Supine (v high sitting) on lung volumes in people with SCI who have abdominal muscle paralysis or weakness. | SCI Physiotherapy Clinical Practice Guidelines

	Supine (v high sitting) on lung volumes in people with SCI who have abdominal muscle paralysis or weakness.
P	People with SCI who have abdominal muscle abdominal muscle paralysis or weakness.	Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence.		Strong opinion statement FOR Positioning in supine should be provided (in favour of sitting) to improve lung volumes in people with SCI who have abdominal muscle paralysis or weakness. Clinical note: Supine may not be suitable for people with significant abdominal distension, central adiposity or those with large abdomens and long-standing SCI.
I	Supine
C	High sitting	Consensus-based opinion statement Strong for (85%)
O	Lung volume	Consensus-based opinion statement Strong for (85%)
	SUMMARY	1 RCT		Mean difference (95% CI): Lung volume in litres 0.4 (-1.3 to 2.1) Favours supine
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Very serious	Inconsistency Serious	Imprecision Serious	Indirectness Serious	Publication bias Serious

SUPINE (V HIGH SITTING) FOR LUNG VOLUMES: 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

SUPINE FOR LUNG VOLUME: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
BOAVENTURA 2003	Supine V Sitting	Elastic binder in sitting and supine	C4-C7 Complete SCI 1 year post injury	10/10	Lung volume (FVC)	High Risk of Bias PEDro = 6/10

The Australian and NZ SCI Physiotherapy guideline committee recommends that positioning in supine should be provided (in favour of sitting) to improve lung volumes in people with SCI who have abdominal muscle paralysis or weakness.

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 the randomised controlled trial is inconclusive preventing an evidence recommendation.

The guideline states:

Positioning in supine should be provided (in favour of sitting) to improve lung volumes in people with SCI who have abdominal muscle paralysis or weakness.

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 the 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 positioning in supine (in favour of sitting) to improve lung volumes based on opinion.

To learn more about the research related to this intervention go to the clinicians tab on this website

Boaventura, C. D.Gastaldi, A. C.Silveira, J. M.Santos, P R.Guimaraes, R. C.De, L. L. C. Effect of an abdominal binder on the efficacy of respiratory muscles in seated and supine tetraplegic patients. Physiotherapy 2003 May;89(5):290-295.