Passive standing (v no intervention) on joint mobility in people with SCI and paralysed lower limbs | SCI Physiotherapy Clinical Practice Guidelines

	Passive standing (v no intervention) on joint mobility in people with SCI and paralysed lower limbs
P	People with SCI	Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence.		Weak opinion statement FOR Passive standing may be provided to prevent and treat loss of ROM in people with SCI and paralysed lower limbs.
I	Passive standing
C	No intervention	Consensus-based opinion statement Weak for (90%)
O	Joint mobility	Consensus-based opinion statement Weak for (90%)
	SUMMARY	1 RCT (see reference)		Mean difference (95% CI): Joint mobility in degrees 4 (2 to 6) Favours passive standing
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision No serious	Indirectness Serious	Publication bias Serious

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

PASSIVE STANIDNG ON JOINT MOBILITY: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
BEN 2005	Long duration stretch V No intervention	30 minutes, 3 x per week for 12 weeks of standing on tilt table	People with SCI and LL paralysis	20/20	Ankle mobility (degrees)	Some Concerns of Risk of Bias PEDro = 8/10

The Australian and NZ SCI Physiotherapy guideline committee recommends passive standing to prevent and treat loss of Range of motion (ROM) in people with SCI and paralysed lower limbs. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:

Passive standing may be provided to prevent and treat loss of ROM in people with SCI and paralysed lower limbs.

This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend passive standing to prevent and treat loss of ROM in people with SCI and paralysed lower limbs based on opinion.

To learn more about this recommendation go to the research summary.

Ben M, Harvey L, Denis S, et al. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries? Australian journal of physiotherapy 2005;51:251.