Physical Therapy for Traumatic and Non-Traumatic Spinal Cord Injuries in Adults: A Systematic Review.

backgroundThis systematic review evaluates clinical trials on spinal cord injury (SCI) physical therapy interventions. The objective is to assess the impact of contemporary physical therapy interventions on patients' functional parameters and recovery outcomes, based on the literature published in the preceding six years.

methodsInclusion and Exclusion Criteria: Eligible studies included randomized controlled trials (RCTs) and clinical trials involving adult participants with SCI who received physiotherapy interventions. Studies published more than six years ago or those not involving physiotherapy as a primary intervention were excluded. Data Synthesis and Presentation: Results were synthesized qualitatively. Due to substantial clinical and methodological heterogeneity across the included trials, a meta-analysis was not performed, and findings are based entirely on qualitative synthesis. Main outcomes were categorized into primary (muscle strength, walking ability, balance, activities of daily living [ADL]) and secondary outcomes (cardio-respiratory function, mental health, pain management) and are presented in order of the number of supporting studies.

resultsStudy Numbers and Characteristics: Of 181 records initially identified, 23 studies (all high-quality clinical trials/RCTs; mean PEDro score 7.2) were ultimately included in the review. Main Outcomes and Direction of Effect: The included studies generally reported positive effects of physiotherapy interventions on several functional and physiological outcomes. Statistically significant improvements favoring the physical therapy groups were reported for balance (7 studies), ADLs (4 studies), and respiratory function (6 studies) across the clinical spectrum. Conversely, positive outcomes in muscle strength (12 studies) and gait/walking ability (7 studies) were predominantly localized within motor-incomplete cohorts. Cardiovascular function outcomes (5 studies) remained inconsistent, while secondary psychological metrics and formal mental health parameters (6 studies) showed no statistically significant changes between groups. DISCUSSION: Limitations of the Evidence: The primary limitation identified across the included evidence is the substantial heterogeneity in the specific physical therapy intervention protocols utilized across trials, which limits direct comparison. INTERPRETATION AND IMPLICATIONS: Current evidence suggests that tailored physical therapy interventions play an important role in driving functional adaptations and managing specific physiological complications in adult SCI populations. The principal implication of these findings is that, while physical therapy is potentially effective, findings must be interpreted with caution due to protocol diversity, and further high-quality, standardized research is urgently required to establish uniform clinical guidelines. Other: Funding Source: This systematic review received no specific grant or primary funding from any agency in the public, commercial, or not-for-profit sectors.