Strength training (v no intervention) on voluntary strength of non-paralysed muscles in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

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

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

STRENGTH TRAINING ON VOLUNTARY STRENGTH INNERVATED MUSCLES: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
HICKS 2003	Circuit training (Pushing, arm ergometry and PRE) V Education	Supervised progressive exercise 2 x weekly for 9 months. Each session 90-120 minutes	C4-L2 SCI	11/12	Elbow flexion strength in kg	High Risk of Bias PEDro = 5/10
MULROY 2011	Home-based shoulder exercise programme V Education	3 x per week for 12 weeks	T2 to T7 SCI	26/32	Shoulder abduction in Nm	High Risk of Bias PEDro = 7/10
YILDRIM 2016	Strength training V No intervention	Upper extremity training 5 x per week for 6 weeks	Paraplegia	13/13	Elbow flexion Nm/kg	Some Concerns of Risk of Bias PEDro = 4/10

The Australian and NZ SCI Physiotherapy guideline committee recommends strength training to improve voluntary strength of non-paralysed muscles in people with SCI. This is an evidence recommendation supported by the results of three randomised controlled trials. The guideline states:

Strength training may be provided to improve voluntary strength of non-paralysed muscles in people with SCI.

This recommendation was formed by considering the results of three randomised controlled trials alongside other factors. The trial results indicate that strength training is better than no strength training to improve muscle strength in non-paralysed muscles. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.

This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend strength training to improve voluntary strength of non-paralysed muscles in people with SCI based on evidence.

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

Mulroy SJ, Thompson L, Kemp B, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Physical therapy 2011; 91: 305-324.
Hicks Al, Martin KA, Ditor DS, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal cord 2003; 41: 34.
Yildirim A, Sürücü GD, Karamercan A et al Short-term effects of upper extremity circuit resistance training on muscle strength and functional independence in patients with paraplegia. J Back Musculoskelet Rehabil. 2016 Nov 21;29(4):817-823.