Lesion medular

Spinal Cord (2009) 47, 184–195

& 2009 International Spinal Cord Society All rights reserved 1362-4393/09 $32.00
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REVIEW The effectiveness of physical interventions for people with spinal cord injuries: a systematic review
LA Harvey, C-WC Lin, JV Glinsky and A De Wolf
Rehabilitation Studies Unit, Northern Clinical School, Faculty of Medicine, University of Sydney, NewSouth Wales, Australia

Study design: Systematic review. Objectives: To provide a quantitative analysis of all randomized controlled trials designed to determine the effectiveness of physical interventions for people with spinal cord injury (SCI). Setting: Sydney, Australia. Methods: A search was conducted for randomized controlled trials involving physical interventions for people with SCI. Tworeviewers independently rated methodological quality using the PEDro scale and extracted key findings from the trials. Results: Four thousand five hundred and forty three abstracts were identified of which 31 trials met the inclusion criteria. Trials examined the effectiveness of fitness and strength training (n ¼ 7), gait training (n ¼ 5), hand therapy (n ¼ 3), stretch (n ¼ 4), acupuncture (n ¼ 3),hand splinting (n ¼ 2) and other related therapies (n ¼ 7). Six trials reported a between-group mean difference with a clearly important treatment effect on at least one outcome measure. These trials supported the use of fitness, strength and gait training as well as acupuncture. Conclusion: There is initial evidence supporting the effectiveness of some physical interventions for people with SCI.However, there is a pressing need for high-quality trials to determine the effectiveness of all physical interventions commonly administered in clinical practice.
Spinal Cord (2009) 47, 184–195; doi:10.1038/sc.2008.100; published online 26 August 2008 Keywords: rehabilitation; spinal cord injury; systematic review

Introduction
Many different types of physical interventions are routinelyprovided to people with spinal cord injury (SCI) as part of their rehabilitation programmes and ongoing care. They include interventions such as strength, fitness and gait training, splinting, stretching and hand therapy. These interventions are typically provided by physiotherapists, occupational therapists, exercise physiologists, medical practitioners and other health-care providers. Physicalinterventions often target specific impairments such as poor strength, cardiovascular fitness, skill and joint mobility, or impairments related to muscle extensibility, bone loss, pain or spasticity. Each of these impairments impose activity limitations that directly or indirectly prevent patients from performing physical activities such as walking, using their hands, mobilizing in a wheelchair andattending to self-care. Physical interventions that address impairments invariably also address activity limitations. By reducing activity limitations, physical interventions address the ultimate aim of rehabilitation, namely to increase participation and thereby improve overall quality of life. Large numbers of physical interventions are advocated for people with SCI. The challenge for clinicians isto ascertain which interventions are most effective. The best evidence for treatment effectiveness comes from high-quality randomized controlled trials.1,2 Some of the key strategies important for minimizing bias in randomized controlled trials include concealing allocation, blinding assessors and performing intention-to-treat analyses. Recent and comprehensive clinical guidelines havesynthesized the evidence supporting physical interventions for people with SCI.3,4 However, these guidelines do not always determine or interpret the size and associated uncertainty of between-group differences. In addition, they do not include some of the commonly administered physical interventions that have been evaluated within randomized controlled trials. The purpose therefore of this systematic...