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.
I
Arm cranking
C
No intervention
Consensus-based opinion statement
No opinion statements
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
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
No serious
Imprecision
No serious
Indirectness
Serious
Publication bias
Serious
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.
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.
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.
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):
0.8 (0.1 to 1.4)
Favours wheelchair skills training
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Very serious
Imprecision
Very serious
Indirectness
Serious
Publication bias
Serious
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.
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.
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.
Worobey LA, Rigot SK, Hogaboom NS, et al. Investigating the efficacy of web-based transfer training on independent wheelchair transfers through randomized controlled trials. Archives of Physical Medicine and Rehabilitation 2018 Jan;99(1):9-16.
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.
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
64 (38 to 89)
Favours VR sitting training
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
Serious
Indirectness
Serious
Publication bias
Serious
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.
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
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.
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.
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.
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
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.
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 RCT's
(see references)
Mean difference (95% CI): Muscle strength in Mean Inspiratory Pressure
-13 (-20 to -8)
Favours respiratory muscle training
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
Not serious
Indirectness
Not serious
Publication bias
Serious
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
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.
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.
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.
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.
Loveridge B, Badour M, Dubbo H. Ventilatory Muscle Endurance Training in Quadriplegics; effects on breathing pattern. Paraplegia 1989; 27: 329-339.
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.
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.
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.
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.
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.
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
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.
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.
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.
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)
Standardised Mean Difference (95% CI)
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.
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.
Yildirim MA, Ones K, Goksenoglu G. Early term effects of robotic assisted gait training on ambulation and functional capacity in patients with spinal cord injury. Turkish journal of medical sciences 2019; 49.
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)
Mean difference (95% CI):
0.4 (0 to 0.9)
Favours strength training
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Very serious
Imprecision
Serious
Indirectness
Serious
Publication bias
Serious
STRENGTH TRAINING ON VOLUNTARY STRENGTH PARTIALLY PARALYSED MUSCLES: GRADE Evidence to Decision
PROBLEM
No
Probably no
Probably yes
Yes
Don't know
DESIRABLE EFFECTS
Trivial
Small
Moderate
Large
Don't know
UNDESIRABLE EFFECTS
Large
Moderate
Small
Trivial
Don't know
CERTAINTY OF EVIDENCE
Very low
Low
Moderate
High
No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME
Important uncertainty or variability
Possibly important uncertainty or variability
Probably no important uncertainty or variability
No important uncertainty or variability
BALANCE OF EFFECTS
Favours the Control
Probably favours the Control
Does not favour either the intervention (I) or the comparison (C)
Probably favours the I
Favours the I
Don't know
RESOURCES REQUIRED
Large costs
Moderate costs
Negligible costs and savings
Moderate savings
Large savings
Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES
Very low
Low
Moderate
High
No included studies
COST EFFECTIVENESS
Favours the comparison
Probably favours the comparison
Does not favour either the intervention or the comparison
Probably favours the intervention
Favours the intervention
No included studies
EQUITY
Reduced
Probably reduced
Probably no impact
Probably increased
Increased
Don't know
ACCEPTABILITY
No
Probably no
Probably yes
Yes
Don't know
FEASIBILITY
No
Probably no
Probably yes
Yes
Don't know
STRENGTH TRAINING ON VOLUNTARY STRENGTH PARTIALLY PARALYSED MUSCLES: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
BYE 2017
Strength training
V
No intervention
4 sets of 10RM, 3 x per week for 12 weeks
C1-S5 SCI
30/30
Maximal voluntary isometric strength in Nm
Some Concerns of
Risk of Bias
PEDro = 8/10
CHEN 2020
Strength training
V
No intervention
200 contraction per day, 6 days per week for 6 weeks
C1-S5 SCI
58/59
Strength manual muscle test
Some Concerns of
Risk of Bias
PEDro = 8/10
GLINSKY 2008
Strength training
V
No intervention
3 sets of 10RM, 3 x per week for 8 weeks
C4-C7 tetraplegia
15/16
Strength in Nm
Some Concerns of
Risk of Bias
PEDro = 8/10
The Australian and NZ SCI Physiotherapy guideline committee recommends strength training to improve voluntary strength of partially paralysed muscles in people with SCI. This is an evidence recommendation supported by the results of three randomised controlled trials. The guideline states:
Strength training may be provided to improve voluntary strength of partially paralysed muscles in people with SCI.
This recommendation was formed by considering the results of three randomised controlled trials alongside other factors. The trial results indicate that strength training is better than no strength training to improve muscle strength in partially paralysed muscles. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend strength training to improve voluntary strength of partially paralysed muscles in people with SCI based on evidence.
To learn more about this recommendation go to the research summary.
Bye EA, Harvey LA, Gambhir A, et al. Strength training for partially paralysed muscles in people with recent spinal cord injury: a within-participant randomised controlled trial. Spinal Cord 2017 May;55(5):460-465.
Chen LW et al. effects of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury: a randomised controlled trial. Spinal cord 2020.
Glinsky J, Harvey L, Korten M, et al. Short-term progressive resistance exercise may not be effective at increasing wrist strength in people with tetraplegia: a randomised controlled trial. Australian Journal of Physiotherapy 2008;54(2):103-108 2008.
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.
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.
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.
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.
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
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
No serious
Imprecision
Very serious
Indirectness
Serious
Publication bias
Serious
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.
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.
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.
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.
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.
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.
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.
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
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
No serious
Inconsistency
Serious
Imprecision
Serious
Indirectness
Serious
Publication bias
Serious
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.
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.
I
Individual or team sports
C
No intervention
Consensus-based opinion statement
Strong for (96%)
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.
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%)
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%)
I
Walking training
C
No intervention
Consensus-based opinion statement
Strong for (75% - 100%)
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 trainingTreadmill gait training (with and without body weight support)Treadmill gait training with electrical stimulation (+/- body weight support)Overground gait training and electrical stimulationRobotic overground gait trainingRobotic treadmill gait trainingConventional 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.
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%)
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)
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
No serious
Imprecision
Serious
Indirectness
No serious
Publication bias
Serious
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
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.
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.
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.
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.
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.
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.
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
I
Sitting balance training
C
No intervention
Consensus-based opinion statement
Strong for (82%)
O
Ability to sit
SUMMARY
2 RCTS33-34
Mean difference (95% CI): Reach distance in mm
22 (-60 to 104)
Favours sitting training
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
No serious
Inconsistency
Very serious
Imprecision
Very serious
Indirectness
Serious
Publication bias
Serious
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
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.
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.
I
Transfer training
C
No intervention
Consensus-based opinion statement
Strong for (100%)
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.
I
Vertical transfer training
C
No intervention
Consensus-based opinion statement
Strong for (81%)
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.
I
Sit to stand training
C
No intervention
Consensus-based opinion statement
Strong for (89%)
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.
I
Standing training
C
No intervention
Consensus-based opinion statement
Strong for (95%)
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.
I
Stair training
C
No intervention
Consensus-based opinion statement
Strong for (85%)
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.
I
Upper limb function training
C
No intervention
Consensus-based opinion statement
Strong for (92%)
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
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
Serious
Imprecision
No serious
Indirectness
Serious
Publication bias
Serious
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.
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.
I
Robotic upper limb training
C
No intervention
Consensus-based opinion statement
Strong for (89%)
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
I
Combined arm cranking and leg cycling (plus or minus Electrical Stimulation)
C
No intervention
Consensus-based opinion statement
Strong for (89%)
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.
I
FES cycling
C
No intervention
Consensus-based opinion statement
Strong for (77%)
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.
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.
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.
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%
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
Very serious
Imprecision
Serious
Indirectness
No serious
Publication bias
Serious
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.
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.
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.
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.
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.
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.
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.
I
Supine
C
High sitting
Consensus-based opinion statement
Strong for (85%)
O
Lung volume
SUMMARY
1 RCT16
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
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
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.
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.
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.
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.
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.
Informed about all the relevant risks and benefits of different physiotherapy interventions
consensus: Strong For Recommendation
People with SCI should be informed about all the relevant risks and benefits of different physiotherapy interventions.
Informed about all the relevant risks and benefits of different physiotherapy interventions
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
People with SCI should be informed about all the relevant risks and benefits of different physiotherapy interventions.
I
Informed about all the relevant risks and benefits of different physiotherapy interventions
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 be informed about all the relevant risks and benefits of different physiotherapy interventions. 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 informed about all the relevant risks and benefits of different physiotherapy 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 should be informed about all the relevant risks and benefits of different physiotherapy interventions.
To learn more about the this intervention go to the research summary.
Physiotherapy treatments that are individualised
consensus: Strong For Recommendation
People with SCI should receive physiotherapy treatments that are individualised and account for any general or specific precautions and contraindications relevant to the individual.
Some interventions have the potential to increase damage to the spine or spinal cord in people with recently acquired/acute SCI. Therefore, they should be administered according to informed local policies and procedures and/or after medical clearance
Physiotherapy treatments that are individualised
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
People with SCI should receive physiotherapy treatments that are individualised and account for any general or specific precautions and contraindications relevant to the individual.
Clinical note: Some interventions have the potential to increase damage to the spine or spinal cord in people with recently acquired/acute SCI. Therefore, they should be administered according to informed local policies and procedures and/or after medical clearance.
I
Physiotherapy treatments that are individualised
C
No intervention
Consensus-based opinion statement
Strong for (100%)
O
Not stated
The Australian and NZ SCI Physiotherapy guideline committee recommends that people with SCI should receive physiotherapy treatments that are individualised and account for any general or specific precautions and contraindications relevant to the individual. 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 physiotherapy treatments that are individualised and account for any general or specific precautions and contraindications relevant to the individual.
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 physiotherapy treatments that are individualised and account for any general or specific precautions and contraindications relevant to the individual.
To learn more about the this intervention go to the research summary.
Intermittent application of positive pressure devices (v no intervention) on lung volume in non- ventilated people with SCI who have respiratory muscle weakness
consensus: Strong For Recommendation
Intermittent application of positive pressure devices should be provided to improve lung volume in non-ventilated people with acute SCI who have respiratory muscle weakness. Positive pressure devices include mechanical insufflation, Intermittent Positive Pressure Breathing (IPPB), Continuous Positive Airway Pressure (CPAP) and brief periods of Bilevel Positive Airway Pressure (BiPAP).
Contraindications and precautions for the use of positive pressure devices must be considered before prescribing these treatments. For example, positive pressure devices are contraindicated in conditions that include but are not limited to untreated pneumothorax, tracheoesophageal fistula and acute traumatic brain injury with increased or poorly controlled intracranial pressure. Positive pressure devices include mechanical insufflation, Intermittent Positive Pressure Breathing (IPPB), Continuous Positive Airway pressure (CPAP) and brief periods of Bilevel Positive Airway Pressure (BiPAP).
Intermittent application of positive pressure devices (v no intervention) on lung volume in non- ventilated people with SCI who have respiratory muscle weakness
P
People with SCI who are not ventilated and have respiratory muscle weakness
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Strong opinion statement FOR
Intermittent application of positive pressure devices should be provided to improve lung volume in non-ventilated people with SCI who have respiratory muscle weakness.
Clinical note: Contraindications and precautions for the use of positive pressure devices must be considered before prescribing these treatments. For example, positive pressure devices are contraindicated in conditions that include but are not limited to untreated pneumothorax, tracheoesophageal fistula and acute traumatic brain injury with increased or poorly controlled intracranial pressure. Positive pressure devices include mechanical insufflation, Intermittent Positive Pressure Breathing (IPPB), Continuous Positive Airway pressure (CPAP) and brief periods of Bilevel Positive Airway Pressure (BiPAP).
I
Intermittent application of positive pressure devices
C
No intervention
Consensus-based opinion statement
Strong for (93%)
O
Lung volume (Litres)
SUMMARY
1 RCT
(see reference)
Mean difference (95% CI): Lung volume in litres
0.1 (-0.5 to 0.7)
Favours intermittent positive pressure breathing
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
Serious
Imprecision
Serious
Indirectness
Serious
Publication bias
Serious
INTERMITTENT APPLICATION OF POSITIVE PRESSURE DEVICES ON 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
INTERMITTENT POSITIVE PRESSURE FOR LUNG VOLUME: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
LAFFONT 2008
Intermittent
positive pressure breathing (IPPB)
V
No intervention
IPPB up to 40cmH20
20mins 2 x per day 5 days per week
or 2 months
C5-T6 Complete
SCI
<6months post
injury
14/14
Lung volume
(VC)
High Risk of Bias
PEDro = 5/10
The Australian and NZ SCI Physiotherapy guideline committee recommends intermittent application of positive pressure devices to improve lung volume in non-ventilated people with acute SCI who have respiratory muscle 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:
Intermittent application of positive pressure devices should be provided to improve lung volume in non-ventilated people with acute SCI who have respiratory muscle 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 intermittent application of positive pressure devices to improve lung volume based on opinion.
To learn more about the research related to this intervention go to the clinicians tab on this website
Laffont I, Bensmail D, Lortat-Jacob S, et al. Intermittent positive-pressure breathing effects in patients with high spinal cord injury. Archives of physical medicine and rehabilitation 2008; 89: 1575-1579.
Intermittent application of positive pressure (v no intervention) on lung volume in ventilated people with SCI who have respiratory muscle weakness
consensus: Strong For Recommendation
Intermittent application of positive pressure therapy techniques should be used (in consultation with medical staff) for improving lung volume in ventilated people with acute SCI that are medically stable.
Positive pressure therapy techniques include ventilator hyper-inflation, mechanical insufflation and manual-hyperinflation. Ventilator hyperinflation is preferred if available. Positive pressure techniques are contraindicated in conditions that include but are not limited to untreated pneumothorax, tracheoesophageal fistula, increased intracranial pressure and facial trauma.
Intermittent application of positive pressure (v no intervention) on lung volume in ventilated people with SCI who have respiratory muscle weakness
P
People with SCI who are ventilated and have respiratory muscle weakness
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
Intermittent application of positive pressure therapy techniques should be used (in consultation with medical staff) for improving lung volume in ventilated people with acute SCI that are medically stable.
Clinical note: Positive pressure therapy techniques include ventilator hyper-inflation, mechanical insufflation and manual-hyperinflation. Ventilator hyperinflation is preferred if available. Positive pressure techniques are contraindicated in conditions that include but are not limited to untreated pneumothorax, tracheoesophageal fistula, increased intracranial pressure and facial trauma.
I
Intermittent application of positive pressure therapy techniques
C
No intervention
Consensus-based opinion statement
Strong for (100%)
O
Lung volume (Litres)
The Australian and NZ SCI Physiotherapy guideline committee recommends intermittent application of positive pressure therapy techniques should be used (in consultation with medical staff) for improving lung volume in ventilated people with acute SCI that are medically stable.
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:
Intermittent application of positive pressure therapy techniques should be used (in consultation with medical staff) for improving lung volume in ventilated people with acute SCI that are medically stable.
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 Intermittent application of positive pressure therapy techniques for improving lung volume based on opinion.
To learn more about the research related to this intervention go to the clinicians tab on this website
Physiotherapy treatment by a registered physiotherapist or their delegate
consensus: Strong For Recommendation
People with SCI should only receive physiotherapy by a registered physiotherapist or delegate.
Physiotherapy treatment by a registered physiotherapist or their delegate
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
Physiotherapy treatments for people with SCI should be provided by registered physiotherapists or their delegate.
I
Physiotherapy treatment by a registered physiotherapist or their delegate
C
No intervention
Consensus-based opinion statement
Strong for (92%)
O
Optimal outcome
The Australian and NZ SCI Physiotherapy guideline committee recommends people with SCI should only receive physiotherapy by a registered physiotherapist or delegate. 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 only receive physiotherapy by a registered physiotherapist or delegate.
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 only receive physiotherapy by a registered physiotherapist or delegate.
To learn more about the this intervention go to the research summary.
Respiratory assessment by a physiotherapist within 24 hours of admission to hospital (existing SCI and management of respiratory condition)
consensus: Strong For Recommendation
People with existing SCI admitted for the management of a respiratory condition should be assessed by a physiotherapist within 24 hours of admission to hospital.
Respiratory assessment by a physiotherapist within 24 hours of admission to hospital (existing SCI and management of respiratory condition)
P
People with existing SCI admitted for the management of a respiratory condition
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
People with existing SCI admitted for the management of a respiratory condition should be assessed by a physiotherapist within 24 hours of admission to hospital.
I
Respiratory assessment by a physiotherapist within 24 hours of admission to hospital
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 existing SCI admitted for the management of a respiratory condition should be assessed by a physiotherapist within 24 hours of admission to hospital. 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 existing SCI admitted for the management of a respiratory condition should be assessed by a physiotherapist within 24 hours of admission to hospital.
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 existing SCI admitted for the management of a respiratory condition should be assessed by a physiotherapist within 24 hours of admission to hospital.
To learn more about the this intervention go to the research summary.
Postural drainage (v no intervention) on secretion clearance in people with SCI who have respiratory muscle weakness or paralysis
consensus: Strong For Recommendation
Targeted postural drainage should be provided to improve secretion clearance in people with SCI who have respiratory muscle weakness or paralysis.
Postural drainage (including head-down tilt) is usually provided as an adjunct to other respiratory therapies. Head down tilt is contraindicated in conditions that include but are not limited to heart failure, reflux and acute Traumatic Brain Injury with increased/poorly controlled intracranial pressure.
Postural drainage (v no intervention) on secretion clearance in people with SCI who have respiratory muscle weakness or paralysis
P
People with SCI who have respiratory muscle weakness or paralysis
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
Targeted postural drainage should be provided to improve secretion clearance in people with SCI who have respiratory muscle weakness or paralysis.
Clinical note: Postural drainage (including head down tilt) is usually provided as an adjunct to other respiratory therapies. Head down tilt is contraindicated in conditions that include but are not limited to heart failure, reflux and acute Traumatic Brain Injury with increased/poorly controlled intracranial pressure.
I
Postural drainage
C
No intervention
Consensus-based opinion statement
Strong for (85%)
O
Secretion clearance
The Australian and NZ SCI Physiotherapy guideline committee recommends targeted postural drainage to improve secretion clearance in people with SCI who have respiratory muscle weakness or paralysis.
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:
Targeted postural drainage should be provided to improve secretion clearance in people with SCI who have respiratory muscle weakness or paralysis.
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 targeted postural drainage to improve secretion clearance based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website
Manually assisted cough (v no intervention) on secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough
consensus: Strong For Recommendation
Manually assisted cough should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
Manually assisted cough is contraindicated in conditions such as recent abdominal trauma. Manually assisted cough should be considered with caution in people with paralytic ileus or rib fractures.
Manually assisted cough (v no intervention) on secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough
P
People with SCI who have abdominal muscle weakness or paralysis and an ineffective cough
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
Consensus Statement: Manually assisted cough should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough
Clinical note: Manually assisted cough is contraindicated in conditions such as recent abdominal trauma. Manually assisted cough should be considered with caution in people with paralytic ileus or rib fractures.
I
Manually assisted cough
C
No intervention
Consensus-based opinion statement
Strong for (100%)
O
Secretion clearance
The Australian and NZ SCI Physiotherapy guideline committee recommends manually assisted cough to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
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:
Manually assisted cough should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
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 manually assisted cough to improve secretion clearance based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Mechanically assisted cough (Insufflation/exsufflation) (v no intervention) on secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough
consensus: Strong For Recommendation
Mechanically assisted cough (insufflation-exsufflation) should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
Contraindications and precautions for the use of positive pressure devices must be considered before prescribing manually assisted cough. For example, positive pressure devices are contraindicated in conditions that include but are not limited to untreated pneumothorax, tracheoesophageal fistula and acute traumatic brain injury with increased/poorly controlled intracranial pressure.
Mechanically assisted cough (insufflation/exsufflation) (v no intervention) on secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
P
People with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
Mechanically assisted cough (insufflation-exsufflation) should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
Clinical Note: Contraindications and precautions for the use of positive pressure devices must be considered before prescribing manually assisted cough. For example, positive pressure devices are contraindicated in conditions that include but are not limited to untreated pneumothorax, tracheoesophageal fistula and acute raumatic brain injury with increased/poorly controlled intracranial pressure.
The Australian and NZ SCI Physiotherapy guideline committee recommends manually assisted cough to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
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:
Manually assisted cough should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
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 manually assisted cough to improve secretion clearance based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Mechanically assisted cough (Insufflation/exsufflation) plus manually assisted cough (v no intervention) on secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
consensus: Strong For Recommendation
A combination of mechanically assisted cough and manually assisted cough should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
Insufflation-exsufflation and manually assisted cough can be provided independently or in combination for increasing secretion clearance in people with SCI.
Mechanically assisted cough (Insufflation/exsufflation) plus manually assisted cough (v no intervention) on secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
P
People with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
A combination of mechanically assisted cough and manually assisted cough should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
Clinical note: Insufflation-exsufflation and manually assisted cough can be provided independently or in combination for increasing secretion clearance in people with SCI.
I
A combination of mechanically assisted cough (Insufflation-exsufflation) and manually assisted cough
C
No intervention
Consensus-based opinion statement
Strong for (100%)
O
Secretion clearance
The Australian and NZ SCI Physiotherapy guideline committee recommends a combination of mechanically assisted cough and manually assisted cough to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
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:
A combination of mechanically assisted cough and manually assisted cough should be provided to improve secretion clearance in people with SCI who have abdominal muscle weakness or paralysis and an ineffective cough.
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 a combination of mechanically assisted cough and manually assisted cough to improve secretion clearance based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website.
Respiratory assessment by a physiotherapist within 24 hours of admission to hospital (newly acquired)
consensus: Strong For Recommendation
People with newly acquired SCI with respiratory muscle weakness should be assessed by a physiotherapist within 24 hours of admission to hospital.
Respiratory assessment by a physiotherapist within 24 hours of admission to hospital (newly acquired)
P
People with a newly acquired SCI with respiratory muscle weakness
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
People with newly acquired SCI with respiratory muscle weakness should receive an assessment by a physiotherapist within 24 hours of admission to the hospital.
I
Assessment by a physiotherapist within 24 hours of admission to hospital
C
No intervention
Consensus-based opinion statement
Strong for (100%)
O
Optimal outcome
The Australian and NZ SCI Physiotherapy guideline committee recommends people with newly acquired SCI with respiratory muscle weakness should be assessed by a physiotherapist within 24 hours of admission to hospital. 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 newly acquired SCI with respiratory muscle weakness should be assessed by a physiotherapist within 24 hours of admission to hospital.
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 newly acquired SCI with respiratory muscle weakness should be assessed by a physiotherapist within 24 hours of admission to hospital.
To learn more about the this intervention go to the research summary.
Physiotherapy assessment and treatment
consensus: Strong For Recommendation
People with newly acquired SCI should receive physiotherapy assessment and treatment for the management of their impairments, activity limitations, and participation restrictions.
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
People with a newly acquired SCI should receive physiotherapy assessment and treatment for the management of their impairments, activity limitations, and participation restrictions.
I
Physiotherapy assessment and treatment
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 newly acquired SCI should receive physiotherapy assessment and treatment. 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 newly acquired SCI should receive physiotherapy assessment and treatment for the management of their impairments, activity limitations, and participation restrictions.
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 newly acquired SCI should receive physiotherapy assessment and treatment based on opinion.
To learn more about the this intervention go to the research evidence.
Strength training combined with electrical stimulation (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI.
consensus: Weak For Recommendation
Electrical Stimulation combined with strength training may be provided to improve voluntary strength of partially paralysed muscles in people with SCI.
Strength training combined with electrical stimulation (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI
P
People with SCI (partially-paralysed muscles)
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Electrical Stimulation combined with strength training may be provided to improve voluntary strength of partially paralysed muscles in people with SCI.
I
Electrical Stimulation combined with strength training
C
No intervention
Consensus-based opinion statement
Weak for (95%)
O
Voluntary strength
SUMMARY
1 RCT
(see reference)
Mean difference (95% CI): Strength in Nm
14 (1 to 27)
Favours electrical stimulation combined with strength training
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
Serious
Indirectness
Serious
Publication bias
Serious
STRENGTH TRAINING PLUS 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
STRENGTH TRAINING PLUS ELECTRICAL STIMULATION ON VOLUNTARY STRENGTH PARTIALLY PARALYSED MUSCLES: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
HARVEY 2010
Strength training plus electrical stimulation
V
No intervention
12 sets of 10 3 x per week for 8 weeks
C3-L2 SCI
10/10
Strength in Nm
Some Concerns of
Risk of Bias
PEDro = 8/10
The Australian and NZ SCI Physiotherapy guideline committee recommends electrical Stimulation combined with strength training may to improve voluntary strength of partially paralysed muscles 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:
Electrical Stimulation combined with strength training may be provided to improve voluntary strength of partially paralysed muscles 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend electrical Stimulation combined with strength training to improve voluntary strength of partially paralysed muscles in people with SCI based on opinion.
To learn more about this recommendation go to the research summary.
Harvey LA, Fornusek C, Bowden JL, et al. Electrical stimulation plus progressive resistance training for leg strength in spinal cord injury: a randomized controlled trial. Spinal Cord 2010 Jul;48(7):570-575 2010.
FES cycling (v no intervention) on spasticity in people with SCI
consensus: Weak For Recommendation
FES cycling may be provided to treat spasticity in people with SCI.
Electrically stimulated cycling (v no intervention) on spasticity in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
FES cycling may be provided to treat spasticity in people with SCI.
I
Electrically stimulated cycling
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Spasticity
SUMMARY
1 RCT
(see reference)
¬Mean difference (95% CI): Spasticity on the Ashworth Scale
-2 (-4 to 1)
Favours FES cycling
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
No serious
Inconsistency
Serious
Imprecision
Serious
Indirectness
Serious
Publication bias
Serious
ELECTRICALLY STIMULATED CYCLING ON SPASTICITY: 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
ELECTRICALLY STIMULATED CYCLING ON SPASTICITY: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
RALSTON 2013
ES cycling
V
No intervention
Four x a week for two weeks (30-45 minutes)
C4 to T10 SCI
14/14
Spasticity - Ashworth
Low Risk of Bias
PEDro = 8
The Australian and NZ SCI Physiotherapy guideline committee recommends FES cycling may be provided to treat spasticity 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 may be provided to treat spasticity 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend FES cycling to treat spasticity in people with SCI. based on opinion.
To learn more about this recommendation go to the research summary.
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
Elevation (v no intervention) on swelling in people with SCI
consensus: Weak For Recommendation
Elevation may be provided to treat extremity swelling in people with SCI.
Elevation (v no intervention) on swelling in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Elevation may be provided to treat extremity swelling in people with SCI.
I
Elevation
C
No intervention
Consensus-based opinion statement
Weak for (78%)
O
Swelling
The Australian and NZ SCI Physiotherapy guideline committee recommends elevation to treat extremity swelling 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:
Elevation may be provided to treat extremity swelling 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend elevation to treat extremity swelling in people with SCI based on opinion.
To learn more about this recommendation go to the research summary.
Passive standing (v no intervention) on spasticity in people with SCI
consensus: Weak For Recommendation
Passive standing may be provided to treat spasticity in people with SCI.
Passive standing (v no intervention) on spasticity in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Passive standing may be provided to treat spasticity in people with SCI.
I
Passive standing
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Spasticity
SUMMARY
1 RCT
(see reference)
Mean difference (95% CI): Spasticity on the Spinal Cord Injury Spasticity Evaluation Tool
0.1 (-0.3 to 0.1)
Favours no intervention
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
No serious
Indirectness
Serious
Publication bias
Serious
PASSIVE STANDING ON SPASTICITY: 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
PASSIVE STANDING ON SPASTICITY: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
KWOK 2005
Passive standing (and usual care)
V
Usual care
Tilt-table standing 5 x per week for 6 weeks (30 mins)
C5-T7 wheelchair dependent people with SCI
17/17
Spinal Cord Injury Spasticity Evaluation tool
Low Risk of Bias
PEDro = 8/10
The Australian and NZ SCI Physiotherapy guideline committee recommends passive standing to treat spasticity 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:
Passive standing may be provided to treat spasticity 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend passive standing to treat spasticity in people with SCI based on opinion.
To learn more about this recommendation go to the research summary.
Kwok, S., Harvey, L., Glinsky, J. et al. Does regular standing improve bowel function in people with spinal cord injury? A randomised crossover trial 2015. Spinal Cord 53, 36–41.
Upper and lower limb splinting versus no intervention on prevention of contractures in people with SCI who are at risk of contracture
consensus: Weak For Recommendation
Upper and lower limb splinting may be provided to prevent joint contracture in people with SCI who are at risk of contracture.
Splinting can cause serious pressure injuries, particularly in those with spasticity, and/or impaired or absent sensation, so should only be administered by physiotherapists with experience in splinting and with careful ongoing monitoring.
Upper and lower limb splinting versus no intervention on prevention of contractures in people with SCI who are at risk of contracture
P
People with SCI who are at risk of contracture
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Upper and lower limb splinting may be provided to prevent joint contracture in people with SCI who are at risk of contracture.
Clinical note: Splinting can cause serious pressure injuries, particularly in those with spasticity, and/or impaired or absent sensation, so should only be administered by physiotherapists with experience in splinting and with careful ongoing monitoring.
I
Upper and lower limb splinting
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Contracture
The Australian and NZ SCI Physiotherapy guideline committee recommends upper and lower limb splinting to prevent joint contracture in people with SCI who are at risk of contracture. 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:
Upper and lower limb splinting may be provided to prevent joint contracture in people with SCI who are at risk of contracture.
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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend upper and lower limb splinting to prevent joint contracture in people with SCI who are at risk of contracture based on opinion.
To learn more about this recommendation go to the research summary.
Neuromuscular electrical stimulation (v no intervention) on swelling in people with SCI
consensus: Weak For Recommendation
Neuromuscular electrical stimulation (NMES) may be provided to treat extremity swelling in people with SCI.
NMES for the treatment of swelling is only recommended for people who can be stimulated with NMES.
Neuromuscular electrical stimulation (v no intervention) on swelling in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Neuromuscular electrical stimulation (NMES) may be provided to treat extremity swelling in people with SCI.
Clinical note: NMES for the treatment of swelling is only recommended for people who can be stimulated with NMES.
I
Neuromuscular electrical stimulation
C
No intervention
Consensus-based opinion statement
Weak for (96%)
O
Swelling
The Australian and NZ SCI Physiotherapy guideline committee recommends neuromuscular electrical stimulation (NMES) to treat extremity swelling 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:
Neuromuscular electrical stimulation (NMES) may be provided to treat extremity swelling 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend neuromuscular electrical stimulation (NMES) to treat extremity swelling in people with SCI based on opinion.
To learn more about this recommendation go to the research summary.
Lymphatic massage (v no intervention) on swelling in people with SCI
consensus: Weak For Recommendation
Lymphatic massage may be provided to treat extremity swelling in people with SCI.
Lymphatic massage (v no intervention) on swelling in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Lymphatic massage may be provided to treat extremity swelling in people with SCI.
I
Lymphatic massage
C
No intervention
Consensus-based opinion statement
Weak for (93%)
O
Swelling
The Australian and NZ SCI Physiotherapy guideline committee recommends lymphatic massage to treat extremity swelling 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:
Lymphatic massage may be provided to treat extremity swelling 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend lymphatic massage to treat extremity swelling in people with SCI based on opinion.
To learn more about this recommendation go to the research summary.
Active Assisted Exercise (v no intervention) on joint mobility (prevention) in people with SCI who are at risk of contracture
consensus: Weak For Recommendation
Active assisted exercises may be provided to prevent loss of joint mobility in people with SCI who are at risk of contracture.
Active Assisted Exercise (v no intervention) on joint mobility (prevention) in people with SCI who are at risk of contracture
P
People with SCI at risk of contracture
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Active assisted exercises may be provided to prevent loss of joint mobility in people with SCI who are at risk of contracture.
I
Active assisted exercises
C
No intervention
Consensus-based opinion statement
Weak for (92%)
O
Contracture
The Australian and NZ SCI Physiotherapy guideline committee recommends active assisted exercises to prevent loss of joint 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:
Active assisted exercises may be provided to prevent loss of joint mobility 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend active assisted exercises to prevent loss of joint mobility in people with SCI based on opinion.
To learn more about this recommendation go to the research summary.
Wheelchair pushing (v no intervention) on cardiorespiratory fitness in people with SCI who are wheelchair dependent
consensus: Weak For Recommendation
Wheelchair pushing may be provided to improve cardiorespiratory fitness in people with SCI who are wheelchair dependent.
Wheelchair pushing for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse.
Wheelchair pushing (v no intervention) on cardiorespiratory fitness in people with SCI who are wheelchair dependent
P
People with SCI who are wheelchair dependent
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Wheelchair pushing may be provided to improve cardiorespiratory fitness in people with SCI who are wheelchair dependent.
Clinical note: Wheelchair pushing for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse.
I
Wheelchair pushing
C
No intervention
Consensus-based opinion statement
Weak for (83%)
O
Cardiorespiratory Fitness (Vo2 peak)
SUMMARY
1 RCT
(see reference)
Mean Difference (95% CI)
0 (-0.2 to 0.1)
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
Very serious
Indirectness
Serious
Publication bias
Serious
WHEELCHAIR PUSHING 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
WHEELCHAIR PUSHING ON CARDIORESPIRATORY FITNESS: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
VAN DER SCHEER 2016
Wheelchair treadmill propulsion
V
No intervention
Wheelchair treadmill propulsion, twice a week (30 mins) for 16 weeks (30-40% HRR)
C4 to L5 SCI
12/13
Vo2 Peak
Some Concerns of
Risk of Bias
PEDro = 7
The Australian and NZ SCI Physiotherapy guideline committee recommends wheelchair pushing to improve cardiorespiratory fitness in people with SCI who are wheelchair dependent. 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:
Wheelchair pushing may be provided to improve cardiorespiratory fitness 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend wheelchair pushing to improve cardiorespiratory fitness in people with SCI who are wheelchair dependent based on opinion.
To learn more about this recommendation go to the research summary.
Van der Scheer JW, de Groot S, Tepper M, Faber W; ALLRISC group, Veeger DH, van der Woude LH. Low-intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels. J Rehabil Med. 2016 Jan;48(1):33-42.
Tenodesis splinting (v no intervention) on a tenodesis grip in people with C6 or C7 tetraplegia
consensus: Weak For Recommendation
Tenodesis splinting may be provided to improve a tenodesis grip in people with C6 and C7 tetraplegia.
Tenodesis splinting (v no intervention) on a tenodesis grip in people with C6 or C7 tetraplegia
P
People with C6 and C7 tetraplegia
Evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
Tenodesis splinting may be provided to improve a tenodesis grip in people with C6 and C7 tetraplegia.
I
Tenodesis splinting
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Tenodesis grip
The Australian and NZ SCI Physiotherapy guideline committee suggests Tenodesis splinting improve a tenodesis grip in people with C6 and C7 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:
Tenodesis splinting may be provided to improve a tenodesis grip in people with C6 and C7 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend tenodesis splinting to improve a tenodesis grip based on opinion.
To learn more about the this intervention go to the research evidence.
Passive range of motion exercises (v no intervention) on joint mobility in people with SCI
consensus: Weak For Recommendation
Passive range of motion exercises may be provided to prevent and treat loss of joint mobility in people with SCI
Passive range of motion exercises (v no intervention) on joint mobility in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Passive range of motion exercises (v no intervention) on joint mobility in people with SCI
I
Passive range of motion exercises
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Joint mobility
SUMMARY
1 RCT 61
Mean difference (95% CI): Joint mobility in degrees
4 (2 to 6)
Favours passive m ovements
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
No serious
Indirectness
Serious
Publication bias
Serious
PASSIVE RANGE OF MOTION EXERCISES: 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
PASSIVE RANGE OF MOTION EXERCISES ON JOINT MOBILITY: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
HARVEY 2009
Passive Movements
V
No Intervention
10 minutes of ankle
passive movements,
10 x per week for 6
months
C3 -C7 tetraplegia
20/20
Modified
Ashworth
Some Concerns of
Risk of Bias
PEDro = 8/10
The Australian and NZ SCI Physiotherapy guideline committee recommends passive range of motion exercises to prevent and treat loss of joint mobility in people with spinal cord injury.
This is a consensus-based opinion statement supported by the opinions of the experts even though there are randomised controlled trials related to this topic. The results of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Passive range of motion exercises may be provided to prevent and treat loss of joint mobility in people with SCI.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, personal experience, equity, accessibility, feasibility and personal experience. The results of the two 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend passive range of motion exercises to prevent and treat loss of joint mobility based on opinion.
To learn more about the this intervention go to the research evidence.
Harvey L, Herbert R, Glinsky J, Moseley A and Bowden J. Effects of six months of regular passive movements on ankle joint mobility in people with spinal cord injury: A randomised controlled trial. Spinal Cord 2009. 47:62-68.
Hand splinting versus no intervention on prevention of hand contractures in people with tetraplegia
consensus: Weak For Recommendation
Hand splinting may be provided to prevent hand contracture in people with tetraplegia who are at risk of contracture.
Hand splinting versus no intervention on prevention of hand contractures in people with tetraplegia
P
People with tetraplegia
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Hand splinting may be provided to prevent hand contracture in people with tetraplegia who are at risk of contracture.
I
Hand splinting
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Contracture
The Australian and NZ SCI Physiotherapy guideline committee recommends hand splinting to prevent hand contracture in people with tetraplegia. This is a consensus-based opinion statement supported by the opinions of the experts even though there are randomised controlled trials related to this topic. The results of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Hand splinting may be provided to prevent hand contracture in people with tetraplegia.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, personal experience, equity, accessibility, feasibility and personal experience. The results of the two 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend hand splinting to prevent hand contracture in people with tetraplegia based on opinion. To learn more about the this intervention go to the research evidence.
Abdominal binders (v no intervention) to improve cough in people with SCI who have abdominal muscle weakness or paralysis
consensus: Weak For Recommendation
An abdominal binder may be provided to improve cough in people with SCI who have abdominal muscle weakness or paralysis.
Abdominal binders (to improve cough) are 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 improving cough.
Abdominal binders (v no intervention) to improve cough in people with SCI who have abdominal muscle weakness or paralysis.
P
People with SCI who have abdominal muscle weakness or paralysis.
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Abdominal binder may be provided to improve cough in people with SCI who have abdominal muscle weakness or paralysis
Clinical note: Abdominal binders (to improve cough) are 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 improving cough.
I
Abdominal FES
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Secretion clearance
SUMMARY
1 RCT
(see reference)
Mean difference (95% CI): Peak expiratory flow in Litres
0.8 (0.1 to 1.5)
Favours abdominal binder
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
Not serious
Indirectness
Not serious
Publication bias
Serious
ABDOMINAL BINDERS ON COUGH: 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 PEAK EXPIRATORY FLOW: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
WADSWORTH 2012
Sitting with abdominal binder
V
Sitting without abdominal binder
Elastic binder
C3-T5 AIS A or
AIS B SCI
Acute
14/14
Peak Expiratory Flow (PEF)
High Risk of Bias
PEDro = 4/10
The Australian and NZ SCI Physiotherapy guideline committee recommends an abdominal binder to improve cough in people with SCI who have abdominal muscle weakness or paralysis. This is a consensus-based opinion statement supported by the opinions of the experts even though there are randomised controlled trials related to this topic. The results of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
An abdominal binder may be provided to improve cough in people with SCI who have abdominal muscle weakness or paralysis.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, personal experience, equity, accessibility, feasibility and personal experience. The results of the two 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend an abdominal binder to improve cough in people with SCI who have abdominal muscle weakness or paralysis based on opinion.
To learn more about the this intervention go to the research evidence.
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.
Abdominal FES (v no intervention) on stimulated cough in people with SCI who have abdominal muscle weakness or paralysis
consensus: Weak For Recommendation
Abdominal FES may be provided to improve stimulated cough in people with SCI who have abdominal muscle weakness or paralysis.
The Australian and NZ SCI Physiotherapy guideline committee recommends abdominal FES to improve stimulated cough in people with SCI who have abdominal muscle weakness or paralysis. This is a consensus-based opinion statement supported by the opinions of the experts even though there are randomised controlled trials related to this topic. The results of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Abdominal FES may be provided to improve stimulated cough in people with SCI who have abdominal muscle weakness or paralysis.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, personal experience, equity, accessibility, feasibility and personal experience. The results of the two 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend abdominal FES to improve stimulated cough in people with SCI who have abdominal muscle weakness or paralysis based on opinion.
To learn more about the this intervention go to the research evidence.
Cheng, P.Chen, C.Wang, C.Chung, C. Effect of neuromuscular electrical stimulation on cough capacity and pulmonary function in patients with acute cervical cord injury. Journal of Rehabilitation Medicine 2006 Jan;38(1):32-36.
Percussion and vibration (v no intervention) on secretion clearance in people with SCI who have respiratory muscle weakness
consensus: Weak For Recommendation
Percussion and vibrations may be provided to improve secretion clearance in people with SCI who have respiratory muscle weakness.
Percussion and vibrations are usually provided as an adjunct to other respiratory therapies.
Percussion and vibration (v no intervention) on secretion clearance in people with SCI who have respiratory muscle weakness
P
People with SCI who have respiratory muscle weakness.
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Consensus Statement: Percussion and vibrations may be provided to improve secretion clearance in people with SCI who have respiratory muscle weakness.
Clinical note: Percussion and vibrations are usually provided as an adjunct to other respiratory therapies.
I
Percussion and vibration
C
No intervention
Consensus-based opinion statement
Weak for (85%)
O
Secretion clearance
The Australian and NZ SCI Physiotherapy guideline committee recommends percussion and vibrations may be provided to improve secretion clearance in people with SCI who have respiratory muscle weakness.
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:
Percussion and vibrations may be provided to improve secretion clearance in people with SCI who have respiratory muscle 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. 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend percussion and vibrations to improve secretion clearance in people with SCI who have respiratory muscle weakness based on opinion.
To learn more about the research related to this intervention go to the research summary tab on the website.
Air stacking (v no intervention) on lung volumes in people with SCI who have respiratory muscle weakness
consensus: Weak For Recommendation
Air stacking may be taught to improve lung volume in people with SCI who have respiratory muscle weakness.
Air stacking involves the use of any positive pressure inspiratory device. These should be provided by a mouthpiece and nose peg rather than a face mask because of the risk of pneumothorax if a face mask is provided.
Air stacking (v no intervention) on lung volumes in people with SCI who have respiratory muscle weakness
P
People with SCI who have respiratory muscle weakness
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Air stacking may be taught to improve lung volume in people with SCI who have respiratory muscle weakness.
Clinical note: Air stacking involves the use of any positive pressure inspiratory device. These should be provided by a mouthpiece and nose peg rather than a face mask because of the risk of pneumothorax if a facemask is provided.
I
Air stacking
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Lung volume (L)
SUMMARY
1 RCT
(see reference)
Mean difference (95% CI): Lung volume in litres
0 (-0.6 to 0.6)
Favours air stacking
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very Serious
Inconsistency
Serious
Imprecision
Serious
Indirectness
Serious
Publication bias
Serious
AIR STACKING ON 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
AIR STACKING FOR LUNG VOLUME: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
JEONG 2015
Air stacking
V
Incentive
spirometry
20 reps air stacking 2 x per day
5 days per week for 6 weeks
tetaplegia
14/12
Lung volume
(FVC)
High Risk of Bias
PEDro = 6/10
The Australian and NZ SCI Physiotherapy guideline committee recommends air stacking may be taught to improve lung volume in people with SCI who have respiratory muscle weakness. This is a consensus-based opinion statement supported by the opinions of the experts even though there are randomised controlled trials related to this topic. The results of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Air stacking may be taught to improve lung volume in people with SCI who have respiratory muscle weakness.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, personal experience, equity, accessibility, feasibility and personal experience. The results of the two 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend that air stacking may be taught to improve lung volume in people with SCI who have respiratory muscle weakness based on opinion.
To learn more about the this intervention go to the research evidence.
Jeong, JH, Yoo WG. Effects of air stacking on pulmonary function and peak cough flow in patients with cervical spinal cord injury. Journal of Physical Therapy Science 2015 Jun;27(6):1951-1952.
Deep breathing exercises (v no intervention) on lung volumes in people with SCI who have respiratory muscle weakness
consensus: Weak For Recommendation
Deep breathing exercises may be provided to improve lung volumes in people with SCI.
People with SCI and respiratory muscle weakness should focus on respiratory strength training exercises, rather than deep breathing exercises.
Deep breathing exercises (v no intervention) on lung volumes in people with SCI who have respiratory muscle weakness
P
People with SCI who have respiratory muscle weakness
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Strong opinion statement FOR
Deep breathing exercises may be provided to improve lung volumes in people with SCI.
Clinical note: People with SCI and respiratory muscle weakness should focus on respiratory strength training exercises, rather than deep breathing exercises.
I
Deep breathing exercises
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Lung volume
The Australian and NZ SCI Physiotherapy guideline committee recommends deep breathing exercises to improve lung volumes in people with SCI. However, people with SCI and respiratory muscle weakness should focus on respiratory strength training exercises, rather than deep breathing exercises.
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:
Deep breathing exercises may be provided to improve lung volumes 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend deep breathing exercises to improve lung volumes 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.
Upper limb and hand function training and FES (v no intervention) on hand function in people with tetraplegia
consensus: Weak For Recommendation
Upper limb and hand function training and FES may be provided to improve hand function in people with tetraplegia
Upper limb and hand function training and FES (v no intervention) on hand function in people with tetraplegia
P
People with tetraplegia
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Upper limb and hand function training and FES may be provided to improve hand function in people with tetraplegia.
I
Upper limb and hand function training and FES
C
No intervention
Consensus-based opinion statement
Weak for (96%)
O
Upper limb and hand function
SUMMARY
2 RCTs36-37
Standardised mean difference (95% CI)
0.2 (-0.3 to 0.8)
Favours hand training with FES
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
No serious
Imprecision
Very serious
Indirectness
No serious
Publication bias
Serious
UPPER LIMB AND HAND FUNCTION TRAINING PLUS FES 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 FUNCTION TRAINING PLUS FES ON UPPER LIMB AND HAND FUNCTION: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
HARVEY 2017
Hand training plus FES (plus usual care)
V
Usual care
1 hour per day, 5 days per week for 8 weeks.
C2-T1 tetraplegia
35/31
Action
Research
Arm Test
(ARAT)
Low Risk of Bias
PEDro = 8/10
HOFFMAN 2013
Hand training plus FES
V
No intervention
5 x per week, 2 hours per day, for 3 weeks.
Chronic tetraplegia
10/9
Jebsen Hand
function test
High Risk of Bias
PEDro = 3/10
The Australian and NZ SCI Physiotherapy guideline committee recommends upper limb and hand function training and FES 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 and hand function training and FES may 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 recommend upper limb and hand function training and FES 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.
Hoffman L F-FE. Effects of practice combined with somatosensory or motor stimulation on hand function in persons with spinal Cord Injury. Topics in spinal cord injury rehabilitation 2013; 19: 288.
Harvey LA, Dunlop SA, Churilov L, et al. Early intensive hand rehabilitation is not more effective than usual care plus one-to-one hand therapy in people with sub-acute spinal cord injury ('Hands On'): a randomised trial. Journal of physiotherapy 2017; 63: 197-204.
Upper limb virtual reality (v no intervention) on upper limb function in people with tetraplegia
consensus: Weak For Recommendation
Upper limb virtual reality training may be provided to improve UL function in people with tetraplegia.
Upper limb virtual reality (v no intervention) on upper limb function in people with tetraplegia
P
People with tetraplegia
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Upper limb virtual reality training may be provided to improve UL function in people with tetraplegia.
I
Upper limb virtual reality training may be provided to improve UL function in people with tetraplegia.
C
No intervention
Consensus-based opinion statement
Weak for (100%)
O
Upper limb function
SUMMARY
3 RCTs
(see references)
Standardised mean difference (95% CI)
0.7 (-1.6 to 0.2)
Favours no intervention
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
Serious
Imprecision
Very serious
Indirectness
No serious
Publication bias
Serious
UPPER LIMB VIRTUAL REALITY TRAINING ON UPPER LIMB 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 VIRTUAL REALITY TRAINING ON UPPER LIMB FUNCTION: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
DIMBWADYO-TERRER 2016
Virtual reality UL training (plus
usual care)
V
Usual care
15 sessions with Toyra(®) virtual reality system for 5 30 minutes per day, 3 days/week for 5 weeks
Complete tetraplegia
15/16
SCIM (self-care sub-score)
Some Concerns of Risk Bias
PEDro = 6/10
LIM 2020
Virtual reality (plus usual care)
V
Usual care
30 minutes of VR training and 30 minutes of conventional therapy per day, 4 x per week for 4 weeks
C4-C6 tetraplegia
10/10
SCIM
High Risk of Bias
PEDro = 5/10
PRASAD 2018
Virtual reality UL training (plus usual care)
V
Usual care
3 x per week for 4 weeks
tetraplegia
11/9
Box and block test
High Risk of Bias
PEDro = 6/10
The Australian and NZ SCI Physiotherapy guideline committee recommends upper limb virtual reality training to improve UL 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 virtual reality training may be provided to improve UL 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 virtual reality training to improve UL function in people with tetraplegia based on opinion.
To learn more about the research related to this intervention go to the research summary.
Dimbwadyo-Terrer I, Gil-Agudo A, Segura-Fragoso A, et al. Effectiveness of the virtual reality system toyra on upper limb function in people with tetraplegia: a pilot randomized clinical trial. BioMed Research International 2016; BioMed Research International 2016; 6397828.
Lim DY, Hwang DM, Cho KH, et al. A Fully Immersive Virtual Reality Method for Upper Limb Rehabilitation in Spinal Cord Injury. Annals of rehabilitation medicine 2020. DOI: https://dx.doi.org/10.5535/arm.19181
Prasad S, Aikat R, Labani S, Khanna N. Efficacy of Virtual Reality in Upper Limb Rehabilitation in Patients with Spinal Cord Injury: A Pilot Randomized Controlled Trial. Asian spine journal 2018; 12: 927-934.
Overground gait training v Robotic gait training to improve walking in people with SCI and motor function in the lower limbs
consensus: Weak For Recommendation
Overground gait training may be provided (in favour of robotic gait training) to improve walking in people with SCI.
Robotic gait training includes the use of devices such as the Lokomat (with and without electrical stimulation) and exoskeletons
Overground gait training v Robotic gait training 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.
Weak opinion statement FOR
Overground gait training may be provided (in favour of robotic gait training)to improve walking in people with SCI.
Clinical note: Robotic gait training includes the use of devices such as the Lokomat (with and without electrical stimulation) and exoskeletons.
I
Overground gait training
C
Robotic gait training
Consensus-based opinion statement
Weak for (85%)
O
Ability to walk
SUMMARY
3 RCTs
(see references)
Mean difference (95% CI): Walking ability: WISCI points
3 (-1 to 7)
Favours robotic gait training
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Very serious
Imprecision
Serious
Indirectness
No serious
Publication bias
Serious
OVERGROUND GAIT TRAINING V ROBOTIC GAIT TRAINING ON WALKING: 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 Robotic training
Favours the I
Don't know
RESOURCES REQUIRED
Large costs Robotic training
Moderate costs
Negligible costs and savings of overground walking training
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 for overground walking training
Probably increased
Increased
Don't know
ACCEPTABILITY
No
Probably no
Probably yes
Yes for overground walking training
Don't know
FEASIBILITY
No
Probably no
Probably yes
Yes for overground walking training
Don't know
OVERGROUND GAIT TRAINING V ROBOTIC GAIT TRAINING ON WALKING: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
ALCOBENDAS-MAESTRO 2012
Overground gait training
V
Robotic Gait training
Intervention: 40 sessions of overground gait training
Comparison: 40 sessions of lokomat
C2 to T12 AIS C
and D SCI
37/38
Walking Index for SCI
Some Concerns of
Risk of Bias
PEDro = 8/10
ESCLARIN-RUZ 2014
Overground gait training
V
Robotic Gait training
Intervention:
Overground training 60 minute, 5 days/week for 8 weeks
Comparison:
Lokomat 60 minutes 5 days/week for 8 weeks
AIS C or D SCI
41/42
Walking Index For SCI
Some Concerns of
Risk of Bias
PEDro = 8/10
HORNBY 2005
Overground gait training
V
Robotic Gait training
Intervention: Overground gait training 3 x 30mins per week for 8 weeks
Comparison: Robotic gait training 3 x 30 mins per week for 8 weeks
T10 to L4 AIS B,C,D SCI
10/10
Walking index for SCI
Some Concerns of
Risk of Bias
PEDro = 3/10
The Australian and NZ SCI Physiotherapy guideline committee recommends overground gait training in favour of robotic gait training to improve walking in people with SCI.
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:
Overground gait training may be provided (in favour of robotic gait training) 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 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 overground gait training in favour of robotic gait training to improve walking in people with SCI based on opinion.
To learn more about the research related to this intervention go to the research summary.
Alcobendas-Maestro M E-RAC-LRMM-GAP-MGG-VEMJL. Lokomat robotic-assisted versus overground training within 3 to 6 months of incomplete spinal cord lesion: randomized controlled trial. Neurorehabilitation and neural repair 2012; 26: 1058.
Esclarin-Ruz A A-MMC-LRP-MGF-SMAG-VEMJL. A comparison of robotic walking therapy and conventional walking therapy in individuals with upper versus lower motor neuron lesions: a randomized controlled trial. Archives of physical medicine and rehabilitation 2014; 95: 1023.
Hornby TG, Campbell DD, Zemon DH, et al. Clinical and quantitative evaluation of robotic-assisted treadmill walking to retrain ambulation after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation 2005 Fall;11(2):1-17.
Overground gait training vs Treadmill gait training (with or without body weight support) to improve walking in people with SCI and motor function in the lower limbs
consensus: Weak For Recommendation
Overground gait training may be provided (in favour of treadmill gait training with or without body weight support) to improve walking in people with SCI.
Overground gait training vs Treadmill gait training (with or without body weight support) to improve walking in people with SCI and motor function in the lower limbs
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.
Weak opinion statement FOR
Overground gait training may be provided (in favour of treadmill gait training with or without body weight support) to improve walking in people with SCI.
I
Overground gait training
C
Treadmill gait training (with and without body weight support)
Consensus-based opinion statement
Weak for (79%)
O
Ability to walk
SUMMARY
4 RCTs
(see references)
Standardised Mean Difference (95% CI)
0 (-0.3 to 0.4)
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
Very serious
Indirectness
Serious
Publication bias
Serious
OVERGROUND GAIT TRAINING V TREADMILL GAIT TRAINING ON WALKING: 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 for overground walking training
Probably increased
Increased
Don't know
ACCEPTABILITY
No
Probably no
Probably yes
Yes for overground walking training
Don't know
FEASIBILITY
No
Probably no
Probably yes
Yes for overground walking training
Don't know
OVERGROUND GAIT TRAINING V TREADMILL GAIT TRAINING ON WALKING: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
DOBKIN 2006
Overground gait training
V
Treadmill gait training
Intervention: Mobility training one hour per day, 5 x per week for 12 weeks
Comparison: Treadmill training plus mobility training one hour per day, 5 x per week for 12 weeks
People with SCI
35/33
Walking speed m/s
High Risk of Bias
PEDro = 7/10
HORNBY 2005
Overground gait training
V
Treadmill gait training
Intervention: Overground gait training 3 x 30mins per week for 8 weeks
Comparison: BWSTT 3 x 30 mins per week for 8 weeks
T10 to L4 AIS B,C,D SCI
10/10
Walking Index for SCI
Some Concerns of
Risk of Bias
PEDro = 3/10
SENTHILVELKUMAR 2015
Overground gait training
V
Body weight support treadmill gait training
Intervention: Body weight support overground training, 30 mins 5 x per week for 8 weeks
Comparison: treadmill training, 30 mins 5 x per week for 8 weeks
People with SCI
7/7
Walking Index for SCI
Some Concerns of
Risk of Bias
PEDro = 7/10
YANG 2014
Overground gait training
V
Treadmill gait training
Intervention: Overground training one hour per day, 5 x per week for 2 months
Comparison: BWSTT one hour per day, 5 times x week for 2 months
People with SCI
10/10
Walking speed m/s
High Risk of Bias
PEDro = 6/10
The Australian and NZ SCI Physiotherapy guideline committee recommends overground gait training in favour of treadmill gait training with or without body weight support to improve walking in people with SCI.
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:
Overground gait training may 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 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 overground gait training in favour of treadmill gait training with or without body weight support to improve walking in people with SCI based on opinion.
To learn more about the research related to this intervention go to the research summary.
Senthilvelkumar T, Magimairaj H, Fletcher J, et al. Comparison of body weight-supported treadmill training versus body weight-supported overground training in people with incomplete tetraplegia: a pilot randomized trial [with consumer summary]. Clinical Rehabilitation 2015 Jan;29(1):42-49.
Yang JF, Musselman KE, Livingstone D, Brunton K, Hendricks G, Hill D. et al. Repetitive mass practice or focused precise practice for retraining walking after incomplete spinal cord injury? A pilot randomized clinical trial. Neurorehabil Neural Repair 2014; 28: 314-324.
Dobkin B, Apple D, Barbeau H, Basso M, Behrman A, Deforge D, Ditunno J, Dudley G, Elashoff R, Fugate L, Harkema S, Saulino M, Scott M; Spinal Cord Injury Locomotor Trial Group. Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI. Neurology. 2006 Feb 28;66(4):484-93.
Field-Fote Ec RKE. Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial. Physical therapy 2011; 91: 48.
Treadmill gait training (with or without body weight support) vs Robotic gait training to improve walking in people with SCI and motor function in the lower limbs
consensus: Weak For Recommendation
Treadmill gait training with or without body weight support may be provided (in favour of robotic gait training) to improve walking in people with SCI.
Treadmill gait training (with or without body weight support) vs Robotic gait training to improve walking in people with SCI and motor function in the lower limbs
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.
Weak opinion statement FOR
Treadmill gait training with or without body weight support may be provided (in favour of robotic gait training) to improve walking in people with SCI.
I
Treadmill gait training (with and without body weight support)
C
Robotic gait training
Consensus-based opinion statement
Weak for (89%)
O
Ability to walk
SUMMARY
2 RCTs
(see references)
Standardised Mean Difference (95% CI)
-0.2 (-0.8 to 0.4)
Favours treadmill gait training (with or without body weight support)
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
Very serious
Indirectness
Serious
Publication bias
Very serious
TREADMILL GAIT TRAINING V ROBOTIC GAIT TRAINING ON WALKING: 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 treadmill gait training
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 for both
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 for treadmill gait training
Don't know
FEASIBILITY
No
Probably no
Probably yes
Yes for treadmill gait training
Don't know
TREADMILL GAIT TRAINING V ROBOTIC GAIT TRAINING ON WALKING: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
FIELD-FOTE 2011
Treadmill gait training
V
Robotic gait training
Intervention: BWSTT with manual assistance 5 days per week for 12 weeks
Comparison: Robotic gait training 5 days per week for 12 weeks
Chronic SCI
14/17
Speed m/s
High Risk of Bias
PEDro = 6/10
HORNBY 2005
Treadmill gait training
V
Robotic gait training
Intervention: BWSTT 3 x 30mins per week for 8 weeks
Comparison: Robotic BWSTT 3 x 30mins per week for 8 weeks
T10 to L4 AIS
B,C,D SCI
10/10
Walking index for SCI
Some Concerns of
Risk of Bias
PEDro = 3/10
The Australian and NZ SCI Physiotherapy guideline committee recommends treadmill gait training with or without body weight support in favour of robotic gait training to improve walking in people with SCI.
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:
Treadmill gait training with or without body weight support may be provided (in favour of robotic gait training) 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 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 treadmill gait training with or without body weight support in favour of robotic gait training to improve walking in people with SCI based on opinion.
To learn more about the research related to this intervention go to the research summary.
Hornby TG, Campbell DD, Zemon DH, et al. Clinical and quantitative evaluation of robotic-assisted treadmill walking to retrain ambulation after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation 2005 Fall;11(2):1-17.
Field-Fote Ec RKE. Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial. Physical therapy 2011; 91: 48.
Hydrotherapy as an adjunct to land therapy to improve function for people with SCI
consensus: Weak For Recommendation
Hydrotherapy may be provided as an adjunct to land based therapy (in favour of no intervention) to improve function in people with SCI.
Hydrotherapy as an adjunct to land therapy to improve mobility for people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Hydrotherapy may be provided as an adjunct to land based therapy (in favour of no intervention) ) to improve function in people with SCI.
I
Land therapy
C
Hydrotherapy
Consensus-based opinion statement
Weak for (95%)
O
Mobility
The Australian and NZ SCI Physiotherapy guideline committee recommends hydrotherapy as an adjunct to land based therapy to improve function 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:
Hydrotherapy may be provided as an adjunct to land based therapy (in favour of no intervention) to improve function 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend hydrotherapy as an adjunct to land based therapy to improve function 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.
Massage (v no intervention) on pain in people with SCI
consensus: Weak For Recommendation
Massage therapy may be provided to treat pain in people with SCI.
Massage (v no intervention) on pain in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Massage therapy may be provided to treat pain in people with SCI.
I
Massage therapy
C
No intervention
Consensus-based opinion statement
Weak for (96%)
O
Pain
SUMMARY
2 RCTs
Mean difference (95% CI)
0.1 (-0.4 to 0.5)
Favours no intervention
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
No serious
Imprecision
Serious
Indirectness
Serious
Publication bias
Serious
MASSAGE ON 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
MASSAGE ON PAIN: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
CHASE 2013
Massage
V
No intervention
Six 20 min massage sessions over 2 weeks
People with complete and incomplete SCI
20/20
Shortform McGill Pain Questionnaire (SF-MPQ)
High Risk of Bias
PEDro = 5/10
LOVAS 2017
Massage
V
Guided imagery relaxation
1 x per week (30 mins) for 5 weeks
People with complete and incomplete SCI
20/20
Intensity on the Brief Pain Inventory
High Risk of Bias
PEDro = 4/10
The Australian and NZ SCI Physiotherapy guideline committee recommends massage therapy to treat pain in people with SCI.
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:
Massage therapy may be provided to treat 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 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 massage therapy may be provided to treat pain in people with SCI based on opinion.
To learn more about the research related to this intervention go to the research summary.
Chase T, Jha A, Brooks CA, et al. A pilot feasibility study of massage to reduce pain in people with spinal cord injury during acute rehabilitation. Spinal Cord 2013 Nov;51(11):847-851.
Lovas J, Tran Y, Middleton J, Bartrop R, Moore N, Craig A. Managing pain and fatigue in people with spinal cord injury: A randomized controlled trial feasibility study examining the efficacy of massage therapy. Spinal Cord 2017; 55: 162-166.
Neuromuscular electrical stimulation (v no intervention) on shoulder subluxation (prevention and treatment) in people with SCI
consensus: Weak For Recommendation
Neuromuscular electrical stimulation of the shoulder may be provided to prevent and treat shoulder subluxation in people with SCI.
This statement applies to people with partial paralysis of the shoulder muscles following SCI.
[table “162” not found /]
The Australian and NZ SCI Physiotherapy guideline committee recommends neuromuscular electrical stimulation of the shoulder to prevent and treat shoulder subluxation 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:
Neuromuscular electrical stimulation of the shoulder may be provided to prevent and treat shoulder subluxation 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend neuromuscular electrical stimulation of the shoulder to prevent and treat shoulder subluxation 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.
Passive standing (v no intervention) on joint mobility in people with SCI and paralysed lower limbs
consensus: Weak For Recommendation
Passive standing may be provided to prevent and treat loss of ROM in people with SCI and paralysed lower limbs.
Passive standing (v no intervention) on joint mobility in people with SCI and paralysed lower limbs
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement FOR
Passive standing may be provided to prevent and treat loss of ROM in people with SCI and paralysed lower limbs.
I
Passive standing
C
No intervention
Consensus-based opinion statement
Weak for (90%)
O
Joint mobility
SUMMARY
1 RCT
(see reference)
Mean difference (95% CI): Joint mobility in degrees
4 (2 to 6)
Favours passive standing
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
No serious
Indirectness
Serious
Publication bias
Serious
PASSIVE STANDING 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
PASSIVE STANIDNG 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 tilt table
People with SCI and LL paralysis
20/20
Ankle mobility (degrees)
Some Concerns of
Risk of Bias
PEDro = 8/10
The Australian and NZ SCI Physiotherapy guideline committee recommends passive standing to prevent and treat loss of Range of motion (ROM) in people with SCI and paralysed 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:
Passive standing may be provided to prevent and treat loss of ROM in people with SCI and paralysed 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend passive standing to prevent and treat loss of ROM in people with SCI and paralysed lower limbs based on opinion.
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.
Active Assisted Exercise (v no intervention) on joint mobility (treatment) in people with SCI who are at risk of contracture
consensus: Weak For Recommendation
Active assisted exercises may be provided to treat loss of joint mobility in people with SCI
Active Assisted Exercise (v no intervention) on joint mobility (treatment) in people with SCI who are at risk of contracture
P
People with SCI at risk of contracture
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Active assisted exercises may be provided to treat loss of joint mobility in people with SCI
I
Active assisted exercises
C
No intervention
Consensus-based opinion statement
Weak for (96%)
O
Contracture
The Australian and NZ SCI Physiotherapy guideline committee recommends active assisted exercises to treat loss of joint 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:
Active assisted exercises may be provided to treat loss of joint mobility 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend active assisted exercises to treat loss of joint mobility in people with SCI based on opinion.
To learn more about this recommendation go to the research summary.
Serial casting (v no intervention) on joint mobility in people with SCI that have contracture
consensus: Weak For Recommendation
Serial casting may be provided to treat contracture in people with SCI.
Serial casting is only recommended if the contractures are impacting activity and participation. It can cause serious pressure injuries, particularly in those with spasticity, and/or impaired or absent sensation, so should only be administered by physiotherapists with experience in serial casting and with careful ongoing monitoring.
Serial casting (v no intervention) on joint mobility in people with SCI that have contracture
P
People with SCI at risk of contracture
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
Serial casting may be provided to treat contracture in people with SCI.
Clinical note: Serial casting is only recommended if the contractures are impacting activity and participation. It can cause serious pressure injuries, particularly in those with spasticity, and/or impaired or absent sensation, so should only be administered by physiotherapists with experience in serial casting and with careful ongoing monitoring.
I
Serial casting
C
No intervention
Consensus-based opinion statement
Weak for (79%)
O
Contracture
The Australian and NZ SCI Physiotherapy guideline committee recommends serial casting to treat contracture 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:
Serial casting may be provided to treat contracture 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend serial casting to treat contracture in people with SCI based on opinion.
To learn more about this recommendation go to the research summary.
Hand splinting versus no intervention on treatment of hand contractures in people with tetraplegia
consensus: Weak For Recommendation
Hand splinting may be provided to treat hand contracture in people with tetraplegia.
Hand splinting versus no intervention on treatment of hand contractures in people with tetraplegia
P
People with tetraplegia
Evidence recommendation
No evidence recommendation
Reason: No RCTs
Weak opinion statement FOR
and splinting may be provided to treat hand contracture in people with tetraplegia.
I
Hand splinting
C
No intervention
Consensus-based opinion statement
Weak for (92%)
O
Contracture
The Australian and NZ SCI Physiotherapy guideline committee recommends hand splinting to treat hand contracture in people with tetraplegia. This is a consensus-based opinion statement supported by the opinions of the experts even though there are randomised controlled trials related to this topic. The results of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:
Hand splinting may be provided to treat hand contracture in people with tetraplegia.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, personal experience, equity, accessibility, feasibility and personal experience. The results of the two 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 weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend hand splinting to treat hand contracture in people with tetraplegia based on opinion. To learn more about the this intervention go to the research evidence.
Passive range of motion exercises (v no intervention) on spasticity in people with SCI
consensus: Weak Against Recommendation
Passive range of motion exercises should not be administered to treat spasticity in people with SCI.
Passive range of motion exercises (v no intervention) on spasticity in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Weak opinion statement AGAINST
Passive range of motion exercises should not be provided to treat spasticity in people with SCI.
I
Passive range of motion exercises
C
No intervention
Consensus-based opinion statement
Weak against (100%)
O
Spasticity
SUMMARY
2 RCTs
Mean difference (95% CI):
Consider studies independently. Unable to pool I2 = 90%
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Very serious
Imprecision
Very serious
Indirectness
Very serious
Publication bias
Serious
PASSIVE RANGE OF MOTION EXERCISES ON SPASTICITY: 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
PASSIVE RANGE OF MOTION EXERCISES ON SPASTICITY: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
CHANG 2013
Continuous Passive Motion (CPM)
V
No intervention
CPM of the ankle joint for 1 hour per day, 5 x per week for 4 weeks
C5-T12 SCI
7/7
Modified Ashworth
Some Concerns of
Risk of Bias
PEDro = 5/10
HARVEY 2009
Passive Movements
V
No intervention
10 minutes of ankle passive movements, 10 x per week for 6 months
C3 -C7 tetraplegia
20/20
Modified Ashworth
Some Concerns of
Risk of Bias
PEDro = 8/10
The Australian and NZ SCI Physiotherapy guideline committee recommends against passive movements to improve treat spasticity in people with SCI. This is a consensus-based opinion statement supported by the opinions of the experts and two randomised controlled trials related to this topic. The guideline states:
Passive range of motion exercises should not be administered to treat spasticity in people with SCI.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, equity, accessibility, feasibility and personal experience.
This is a consensus-based opinion statement. Opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a weak statement which means that the guideline panel is confident they can probably recommend against passive movements to treat spasticity based on opinion. To learn more about the this intervention go to the research summary.
Harvey L, Herbert R, Glinsky J, Moseley A and Bowden J. Effects of six months of regular passive movements on ankle joint mobility in people with spinal cord injury: A randomised controlled trial. Spinal Cord 2009. 47:62-68.
Chang Y-J, Liang J-N, Hsu M-J, et al. Effects of continuous passive motion on reversing the adapted spinal circuit in humans with chronic spinal cord injury. Archives of physical medicine and rehabilitation 2013; 94: 822-828.
Positive expiratory pressure devices (v no intervention) on secretion clearance in people with SCI who have expiratory muscle weakness
consensus: Weak Against Recommendation
Positive expiratory pressure devices should not be provided to improve secretion clearance in people with SCI who have expiratory muscle weakness.
Positive expiratory pressure techniques include oscillating positive pressure devices.
Positive expiratory pressure devices (v no intervention) on secretion clearance in people with SCI who have expiratory muscle weakness
P
People with SCI who have respiratory muscle weakness.
Evidence recommendation
No evidence recommendation
Reason: Reason: No RCTs
Weak opinion statement AGAINST
Positive expiratory pressure devices should not be provided to improve secretion clearance in people with SCI who have expiratory muscle weakness.
The Australian and NZ SCI Physiotherapy guideline committee recommends against positive expiratory pressure devices to improve secretion clearance in people with SCI who have expiratory muscle weakness. This is a consensus-based opinion statement supported by the opinions of the experts and two randomised controlled trials related to this topic. The guideline states:
Positive expiratory pressure devices should not be provided to improve secretion clearance in people with SCI who have expiratory muscle weakness.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, equity, accessibility, feasibility and personal experience. This is a consensus-based opinion statement. Opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a weak statement which means that the guideline panel is confident they can probably recommend against positive expiratory pressure devices to improve secretion clearance in people with SCI who have expiratory muscle weakness based on opinion.
To learn more about the this intervention go to the research summary.
Gait training (BWS or robotics) (v no intervention) on functional walking for people with no motor function in the lower limbs
consensus: Strong Against Recommendation
Gait training (BWS or robotics) should not be provided to improve functional walking in people with SCI that have no motor function in the lower limbs.
Gait training (BWS or robotics) (v no intervention) on functional walking ability in people with no motor function in the lower limbs
P
People with SCI that have no motor function in the lower limbs.
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Strong opinion statement AGAINST
Gait training (BWS or robotics) should not be provided to improve functional walking in people with SCI that have no motor function in the lower limbs.
I
Gait training
C
No intervention
Consensus-based opinion statement
Strong Against (100%)
O
Ability to walk
The Australian and NZ SCI Physiotherapy guideline committee recommends against gait training with Body weight support or robotics to improve functional walking in people with SCI that have no motor function in their legs. This recommendation is based on opinion only and is not supported by evidence from randomised controlled trials. The guideline states:
Gait training (Body weight support or robotics) should not be provided to improve functional walking in people with SCI that have no motor function in the lower limbs.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, equity, accessibility, feasibility and personal experience.
This is a consensus-based opinion statement. Opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong statement which means that the guideline panel is confident they can not recommend gait training with body weight support or robotics to improve functional walking (in people with SCI that have no motor function in the lower limbs) based on opinion.
To learn more about the this intervention go to the research summary.
Whole body vibration (v no intervention) on voluntary strength in people with SCI
consensus: Strong Against Recommendation
Whole body vibration should not be provided to improve voluntary strength in people with SCI.
Whole body vibration on platform
V
Sham vibration on platform
Whole body Vibration (four 45-second bouts with 1- minute intervening rest periods)
Chronic motor incomplete SCI C2 to T12F
12/12
Maximal isometric quadriceps strength in kg
Some Concerns of
Risk of Bias
PEDro = 4/10
The Australian and NZ SCI Physiotherapy guideline committee recommends against whole body vibration to improve strength in people with SCI. This is a consensus-based opinion statement supported by the opinions of the experts and one randomised controlled trial related to this topic. The guideline states:
Whole body vibration should not be provided to improve voluntary strength in people with SCI.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, equity, accessibility, feasibility and personal experience.
This is a consensus-based opinion statement. Opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong statement which means that the guideline panel is confident they can not recommend whole body vibration to improve strength based on opinion.
To learn more about the this intervention go to the research summary.
Bosveld R, Field-Fote EC. Single-dose effects of whole body vibration on quadriceps strength in individuals with motor-incomplete spinal cord injury. J Spinal Cord Med. 2015 Nov;38(6):784-91.
Gait training (orthotics) vs no intervention to improve functional walking in people with SCI that have no motor function in the lower limbs
consensus: Strong Against Recommendation
Gait training (orthotics) should not be provided to improve functional walking in people with SCI that have no motor function in the lower limbs.
Bilateral knee ankle foot orthosis (KAFOs) or hip knee ankle foot orthosis (HKAFOs) may be useful in certain circumstances for goals such as standing or fitness.
Gait training (Orthotics) (v no intervention) on functional walking ability in people with no motor function in the lower limbs
P
People with SCI that have no motor function in the lower limbs.
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
Strong opinion statement AGAINST
Gait training (orthotics) should not be provided to improve functional walking in people with SCI that have no motor function in the lower limbs.
I
Gait training
C
No intervention
Consensus-based opinion statement
Strong Against (89%)
O
Ability to walk
The Australian and NZ SCI Physiotherapy guideline committee recommends against gait training with orthotics to improve functional walking in people with SCI that have no motor function in their legs. This recommendation is based on opinion only and is not supported by evidence from randomised controlled trials. The guideline states:
Gait training (orthotics) should not be provided to improve functional walking in people with SCI that have no motor function in the lower limbs.
This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, equity, accessibility, feasibility and personal experience.
This is a consensus-based opinion statement. Opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a strong statement which means that the guideline panel is confident they can not recommend gait training with orthotics to improve functional walking (in people with SCI that have no motor function in the lower limbs) based on opinion.
To learn more about the this intervention go to the research summary.
Passive movements (v no intervention) on shoulder pain
consensus: No Recommendation
No evidence recommendation or consensus-based opinion statement
Passive movements (v no intervention) on shoulder pain
P
People with SCI at risk of shoulder pain
Evidence recommendation
No evidence recommendation
Reason: No RCTs
No evidence recommendation or consensus-based opinion statement
I
Passive movements
C
No intervention
Consensus-based opinion statement
No consensus statements
Reason: No consensus could be reached
O
Shoulder pain
The Australian and NZ SCI Physiotherapy guideline committee was unable to make an evidence based recommendation or consensus based opinion statement on passive movements to prevent and treat shoulder pain in people with SCI.
Passive standing (v no intervention) on bone mineral density
consensus: No Recommendation
No evidence recommendation or consensus-based opinion statement
Passive standing (v no intervention) on bone mineral density
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No recommendation due to insufficient or inconclusive evidence.
No evidence recommendation or consensus-based opinion
statement
No recommendation can be made on passive standing to improve bone mineral density in people with SCI.
I
Passive standing
C
No intervention
Consensus-based opinion statement
No consensus statements
Reason: No consensus could be reached
O
Bone mineral density
SUMMARY
1 RCT56
Mean difference (95% CI): Bone mineral density g/cm2
0.01 (-0.02 to 0.03)
Favours passive standing
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
No serious
Indirectness
Serious
Publication bias
Serious
PASSIVE STANDING ON BONE MINERAL DENSITY: 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
PASSIVE STANDING ON BONE MINERAL DENSITY: 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
Bone mineral density g/cm2
Some Concerns of
Risk of Bias
PEDro = 8/10
The Australian and NZ SCI Physiotherapy guideline committee was unable to make an evidence based recommendation or consensus based opinion statement on passive standing for bone mineral density in people with SCI.
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.
Vibration (v no intervention) on spasticity in people with SCI
consensus: No Recommendation
No evidence recommendation or consensus-based opinion statement could be made about vibration to treat spasticity in people with SCI.
Vibration (v no intervention) on spasticity in people with SCI
P
People with SCI
Evidence recommendation
No evidence recommendation
Reason: No RCTs
No evidence recommendation or consensus-based opinion statement
No recommendation can be made on vibration to improve spasticity in people with SCI.
I
Vibration
C
No intervention
Consensus-based opinion statement
No consensus statements
Reason: No consensus could be reached
O
Spasticity
The Australian and NZ SCI Physiotherapy guideline committee was unable to make an evidence based recommendation or consensus based opinion statement on vibration to treat spasticity in people with SCI.
Abdominal FES (v no intervention) on lung volumes in people with SCI who have respiratory muscle weakness
consensus: No Recommendation
No evidence recommendation or consensus-based opinion statement.
Reason: No consensus could be reached
The Australian and NZ SCI Physiotherapy guideline committee was unable to make an evidence based recommendation or consensus based opinion statement on abdominal FES to improve lung volumes in people with SCI.
Cheng, P.Chen, C.Wang, C.Chung, C. Effect of neuromuscular electrical stimulation on cough capacity and pulmonary function in patients with acute cervical cord injury. Journal of Rehabilitation Medicine 2006 Jan;38(1):32-36.
