All Recommendations

Arm cranking (v no intervention) on cardiorespiratory fitness in people with SCI

evidence: Weak For Recommendation

Arm cranking may be provided to improve cardiorespiratory fitness in people with SCI.

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	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

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.

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	Manual wheelchair skills training (v no intervention) on wheelchair skills in people with SCI
P	People with SCI	Evidence recommendation Weak for (95%)	Weak evidence recommendation FOR Evidence recommendation: manual wheelchair skills training may be provided to improve manual wheelchair skills in people with SCI.
I	Manual wheelchair skills training
C	No intervention	Consensus-based opinion statement No opinion statements
O	Wheelchair skills
	SUMMARY	4 RCTs (see references)	Standardised Mean difference (95% CI): 0.7 (0 to 1.4) Favours wheelchair skills training
	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

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.

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	Virtual reality sitting training (v no intervention) on ability to sit in people with SCI
P	People with SCI	Evidence recommendation Weak for (95%)	Weak evidence recommendation FOR Virtual Reality sitting training may be provided to improve ability in sitting in people with SCI.
I	Virtual reality (VR) sitting training
C	No intervention	Consensus-based opinion statement No opinion statements
O	Ability to sit
	SUMMARY	1 RCT (see reference)	Mean difference (95% CI): Seated reach in mm 63 (38 to 89) Favours VR sitting training
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision Serious	Indirectness Serious	Publication bias Serious

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

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.

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	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

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.

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	Respiratory muscle training (v no intervention) on respiratory muscle strength in people with SCI who have respiratory muscle weakness
P	People with SCI who have respiratory muscle weakness	Evidence recommendation Weak for (100%)	Weak evidence recommendation FOR Respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness. Clinical note: Respiratory muscle training most commonly involves inspiratory muscle training but can also include expiratory muscle training
I	Respiratory muscle training
C	No intervention	Opinion statement No opinion statements
O	Muscle strength (mean inspiratory pressure)
	SUMMARY	10 RCTs (see references)	Mean difference (95% CI): Muscle strength in Mean Inspiratory Pressure -13 (-17 to -9) Favours respiratory muscle training
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision Not serious	Indirectness Not serious	Publication bias Serious

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

RESPIRATORY MUSCLE TRAINING FOR RESPIRATORY MUSCLE STRENGTH: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
BOSWELL-RUYS 2020	Resistive Inspiratory muscle training (RMT) V Sham RMT	3-5 sets 12 breaths 2 x day 5 days per week for 6 weeks @ > 30% MIP	C4-C8 SCI AIS A, B, C > 4 weeks post-injury	29/31	Maximal Inspiratory pressure (MIP)	Very low Risk of Bias PEDro = 10/10
Liaw 2000	Inspiratory muscle training (& usual care) V Usual care	15-20 minutes 2 x day; 7 days per week for 6/52	C4-C7 complete SCI < 6 months post-injury	10/10	Maximal Inspiratory pressure (MIP)	High Risk of Bias PEDro = 4/10
LITCHKE 2008	Respiratory resistance training V No intervention	1 set of exercises 2-3 x per day daily for 10 weeks	>80% participants with SCI C5-T12 SCI > 6 months post-injury	4/5	Maximal Inspiratory pressure (MIP)	Some Concerns about Risk of Bias PEDro = 5/10
LITCHKE 2011	Concurrent flow resistance V No intervention	10 breaths 3 different x per day daily for 9 weeks	>80% participants with SCI C5-C7 SCI	5/7	Maximal Inspiratory pressure (MIP)	High Risk of Bias PEDro = 3/10
LOVERIDGE 1989	Concurrent flow resistance V No intervention	85% of sustained inspiratory pressure 2 x day for 15 minutes 5 days per week for 8 weeks	C6-C7 complete SCI >1 year post-injury	6/6	Maximal Inspiratory pressure (MIP)	Some Concerns about Risk of Bias PEDro = 4/10
MUELLER 2013	Inspiratory resistance training V placebo	90 breaths @ > 80% max inspiratory power 4 x per week for 8 weeks	C6-C7 complete SCI >1 year post-injury	8/8	Maximal Inspiratory pressure (MIP)	Some Concerns about Risk of Bias PEDro = 4/10
POSTMA 2014	Resistive Inspiratory muscle training (& usual care) V Usual care	90 breaths @ > 80% max inspiratory power 4 x per week for 8 weeks	T12 and above SCI AIS A-D initial rehab FEV1 <80% predicted	19/21	Maximal Inspiratory pressure (MIP)	High Risk of Bias PEDro = 7/10
ROTH 2010	Expiratory muscle training V Sham	Exp muscle resistive training 10 reps, twice a day, 5 x per week for 6 weeks	T1 and above motor complete SCI	16/13	Maximal Inspiratory pressure (MIP)	High Risk of Bias PEDro = 4/10
SOUMYASHREE 2018	Inspiratory muscle training V Breathing exercises	15 minutes @ 40 MIP 5 x per week for 4 weeks	T1-12 SCI AIS A-D	15/12	Maximal Inspiratory pressure (MIP)	Some Concerns of Risk of bias PEDro = 7/10
WEST 2014	Inspiratory muscle training V Sham	30 breaths at 50-60% Pimax 2 x day 5 days per week for 6 weeks	C5-C7 SCI AIS A or B ≥3 years post-injury	5/5	Maximal Inspiratory pressure (MIP)	High Risk of Bias PEDro = 4/10

TENS (v no intervention) on pain in people with SCI

evidence: Weak For Recommendation

TENS may be provided for pain in people with SCI.

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	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

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.

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	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

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.

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	Strength training (v no intervention) on voluntary strength of non-paralysed muscles in people with SCI
P	People with SCI (non- paralysed muscles)	Evidence recommendation Weak for (91%)	Weak evidence recommendation FOR Strength training may be provided to improve voluntary strength of non-paralysed muscles in people with SCI.
I	Strength training
C	No intervention	Consensus-based opinion statement No opinion statements
O	Voluntary strength
	SUMMARY	3 RCTs (see references)	Consider studies independently. Unable to pool I2 = 78%
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Very serious	Inconsistency Very serious	Imprecision Serious	Indirectness No serious	Publication bias Serious

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

Strength training (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.

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

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

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.

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	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

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.

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	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

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.

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	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

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.

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	Electrical stimulation alone (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI
P	People with SCI (partially-paralysed muscles)	Evidence recommendation Weak Against (96%)	Weak evidence recommendation AGAINST Electrical stimulation alone should not be provided to improve voluntary strength of partially paralysed muscles in people with SCI. Clinical note: When electrical stimulation is used in partially paralysed muscles it should be combined with voluntary effort.
I	Electrical stimulation alone
C	No intervention	Consensus-based opinion statement No opinion statements
O	Voluntary strength
	SUMMARY	1 RCT (see reference)	Mean difference (95% CI): Strength in Nm 0 (-0.5 to 0.6) Favours electrical stimulation
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision No serious	Indirectness Serious	Publication bias Serious

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

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.

Feedback

	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

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.

Feedback

	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

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.

Feedback

	Empowered to mange their injuries
P	People with SCI	Evidence recommendation No evidence recommendation Reason: No RCTs	Strong opinion statement FOR People with SCI should be empowered to manage their injuries including managing their physical rehabilitation and physical function.
I	Empowered to mange their injuries
C	No intervention	Consensus-based opinion statement Strong for (100%)
O	Optimal outcome

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

Feedback

	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

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.

Feedback

	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

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.

Feedback

	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

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.

Feedback

	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

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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).

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

Physiotherapy services

consensus: Strong For Recommendation

People with a newly acquired SCI should receive physiotherapy services throughout their acute and rehabilitation phases.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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).

Feedback

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.

Feedback

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.

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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.

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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.

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Person centred care

consensus: Strong For Recommendation

People with SCI should receive person-centred care.

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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.

Feedback

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.

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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.

Feedback

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).

Feedback

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.

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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.

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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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

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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.

Feedback

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.

Feedback

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.

Feedback

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.

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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.

Feedback

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.

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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.

Feedback

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

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

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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.

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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

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

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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.

Feedback

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.

Feedback

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.

Feedback

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

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

Feedback

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.

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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.

Feedback

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.

Feedback

Passive movements (v no intervention) on shoulder pain

consensus: No Recommendation

No evidence recommendation or consensus-based opinion statement

Feedback

Passive standing (v no intervention) on bone mineral density

consensus: No Recommendation

No evidence recommendation or consensus-based opinion statement

Feedback

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.

Feedback

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

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

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

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

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

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

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

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

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