Author Year
Country
Score
Research Design
Total Sample Size

Methods

Outcome

Klose et al. 1990
USA
PEDro=5
RCT
N=43

Population: Gender: males and females; age (range): 18-45; level of injury (range): C4-C6; incomplete injury; time since injury: at least one year.
Treatment: Training blocks of either (1) supervised physical exercise therapy (PET), (2) neuromuscular stimulation, (3) electromyographic biofeedback. Group 1 received 8 weeks each of EMG biofeedback followed by PET, group 2 received 8 weeks each of EMG biofeedback followed by NMS, group 3 received 8 weeks each of NMS followed by PET, and group 4 received 16 weeks of PET (3days/ wk).
Outcome Measures: Manual muscle tests, self-care scores, mobility measures, and voluntary EMG activity which were measured before training, at eight weeks, and after 16 weeks of training.

• Significant improvements were found for measures of mobility, self-care, and left arm manual muscle test scores (p<0.05).
• The repeated measures component was significant for all of the outcome measures except the EMG;s (p<0.01).
• All exercise modes were effective. No difference was found on comparisons between groups.

da Silva et al. 2005
Brazil
Downs & Black score=18
Prospective controlled trial
N=16

Population: Chronic SCI with AIS A; Experimental Group (EG): Gender: m=7, f=1; Age range=21-34 yrs; Time range post injury= 15-40 mos. Control Group (CG): Gender: m=7, f=1; Age range= 21-41 yrs; Time range post injury=14-30 mos.
Treatment: Comparison of swimming program vs. normal daily activities upon discharge from rehabilitation (both groups received orientation class during rehabilitation on numerous SCI related topics including swimming). Experimental group (EG): Swimming program with a Physical Educator professor, 2x/wk, 45 min/each, consisting of a warm up, main exercise & cool-down. Control group (CG): unstated (normal daily activities).
Outcome Measures: Functional Independence Measure (FIM) at discharge & follow-up (avg 4 mos post-discharge).

• Pre vs. post swimming program:
• Body care: EG -↑ (p=0.01), CG - ↑ (p=0.02)  
• Transference: EG - ↑ (p=0.00), CG - ↑ (p=0.04)  
• Overall motor score= EG - ↑ (p=0.00), CG -↑ (p=0.01)   
• Overall FIM score = EG - ↑ (p=0.00), CG -↑ (p=0.02)  
• Other areas did not have significant changes in either group.  
• More significant ↑ (difference scores in EG vs. CG for transference (p=0.02), overall motor score (p=0.01) and overall score (p=0.01).

Hjeltnes & Wallberg-Henriksson 1998
Norway
Downs & Black score=16
Prospective controlled trial (dissimilar control group)
N=27

Population: SCI during inpatient rehabilitation. Exercise group: 10 Tetraplegics; AIS: A=7, B=3; Mean time post injury= 99 days.  Control Group: 10 Paraplegics; AIS: A=10; Mean time post injury= 78 days.
Treatment: Exercise group: standard rehabilitation + arm ergometry (tetraplegia), 30 min/day, 3 day/wk for a 12-16 wk period; Control group: standard rehabilitation (paraplegia).
Outcome Measures: Ability to perform activities of daily living (Sunnaas ADL index), muscle strength (manual muscle testing), physiological assessments (VO2, load) collected pre, mid & post program.

• Experimental (tetraplegia) and Control (paraplegia) groups were not compared for functional and strength scores. Otherwise :
• ↑ in ADL ability from pre to post program in those with tetraplegia (p<0.001).
• ↑ in manual muscle scores from pre to post program in those with tetraplegia (p<0.001).
• Peak resistance to cycling increased over cycling program but VO2 did not.

Duran et al. 2001
Colombia
Downs & Black score=16
Pre-post
N=13

Population: Paraplegia undergoing outpatient rehabilitation; Gender: m=12. f=1; Age range= 17-38yrs; Time range post injury=2-120 mos; ASIA: A=11, B=1, C=1.
Treatment: 16 wk exercise program (4 wks of adaptation, 1 wk of enhancement, 11 wks specific program)- 3x/wk, 120 min/session, containing mobility, coordination, strength, aerobic resistance and relaxation exercises.
Outcome Measures: Functional Independence Measure (FIM), Wheelchair skills test and various strength/resistance and physiological measures collected pre & post program.

• ↑ FIM from pre to post program, 106 to 113 respectively (p<0.001).
• Reduced time for all 9 wheelchair skills from pre to post program, (p<0.04 or less).
• ↑ in work capacity (weight lifted and reps) pre to post program.
• Generally no sig. diff. in various physiological parameters.

Sloan et al. 1994
Australia
Downs & Black score=14
Pre-post
N=12

Population: SCI≥~3 months: Complete=1, Incomplete=11; Gender: m=7, f=5; Age range=15-54 yrs; Time range post injury: 2 -138 mos.
Treatment: Functional electrical stimulation (FES) induced cycling programme: 3x/wk for 3 mos, all programmes were individualized & gradual progressed to 30 min/session.
Outcome Measures: Functional assessment: independence & activities of daily living (ADL) tasks, muscle testing (grade and size) collected pre & post programme.

• All incomplete SCI patients had subjective self-reported improvements in well-being & functional independence, namely walking, dressing, transferring and ADL tasks.
• Most muscles increased in area and strength.
• Variable changes in spasticity (2 people discontinued because of increases in spasticity).

Dallmeijer et al. 1999
The Netherlands
Downs & Black score=13
Pre-post
Initial N=27, Final N=20

Population: SCI upon discharge from rehabilitation: Tetraplegic=9, Paraplegic=11; AIS B, C & D; Gender: m=16, f=4; Mean age= 40.3 yrs; Mean time post injury: t1=331 days, t2=765 days.
Treatment: Described changes in first years post-discharge and examined effect of those participating in ≥1 hour/week of sport vs. those with no activity on physical capacity.            
Outcome Measures: Standardized ADL tasks physical strain & performance time (ascending ramp, transfer, passing door, washing hands); Sport activity & health status questionnaire; physical capacity (strength, power, VO2 on wheelchair ergometer test) collected @ discharge (t1) & follow-up (t2, mean time=1.2 yrs).

• Description of participation, illness, musculoskeletal system complaints:
•  8/20=sedentary, 12 participated in ≥1 hour/week (Overall group mean= 2.5 hrs/wk).
• 10/20=serious illness during time span (UTI, pressure sores, pain, intestinal problems, pneumonia).
• 9/20 Musculoskeletal system complaints.
• Physical strain: was reduced over year for all ADL tasks, except hand washing.  
• Performance time: ↓ in transfer & ramp only (p<0.05) between t1 and t2 but not for other ADL tasks.
• Participation in sport was correlated with measures of improved physical capacity (no relationship with ADL was assessed).   

Effing et al. 2006
The Netherlands
Downs & Black score=13
Pre-post (Single subject controlled design)
N=3

Population: Chronic incomplete SCI; Gender: all male; Age range=45-51 yrs; Time range post injury=29-168 mos; AIS: C=2, D=1.
Treatment: Body weight supported treadmill training 5x/wk for 30 min for 12 wks, each session personalized to physical abilities.
Outcome Measures: Perceived performance on activities of daily living (ADL) – Canadian Occupational Performance Measure (COPM); Semi-structured interview; Performance based walking – Walking Capacity Scale; Walking Speed – 7 meters; Balance & Mobility - Get Up & Go Test. Collected at baseline, 6 weeks – treatment, 12 weeks – wash-out, 6 weeks – follow-up, 6 months.

• Subject 1:
• Perceived ADL performance: rather stable, ↓ satisfaction during intervention phase (p<0.01).
• Interview: walked further without rest, felt better overall
• Walking speed: ↑ speed with ↓ steps (p<0.05)
• Balance: ↑ (p<0.05).
• Subject 2:
• Perceived ADL performance: ↑ improvement during intervention into washout period (p<0.01)
• Interview: transfer independently, ↓pain medications, ↓ spasms, felt better overall
• Walking performance: ↑ (p<0.01)
• Could not perform walking speed & balance tests.
• Subject 3:
• Perceived ADL performance: ↑ improvement; however, not in the intervention phase (p<0.05).
• Interview: sit longer in a wheelchair, more stability, walking ability with a cane, ↓ pressure ulcers, felt better overall
• Walking performance: ↑ (p<0.05)
• Balance: ↑ (p<0.01).