias PEDro = 8 |
The Australian and NZ SCI Physiotherapy guideline committee recommends against FES cycling to improve swelling in people with SCI. This is an evidence recommendation supported by the results of one randomised controlled trial. The guideline states:
FES cycling should not be provided to decrease swelling in people with SCI.
This recommendation was formed by considering the results of one randomised controlled trial alongside other factors. The trial results indicate that FES cycling is not better than no FES cycling to improve swelling. 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 against FES cycling to improve swelling in people with SCI based on evidence.
To learn more about this recommendation go to the research summary.
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Ralston KE, Harvey LA, Batty J, et al. Functional electrical stimulation cycling has no clear effect on urine output, lower limb swelling, and spasticity in people with spinal cord injury: a randomised cross-over trial [with consumer summary]. Journal of Physiotherapy 2013 Dec;59(4):237-243
Individual or team sports (v no intervention) on cardiorespiratory fitness in people with SCI
consensus: Strong For Recommendation
Individual or team sports should be available to improve cardiorespiratory fitness in people with SCI.
| Individual or team sports (v no intervention) on cardiorespiratory fitness in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Individual or team sports should be available to improve cardiorespiratory fitness in people with SCI. |
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| I | Individual or team sports | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (96%) |
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| O | Cardiorespiratory Fitness | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends individual or team sports to improve cardiorespiratory fitness in people with SCI. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Individual or team sports should be available to improve cardiorespiratory fitness in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors.The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend individual or team sports to improve cardiorespiratory fitness in people with SCI.
To learn more about the this intervention go to the research evidence.
Empowered to manage their injuries
consensus: Strong For Recommendation
People with SCI should be empowered to manage their injuries including managing their physical rehabilitation and physical function.
| Empowered to mange their injuries | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI should be empowered to manage their injuries including managing their physical rehabilitation and physical function. |
|
| I | Empowered to mange their injuries | |||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
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| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends people with SCI should be empowered to manage their injuries. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI should be empowered to manage their injuries including managing their physical rehabilitation and physical function.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI should be empowered to manage their injuries based on opinion.
To learn more about the this intervention go to the research evidence.
Walking training (v no intervention) on ability to walk in people who have lower limb motor function
consensus: Strong For Recommendation
Walking training should be provided to people with SCI who have lower limb motor function.
Walking training can include:
Overground gait training
Treadmill gait training (with and without 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
| Walking training (v no intervention) on ability to walk in people who have lower limb motor function | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who have lower limb motor function | Evidence recommendation Reason: No RCTs | Strong opinion statement FOR Walking training should be provided to people with SCI who have lower limb motor function. Walking training can include: • Overground gait training (100%) • Treadmill gait training (with and without body weight support) (100%) • Treadmill gait training with electrical stimulation (+/- body weight support) (100%) • Overground gait training and electrical stimulation (100%) • Robotic overground gait training (92%) • Robotic treadmill gait training (75%) • Conventional therapy (package of interventions including gait training) (85%) • Gait training with orthotics (100%) |
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| I | Walking training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (75% - 100%) |
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| O | Walking ability | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends walking training to improve walking in people with SCI who have lower limb motor function.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials that compare walking training to no intervention. The guideline states:
Walking training should be provided to people with SCI who have lower limb motor function.
Walking training can include:
Overground gait training
Treadmill gait training (with and without 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
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend walking training to improve walking based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
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
consensus: Strong For Recommendation
Conventional therapy (package of interventions that includes gait training) should be provided (in favour of treadmill gait training with or without body weight support) to improve walking in people with SCI.
| 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 | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI and motor function in the lower limbs | Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence. | Strong opinion statement FOR Conventional therapy (package of interventions that includes gait training) should be provided (in favour of treadmill gait training with or without body weight support) to improve walking in people with SCI. |
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| I | Conventional therapy (package of interventions that includes gait training) | ||||||
| C | Treadmill gait training (with or without body weight support) | Consensus-based opinion statement Strong for (96%) |
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| O | Walking ability | ||||||
| SUMMARY | 4 RCTS | Mean difference (95% CI): Walking speed in m/s 0.08 (-0.12 to 0.27) Favours conventional therapy (package of therapies including gait training) |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency No serious | Imprecision Serious | Indirectness No serious | Publication bias Serious |
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| CONVENTIONAL THERAPY V TREADMILL ON ABILITY TO WALK: 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 | |
| CONVENTIONAL THERAPY V TREADMILL ON ABILITY TO WALK: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| ALEXEEVA 2011 | Conventional therapy V Body weight support treadmill training (BWSTT) | BWSTT: 30% BWS 60 mins of training, 3 x per week for 13 weeks | AIS C and D SCI | 9/12 | Walking speed m/s | Some Concerns of Risk of Bias PEDro = 7/10 |
| LUCARELI 2011 | Conventional therapy V BWSTT | BWSTT: 30 mins of training, 2 x per week for 4 months (total 30 sessions) | AIS C and D SCI | 12/12 | Walking speed m/s | Some Concerns of Risk of Bias PEDro = 6/10 |
| PIIRA 2019 | Conventional therapy V BWSTT | BWSTT: 2 daily sessions, 90 minutes per day, 5 days per week over 12 weeks | AIS C and D SCI | 7/7 | Walking speed m/s | Some Concerns of Risk of Bias PEDro = 7/10 |
| SADEGHI 2015 | Conventional therapy V BWSTT | BWSTT: 60 min per session, 4 x per week for 12 weeks | AIS B and C SCI | 10/7 | Walking speed m/s | High Risk of Bias PEDro = 6/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends conventional therapy (package of interventions that includes gait training) in favour of treadmill gait training with or without body weight support to improve walking
This is a consensus-based opinion statement supported by the opinions of the experts even though there is randomised controlled trials related to this topic. However, the result of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Conventional therapy (package of interventions that includes gait training) should be provided (in favour of treadmill gait training with or without body weight support) to improve walking in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. The results of randomised controlled trials were also taken into consideration. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend conventional therapy (package of interventions that includes gait training) should be provided (in favour of treadmill gait training with or without body weight support) to improve walking based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website
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Alexeeva N et al. Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial. Journal of spinal cord medicine 2011; 34: 362-369.
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Lucareli PR, Lima MO, Lima FPS, et al. Gait analysis following treadmill training with body weight support versus conventional physical therapy: a prospective randomized controlled single blind study. Spinal Cord 2011 Sep;49(9):1001-1007.
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Piira A, Lannem AM, Sorensen M, et al. Manually assisted body-weight supported locomotor training does not re-establish walking in non-walking subjects with chronic incomplete spinal cord injury: A randomized clinical trial. Journal of rehabilitation medicine 2019; 51: 113-119.
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Sadeghi H, Banitalebi E, Dehkordi M. The effect of body-weight-supported training exercises on functional ambulation profile in patients with paraplegic spinal cord injury. Phys Treat 2015; 4: 205–212.
Power wheelchair skills training (v no intervention) on power wheelchair skills in people with SCI who are dependent on a power wheelchair for mobility
consensus: Strong For Recommendation
Power wheelchair skills training should be provided to improve ability to use a power wheelchair in people with SCI who are dependent on a power wheelchair for mobility.
| Power wheelchair skills training (v no intervention) on power wheelchair skills in people with SCI who are dependent on a power wheelchair for mobility | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who are dependent on a power wheelchair for mobility | Evidence recommendation Reason: No RCTs | Strong opinion statement FOR Power wheelchair skills training should be provided to improve ability to use a power wheelchair in people with SCI who are dependent on a power wheelchair for mobility. |
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| I | Power wheelchair skills training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
|||||
| O | Power wheelchair mobility | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends power wheelchair training to improve power wheelchair mobility in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Power wheelchair skills training should be provided to improve ability to use a power wheelchair in people with SCI who are dependent on a power wheelchair for mobility.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend power wheelchair skills to improve the ability to use a power wheelchair based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Bed mobility (v no intervention) on ability to move in bed in people with SCI
consensus: Strong For Recommendation
Bed mobility training should be provided to improve the ability to move in bed in people with SCI.
This statement includes rolling and moving from supine to sitting for people with SCI that have sufficient muscle strength to actively participate in bed mobility training.
| Bed mobility (v no intervention) on ability to move in bed in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation Reason: No RCTs | Strong opinion statement FOR Bed mobility training should be provided to improve the ability to move in bed in people with SCI. Clinical note: This statement includes rolling and moving from supine to sitting for people with SCI that have sufficient muscle strength to actively participate in bed mobility training. |
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| I | Bed mobility training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
|||||
| O | Ability to move in bed | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends bed mobility training to improve the ability to move in bed in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic The guideline states:
Bed mobility training should be provided to improve the ability to move in bed in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend bed mobility training to to improve the ability to move in bed based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Sitting training (v no intervention) on ability to sit in people with SCI and motor function in the lower limbs
consensus: Strong For Recommendation
Sitting balance training should be provided to improve the ability to sit in people with SCI and motor function in the lower limbs.
| Sitting training (v no intervention) to improve the ability to sit in people with SCI and motor function in the lower limbs | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI and motor function in the lower limbs | Evidence recommendation Reason: No RCTs | Strong opinion statement FOR Sitting balance training should be provided to improve the ability to sit in people with SCI and motor function in the lower limbs. |
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| I | People with SCI and motor function in the lower limbs | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (78%) |
|||||
| O | Ability to sit | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends sitting training to improve sitting in people with SCI who have lower limb motor function.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic The guideline states:
Sitting balance training should be provided to improve the ability to sit in people with SCI and motor function in the lower limbs.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend sitting training to improve sitting in people with SCI who have lower limb motor function based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Sitting training (v no intervention) on ability to sit in people with SCI and paralysis of the lower limbs/trunk
consensus: Strong For Recommendation
Sitting balance training should be provided to improve the ability to sit in people with SCI and paralysis of the lower limbs/trunk.
| Sitting training (v no intervention) to improve the ability to sit in people with SCI and paralysis of the lower limbs/trunk | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI and paralysis of the lower limbs/trunk. | Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence. | Strong opinion statement FOR Sitting balance training should be provided to improve the ability to sit in people with SCI and paralysis of the lower limbs/trunk |
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| I | Sitting balance training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (82%) |
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| O | Ability to sit | ||||||
| SUMMARY | 2 RCTS33-34 | Mean difference (95% CI): Reach distance in mm 22 (-60 to 104) Favours sitting training |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias No serious | Inconsistency Very serious | Imprecision Very serious | Indirectness Serious | Publication bias Serious |
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 |
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| SITTING TRAINING ON ABILITY TO SIT: 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 | |
| SITTING TRAINING ON ABILITY TO SIT: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BOSWELL-RUYS 2010 | Sitting training V No intervention | 1 hour of training, 3 x per week for 6 weeks | T1-T12 with chronic SCI | 15/15 | Maximal balance range test (mm) | Some concerns of Risk of Bias PEDro = 8/10 |
| HARVEY 2011 | Sitting training (plus usual care) V Usual care | 3 additional 30- minute sessions per week of motor retraining for sitting | Acute paraplegia | 16/16 | Maximal lean test (mm) | Some concerns of Risk of Bias PEDro = 8/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends sitting balance training to improve the ability to sit in people with SCI and paralysis of the lower limbs/trunk.
This is a consensus-based opinion statement supported by the opinions of the experts even though there is randomised controlled trials related to this topic. However, the result of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Sitting balance training should be provided to improve the ability to sit in people with SCI and paralysis of the lower limbs/trunk.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. The results of randomised controlled trials were also taken into consideration. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend sitting balance training to improve the ability to sit in people with SCI and paralysis of the lower limbs/trunk based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website
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Boswell-Ruys CL, Harvey LA, Barker JJ, et al. Training unsupported sitting in people with chronic spinal cord injuries: a randomized controlled trial. Spinal Cord 2010 Feb;48(2):138-14.
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Harvey LA, Ristev D, Hossain MS, et al. Training unsupported sitting does not improve ability to sit in people with recently acquired paraplegia: a randomised trial. Journal of Physiotherapy 2011;57(2):83-90.
Transfer training v no intervention on ability to transfer in people with SCI
consensus: Strong For Recommendation
Transfer training should be provided to improve the ability to transfer in people with SCI.
This statement includes transfers for people with SCI that have sufficient muscle strength to actively participate in transfer training. The method of transfer will depend on muscle strength.
| Transfer training v no intervention on ability to transfer in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Transfer training should be provided to improve the ability to transfer in people with SCI. Clinical note: This statement includes transfers for people with SCI that have sufficient muscle strength to actively participate in transfer training. The method of transfer will depend on muscle strength. |
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| I | Transfer training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
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| O | Ability to transfer | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends transfer training to improve the ability to transfer in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Transfer training should be provided to improve the ability to transfer in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend transfer training to improve ability to transfer in people with SCI. To learn more about the research related to this intervention go to the clinicians tab on this website.
Vertical transfer training (v no intervention) on ability to vertically transfer in people with SCI who are wheelchair dependent
consensus: Strong For Recommendation
Vertical transfer training should be provided to improve the ability to vertically transfer in people with SCI who are wheelchair dependent.
This statement includes floor-to-wheelchair and wheelchair-to-floor transfers for people with sufficient strength to participate in vertical transfer training.
| Vertical transfer training (v no intervention) on ability to vertically transfer in people with SCI who are wheelchair dependent | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI that are wheelchair dependent | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Vertical transfer training should be provided to improve the ability to vertically transfer in people with SCI who are wheelchair dependent. Clinical note: This statement includes floor to wheelchair and wheelchair to floor transfers for people with sufficient strength to participate in vertical transfer training. |
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| I | Vertical transfer training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (81%) |
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| O | Ability to transfer | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends vertical transfer training to improve the ability to vertically transfer in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Vertical transfer training should be provided to improve the ability to vertically transfer in people with SCI who are wheelchair dependent.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend vertical transfer training to improve ability to vertically transfer in people with SCI. To learn more about the research related to this intervention go to the clinicians tab on this website.
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
consensus: Strong For Recommendation
Sit to stand training should be provided to improve the ability to move from sit to stand in people with SCI and motor function in the lower limbs.
This statement includes standing up from sitting for people with SCI that have sufficient muscle strength to actively participate in sit to stand training.
| 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 | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI and motor function in the lower limbs | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Sit to stand training should be provided to improve the ability to move from sit to stand in people with SCI and motor function in the lower limbs. Clinical note: This statement includes standing up from sitting for people with SCI that have sufficient muscle strength to actively participate in sit to stand training. |
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| I | Sit to stand training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (89%) |
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| O | Ability to move into standing | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends sit to stand training to improve the ability to stand up in people with SCI and motor function in the lower limbs.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Sit to stand training should be provided to improve the ability to move from sit to stand in people with SCI and motor function in the lower limbs.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend sit to stand training to improve ability to stand up in people with SCI and motor function in the lower limbs. To learn more about the research related to this intervention go to the clinicians tab on this website.
Standing training (v no intervention) on ability to stand in people with SCI and motor function in the lower limbs
consensus: Strong For Recommendation
Standing training should be provided to improve the ability to stand in people with SCI (who have motor function in the lower limbs).
This statement includes standing training for people with SCI that have sufficient muscle strength to actively participate in standing training.
| Standing training (v no intervention) on ability to stand in people with SCI and motor function in the lower limbs | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI and motor function in the lower limbs | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Standing training should be provided to improve the ability to stand in people with SCI (who have motor function in the lower limbs). Clinical note: This statement includes standing training for people with SCI that have sufficient muscle strength to actively participate in standing training. |
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| I | Standing training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (95%) |
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| O | Ability to stand | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends standing training to improve the ability to stand in people with SCI (who have motor function in the lower limbs).
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic The guideline states:
Standing training should be provided to improve the ability to stand in people with SCI (who have motor function in the lower limbs).
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend standing training to to improve the ability to stand based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Stair training (v no intervention) on ability to climb stairs in people with SCI and motor function in the lower limbs
consensus: Strong For Recommendation
Stair training should be provided to improve the ability to climb stairs in people with SCI who can walk.
This statement includes ascending and descending stairs for people with SCI (and upright mobility) that have sufficient muscle strength and/or appropriate assistive devices to actively participate in stair training.
| Stair training (v no intervention) on ability to climb stairs in people with SCI and motor function in the lower limbs | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI and motor function in the lower limbs | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Stair training should be provided to improve the ability to climb stairs in people with SCI who can walk. Clinical note: This statement includes ascending and descending stairs for people with SCI (and upright mobility) that have sufficient muscle strength and/or appropriate assistive devices to actively participate in stair training. |
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| I | Stair training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (85%) |
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| O | Ability to climb stairs | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends standing training Stair training to improve the ability to climb stairs in people with SCI who can walk.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic The guideline states:
Stair training should be provided to improve the ability to climb stairs in people with SCI who can walk.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend stair training to to improve the ability to climb stairs in people with SCI who can walk based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Upper limb and hand function training (v no intervention) on upper limb and hand function in people with tetraplegia
consensus: Strong For Recommendation
Upper limb function training should be provided to improve hand function in people with tetraplegia.
| Upper limb and hand function training (v no intervention) on upper limb and hand function in people with tetraplegia | |||||||
|---|---|---|---|---|---|---|---|
| P | People with tetraplegia | Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence. | Strong opinion statement FOR Upper limb function training should be provided to improve hand function in people with tetraplegia. |
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| I | Upper limb function training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (92%) |
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| O | Upper limb and hand function | ||||||
| SUMMARY | 1 RCT35 | Mean difference (95% CI): Hand function in points on Jebsen Hand Function test 128 (60 to 196) Favours hand training |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency Serious | Imprecision No serious | Indirectness Serious | Publication bias Serious |
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 |
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| UPPER LIMB and HAND TRAINING ON UPPER LIMB and HAND FUNCTION: 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 | |
| UPPER LIMB and HAND TRAINING ON UPPER LIMB and HAND FUNCTION: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BEEKHUIZEN 2008 | Hand training v No intervention | 2 hours of massed practice hand training 5 x per week for 3 weeks | C4-C7 tetraplegia | 6/6 | Jebsen Hand Function test (points) | High Risk of Bias PEDro = 4/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends upper limb function training to improve hand function in people with tetraplegia.
This is a consensus-based opinion statement supported by the opinions of the experts even though there is one randomised controlled trial related to this topic. However, the result of this randomised controlled trial is inconclusive preventing an evidence recommendation. The guideline states:
Upper limb function training should be provided to improve hand function in people with tetraplegia.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. The results of one randomised controlled trial was also taken into consideration. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can probably recommend upper limb function training to improve hand function in people with tetraplegia based on opinion. To learn more about the research related to this intervention go to the research summary.
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Beekhuizen KS, Field-Fote EC. Massed practice versus massed practice with stimulation: effects on upper extremity function and cortical plasticity in individuals with incomplete cervical spinal cord injury. Neurorehabilitation and neural repair 2005; 19: 33.
Robotic Upper limb training (v no intervention) on upper limb function in people with tetraplegia
consensus: Strong For Recommendation
Robotic upper limb training should be provided to improve upper limb function in people with tetraplegia.
| Robotic Upper limb training (v no intervention) on upper limb function in people with tetraplegia | |||||||
|---|---|---|---|---|---|---|---|
| P | People with tetraplegia | Evidence recommendation Reason: No RCTs | Strong opinion statement FOR Robotic upper limb training should be provided to improve upper limb function in people with tetraplegia. |
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| I | Robotic upper limb training | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (89%) |
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| O | Upper limb function | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends robotic upper limb training to improve upper limb function in people with tetraplegia.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic The guideline states:
Robotic upper limb training should be provided to improve upper limb function in people with tetraplegia.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend robotic upper limb training to improve upper limb function in people with tetraplegia based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Combined arm cranking and leg cycling (plus or minus Electrical Stimulation) v no intervention to improve cardiorespiratory fitness in people with SCI
consensus: Strong For Recommendation
Combined arm cranking and leg cycling (plus or minus Electrical Stimulation) should be provided to improve cardiorespiratory fitness in people with SCI.
| Combined arm cranking and leg cycling (plus or minus Electrical Stimulation) v no intervention to improve cardiorespiratory fitness in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Combined arm cranking and leg cycling (plus or minus Electrical Stimulation) should be provided to improve cardiorespiratory fitness in people with SCI |
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| I | Combined arm cranking and leg cycling (plus or minus Electrical Stimulation) | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (89%) |
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| O | Cardiorespiratory Fitness | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends combined arm cranking and leg cycling (plus or minus Electrical Stimulation) to improve cardiorespiratory fitness in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Combined arm cranking and leg cycling (plus or minus Electrical Stimulation) should be provided to improve cardiorespiratory fitness in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend combined arm cranking and leg cycling (plus or minus Electrical Stimulation) sto improve cardiorespiratory fitness in people with SCI based on opinion.
To learn more about the research related to this intervention go to the research summary tab on the website.
FES cycling (v no intervention) on cardiorespiratory fitness in people with SCI
consensus: Strong For Recommendation
FES cycling should be provided to improve cardiorespiratory fitness in people with SCI.
| FES cycling (v no intervention) on cardiorespiratory fitness in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR FES cycling should be provided to improve cardiorespiratory fitness in people with SCI. |
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| I | FES cycling | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (77%) |
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| O | Cardiorespiratory Fitness | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends FES cycling should be provided to improve cardiorespiratory fitness in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
FES cycling should be provided to improve cardiorespiratory fitness in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend FES cycling to improve cardiorespiratory fitness in people with SCI based on opinion.
To learn more about the research related to this intervention go to the research summary tab on the website.
Physiotherapy services
consensus: Strong For Recommendation
People with a newly acquired SCI should receive physiotherapy services throughout their acute and rehabilitation phases.
| Physiotherapy assessment and treatment | ||||
|---|---|---|---|---|
| P | People with a newly acquired SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with a newly acquired SCI should receive physiotherapy services throughout their acute and rehabilitation phases. |
|
| I | Physiotherapy Services | |||
| C | Optimal outcome | Consensus-based opinion statement Strong for (100%) |
||
| O | Not stated | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends people with a newly acquired SCI should receive physiotherapy services. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with a newly acquired SCI should receive physiotherapy services throughout their acute and rehabilitation phases.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with a newly acquired SCI should receive physiotherapy service based on opinion.
To learn more about the this intervention go to the research summary.
Education to avoid overuse and trauma (v no intervention) on shoulder pain in people with SCI
consensus: Strong For Recommendation
Education to avoid shoulder overuse and trauma should be provided to prevent and treat shoulder pain in people with SCI.
Education could include education about strategies to avoid shoulder overuse and trauma.
| Education to avoid overuse and trauma (v no intervention) on shoulder pain in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Education to avoid shoulder overuse and trauma should be provided to prevent and treat shoulder pain in people with SCI. Clinical note: Education could include education about strategies to avoid shoulder overuse and trauma. |
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| I | Education to avoid shoulder overuse and trauma | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
|||||
| O | Shoulder pain | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends education to avoid shoulder overuse and trauma to prevent and treat shoulder pain in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Education to avoid shoulder overuse and trauma should be provided to prevent and treat shoulder pain in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend education to avoid shoulder overuse and trauma sto prevent and treat shoulder pain in people with SCI based on opinion. To learn more about the research related to this intervention go to the research summary tab on the website.
Shoulder exercises (v no intervention) on shoulder pain (treatment) in people with SCI
consensus: Strong For Recommendation
Shoulder exercises should be provided to treat shoulder pain in people with SCI.
| Shoulder exercises (v no intervention) on shoulder pain (treatment) in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who have shoulder pain | Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence. | Strong opinion statement FOR Shoulder exercises should be provided to treat shoulder pain in people with SCI. |
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| I | Shoulder exercises | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (81%) |
|||||
| O | Shoulder pain | ||||||
| SUMMARY | 5 RCTs | Mean difference (95% CI): Pain on Wheelchair Users Shoulder Pain Index in points Consider studies independently. Unable to pool I2=76% |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency Very serious | Imprecision Serious | Indirectness No serious | Publication bias Serious |
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 |
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| SHOULDER EXERCISES FOR SHOULDER PAIN: 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 | |
| SHOULDER EXERCISES FOR SHOULDER PAIN Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| CARDENAS 2019 | Shoulder home exercise programme V Control (education) | 3 x per week for 12 weeks based on Mulroy 2011 | People with SCI and shoulder pain (all levels) | 11/8 | Wheelchair users Shoulder Pain Index (WUSPI) | High Risk of Bias PEDro = 6/10 |
| CURTIS 2011/b> | Shoulder exercises V No intervention | 5 exercises twice daily for 6 months | C6 or lower SCI | 17/18 | WUSPI | Some Concerns of Risk of Bias PEDro = 4/10 |
| DONDAL 2015 | Shoulder strengthening and stretching exercises V No intervention | 3 x per week for 4 weeks | Below T1 SCI | 15/15 | WUSPI | High Risk of Bias PEDro = 6/10 |
| MULROY 2011 | Home-based shoulder exercise programme V Control (education) | 3 x per week for 12 weeks | T2 to T7 SCI with shoulder pain | 26/32 | WUSPI | High Risk of Bias PEDro = 7/10 |
| NIGHTINGALE 2018 | Arm cranking (portable desktop ergometer) V No intervention | 4 x per week for 6 weeks (moderate intensity) | Below T2 SCI | 13/8 | WUSPI | Some Concerns of Risk of Bias PEDro = 5/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends shoulder exercises to treat shoulder pain in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts even though there is five randomised controlled trials related to this topic. However, the result of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Shoulder exercises should be provided to treat shoulder pain in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. The results of five randomised controlled trials were also taken into consideration. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend shoulder exercises to treat shoulder pain in people with SCI based on opinion. To learn more about the research related to this intervention go to the research summary on the website.
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Cardenas DD, Felix ER, Cowan R, et al. Effects of Home Exercises on Shoulder Pain and Pathology in Chronic Spinal Cord Injury: A Randomized Controlled Trial. American journal of physical medicine & rehabilitation 2020; 99: 504-513.
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Curtis KA, Tyner TM, Zachary L, et al. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users. Spinal cord 1999; 37: 421-429.
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Dondal K, Kulkarni V, Patole R, et al. Effect of Shoulder Exercises on Functional Performance in Paraplegic Wheelchair users having Shoulder Pain. Indian Journal of Physiotherapy & Occupational Therapy 2015; 9: 83-86.
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Mulroy SJ, Thompson L, Kemp B, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Physical therapy 2011; 91: 305-324.
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Nightingale TE, Rouse PC, Walhin JP, et al. Home-based exercise enhances health-related quality of life in persons with spinal cord injury: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2018 Oct;99(10):1998-2006.
Equipment to support the shoulder (v no intervention) on shoulder subluxation (prevention) in people with SCI at risk of shoulder subluxation
consensus: Strong For Recommendation
Equipment to support the shoulder such as wheelchair armrests or shoulder support devices should be provided to prevent and treat shoulder subluxation.
Equipment to support the shoulder includes wheelchair armrests or pillows under the elbows.
| Equipment to support the shoulder (v no intervention) on shoulder subluxation (prevention) in people with SCI at risk of shoulder subluxation | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI at risk of shoulder subluxation | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Equipment to support the shoulder such as wheelchair armrests or shoulder support devices should be provided to prevent and treat shoulder subluxation. Clinical note: Equipment to support the shoulder includes wheelchair armrests or pillows under the elbows. |
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| I | Supportive equipment | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (83%) |
|||||
| O | Shoulder subluxation | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends equipment to support the shoulder such as wheelchair armrests or shoulder support devices to prevent and treat shoulder subluxation.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Equipment to support the shoulder such as wheelchair armrests or shoulder support devices should be provided to prevent and treat shoulder subluxation.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend equipment to support the shoulder such as wheelchair armrests or shoulder support devices to prevent and treat shoulder subluxation based on opinion.
To learn more about the research related to this intervention go to the research summary tab on the website.
Supine (v high sitting) on lung volumes in people with SCI who have abdominal muscle paralysis or weakness.
consensus: Strong For Recommendation
Positioning in supine should be provided (in favour of sitting) to improve lung volumes in people with SCI who have abdominal muscle paralysis or weakness.
Supine may not be suitable for people with significant abdominal distension, central adiposity or those with large abdomens and long-standing SCI.
| Supine (v high sitting) on lung volumes in people with SCI who have abdominal muscle paralysis or weakness. | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who have abdominal muscle abdominal muscle paralysis or weakness. | Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence. | Strong opinion statement FOR Positioning in supine should be provided (in favour of sitting) to improve lung volumes in people with SCI who have abdominal muscle paralysis or weakness. Clinical note: Supine may not be suitable for people with significant abdominal distension, central adiposity or those with large abdomens and long-standing SCI. |
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| I | Supine | ||||||
| C | High sitting | Consensus-based opinion statement Strong for (85%) |
|||||
| O | Lung volume | ||||||
| SUMMARY | 1 RCT | Mean difference (95% CI): Lung volume in litres 0.4 (-1.3 to 2.1) Favours supine |
|||||
| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Very serious | Inconsistency Serious | Imprecision Serious | Indirectness Serious | Publication bias Serious |
||
 |
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| SUPINE (V HIGH SITTING) FOR LUNG VOLUMES: 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 | |
| SUPINE FOR LUNG VOLUME: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BOAVENTURA 2003 | Supine V Sitting | Elastic binder in sitting and supine | C4-C7 Complete SCI 1 year post injury | 10/10 | Lung volume (FVC) | High Risk of Bias PEDro = 6/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends that positioning in supine should be provided (in favour of sitting) to improve lung volumes in people with SCI who have abdominal muscle paralysis or weakness.
This is a consensus-based opinion statement supported by the opinions of the experts even though there is one randomised controlled trial related to this topic. However, the result of the randomised controlled trial is inconclusive preventing an evidence recommendation.
The guideline states:
Positioning in supine should be provided (in favour of sitting) to improve lung volumes in people with SCI who have abdominal muscle paralysis or weakness.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. The results of the one randomised controlled trial was also taken into consideration.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend positioning in supine (in favour of sitting) to improve lung volumes based on opinion.
To learn more about the research related to this intervention go to the clinicians tab on this website
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Boaventura, C. D.Gastaldi, A. C.Silveira, J. M.Santos, P R.Guimaraes, R. C.De, L. L. C. Effect of an abdominal binder on the efficacy of respiratory muscles in seated and supine tetraplegic patients. Physiotherapy 2003 May;89(5):290-295.
Assessment by a multidisciplinary team for spasticity management
consensus: Strong For Recommendation
People with SCI should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to manage spasticity.
| Assessment by a multidisciplinary team for spasticity management | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to manage spasticity. |
|
| I | Assessment by a multidisciplinary team for spasticity management | |||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with SCI should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to manage spasticity. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to manage spasticity.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to manage spasticity.
To learn more about the this intervention go to the research summary.
Assessment by a multidisciplinary team for UL reconstructive surgery
consensus: Strong For Recommendation
People with tetraplegia should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to determine suitability for upper limb reconstructive surgery.
| Assessment by a multidisciplinary team for UL reconstructive surgery | ||||
|---|---|---|---|---|
| P | People with tetraplegia | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI (tetraplegia) should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to determine suitability for upper limb reconstructive surgery. |
|
| I | Assessment by a multidisciplinary team for UL reconstructive surgery | |||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with tetraplegia should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to determine suitability for upper limb reconstructive surgery. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with tetraplegia should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to determine suitability for upper limb reconstructive surgery.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with tetraplegia should be assessed by a multidisciplinary team (that includes a physiotherapist) as appropriate to determine suitability for upper limb reconstructive surgery based on opinion.
To learn more about the this intervention go to the research summary.
Assessment by an multidisciplinary team for prevention and treatment of pressure injuries
consensus: Strong For Recommendation
People with SCI should be assessed by an multidisciplinary team (that includes a physiotherapist) as appropriate to prevent and treat pressure injuries.
| Assessment by an multidisciplinary team for prevention and treatment of pressure injuries | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI should be assessed by an multidisciplinary team (that includes physiotherapist) as appropriate to prevent and treat pressure injuries. |
|
| I | Assessment by an multidisciplinary team for prevention and treatment of pressure injuries | |||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with SCI should be assessed by an multidisciplinary team (that includes a physiotherapist) as appropriate to prevent and treat pressure injuries. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI should be assessed by an multidisciplinary team (that includes a physiotherapist) as appropriate to prevent and treat pressure injuries.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI should be assessed by an multidisciplinary team (that includes a physiotherapist) as appropriate to prevent and treat pressure injuries.
To learn more about the this intervention go to the research summary.
Physiotherapy as appropriate throughout the lifetime
consensus: Strong For Recommendation
| People with SCI should have physiotherapy as appropriate for the management of impairments, activity limitations or participation opportunities throughout their lives. |
| Physiotherapy as appropriate throughout the lifetime | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI should have physiotherapy as appropriate for the management of impairments, activity limitations or participation opportunities throughout their lives. |
|
| I | Physiotherapy as appropriate throughout the lifetime | |||
| C | No intervention | Consensus-based opinion statement Strong for (96%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with SCI should have physiotherapy as appropriate for the management of impairments, activity limitations or participation opportunities throughout the course of their life. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI should have physiotherapy as appropriate for the management of impairments, activity limitations or participation opportunities throughout the course of their life.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI should have physiotherapy as appropriate for the management of impairments, activity limitations or participation opportunities throughout the course of their life.
To learn more about the this intervention go to the research summary.
Discharged into the community with a respiratory management plan
consensus: Strong For Recommendation
People with SCI and respiratory muscle weakness who are at high risk of respiratory complications should be discharged into the community from hospital with a respiratory management plan in place (including education to the care team on appropriate interventions).
| Discharged into the community with a respiratory management plan | ||||
|---|---|---|---|---|
| P | People with SCI and respiratory muscle weakness who are at high risk of respiratory complications | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI and respiratory muscle weakness who are at high risk of respiratory complications should be discharged into the community from hospital with a respiratory management plan in place (including education to the care team on appropriate interventions). |
|
| I | Respiratory management plan | |||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with SCI and respiratory muscle weakness who are at high risk of respiratory complications should be discharged into the community from hospital with a respiratory management plan. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI and respiratory muscle weakness who are at high risk of respiratory complications should be discharged into the community from hospital with a respiratory management plan in place (including education to the care team on appropriate interventions).
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI and respiratory muscle weakness who are at high risk of respiratory complications should be discharged into the community from hospital with a respiratory management plan based on opinion.
To learn more about the this intervention go to the research evidence.
Appropriate equipment to maximise independence
consensus: Strong For Recommendation
People with SCI should receive appropriate equipment to maximise their independence, community participation or physical activity.
| Appropriate equipment to maximise independence | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI should receive appropriate equipment to maximise their independence, community participation or physical activity. |
|
| I | Appropriate equipment to maximise independence | |||
| C | No intervention | Consensus-based opinion statement Strong for (96%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends People with SCI should receive appropriate equipment to maximise their independence, community participation or physical activity. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI should receive appropriate equipment to maximise their independence, community participation or physical activity.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI should receive appropriate equipment to maximise their independence, community participation or physical activity based on opinion.
To learn more about the this intervention go to the research summary.
Assessment by a physiotherapist throughout the lifetime
consensus: Strong For Recommendation
People with SCI should be assessed by a physiotherapist as appropriate throughout their lives.
| Assessment by a physiotherapist throughout the lifetime | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI should be assessed by a physiotherapist as appropriate throughout their lives. |
|
| I | Assessment by a physiotherapist as appropriate throughout the lifetime | |||
| C | No intervention | Consensus-based opinion statement Strong for (83%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with SCI should be assessed by a physiotherapist as appropriate throughout their lives. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI should be assessed by a physiotherapist as appropriate throughout their lives.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI should be assessed by a physiotherapist as appropriate throughout their lives.
To learn more about the this intervention go to the research summary.
Provision of hard or electronic copy of individualised exercise programs
consensus: Strong For Recommendation
People with SCI who are prescribed exercises should be provided with a hard or electronic copy of their individualised exercise programs.
| Provision of hard or electronic copy of individualised exercise programs | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI who are prescribed exercises should be provided with a hard or electronic copy of their individualised exercise programs. |
|
| I | Provision of hard or electronic copy of individualised exercise programs | |||
| C | No intervention | Consensus-based opinion statement Strong for (86%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends people with SCI who are prescribed exercises should be provided with a hard or electronic copy of their individualised exercise programs. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI who are prescribed exercises should be provided with a hard or electronic copy of their individualised exercise programs.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI who are prescribed exercises should be provided with a hard or electronic copy of their individualised exercise programs based on opinion.
To learn more about the this intervention go to the research summary.
SMART Goals
consensus: Strong For Recommendation
People with SCI should have the opportunity to participate in setting goals for their physiotherapy sessions that are SMART, collaborative, and regularly reviewed.
| SMART Goals | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI should have the opportunity to participate in setting goals for their physiotherapy sessions that are SMART, collaborative, and regularly reviewed. |
|
| I | SMART Goals | |||
| C | No intervention | Consensus-based opinion statement Strong for (96%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with SCI should have the opportunity to participate in setting goals for their physiotherapy sessions that are SMART, collaborative, and regularly reviewed. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI should have the opportunity to participate in setting goals for their physiotherapy sessions that are SMART, collaborative, and regularly reviewed.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI should have the opportunity to participate in setting goals for their physiotherapy sessions that are SMART, collaborative, and regularly reviewed.
To learn more about the this intervention go to the research summary.
Person centred care
consensus: Strong For Recommendation
People with SCI should receive person-centred care.
| Person centred care | ||||
|---|---|---|---|---|
| P | People with SCI | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR People with SCI should receive person-centered care. |
|
| I | Person centred care | |||
| C | No intervention | Consensus-based opinion statement Strong for (100%) |
||
| O | Optimal outcome | |||
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with SCI should receive person-centred care. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
People with SCI should receive person-centred care.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend that people with SCI should receive person-centred care.
To learn more about the this intervention go to the research summary.
Abdominal binders v no intervention on postural hypotension in people with SCI
consensus: Strong For Recommendation
Abdominal binders should be provided to improve postural hypotension in people with SCI.
Abdominal binders are only provided in people with abdominal paralysis (partial or full) and may not be suitable for people with significant abdominal distension, central adiposity or large abdomens. Abdominal binders may also be provided for purposes other than postural hypotension.
| Abdominal binders v no intervention on postural hypotension in people with SCI | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who have abdominal muscle paralysis (full or partial). | Evidence recommendation No evidence recommendation Reason: No RCTs | Strong opinion statement FOR Abdominal binders should be provided to improve postural hypotension in people with SCI. Clinical note: Abdominal binders are only provided in people with abdominal paralysis (partial or full) and may not be suitable for people significant abdominal distension, central adiposity or large abdomens. Abdominal binders may also be provided for purposes other than postural hypotension. |
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| I | Abdominal binders | ||||||
| C | No intervention | Consensus-based opinion statement Strong for (83%) |
|||||
| O | Postural hypotension | ||||||
The Australian and NZ SCI Physiotherapy guideline committee recommends abdominal binders to improve postural hypotension in people with SCI.
This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:
Abdominal binders should be provided to improve postural hypotension in people with SCI.
This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.
This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend abdominal binders to improve postural hypotension based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.