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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.
[ninja_form id=1 title="My Form Title"]
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.