Sitting training (v no intervention) on ability to sit in people with SCI and paralysis of the lower limbs/trunk | SCI Physiotherapy Clinical Practice Guidelines

	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	Consensus-based opinion statement Strong for (82%)
	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.