A Systematic Review of Experimental Strategies Aimed at Improving Motor Function after Acute and Chronic Spinal Cord Injury

JOURNAL OF NEUROTRAUMA, 2016 · DOI: 10.1089/neu.2014.3812 · Published: March 1, 2016

Spinal Cord Injury Neurology Research Methodology & Design

Simple Explanation

This review examines strategies for improving motor function after spinal cord injury (SCI). It assesses the quality and evidence behind different treatments, including single interventions like cell therapies and multiple interventions combining strategies. The review found that approaches combining multiple strategies, especially those including rehabilitation, had the highest level of evidence supporting their use. Many studies reviewed had methodological weaknesses, such as biased participant selection and lack of proper blinding, which limits the confidence in their results.

Study Duration

Not specified

Participants

39 studies selected for review

Evidence Level

Level III, for multi-intervention approaches with rehabilitation

Key Findings

1
The highest level of evidence supports multi-intervention approaches that include a rehabilitation component for improving motor function after SCI.
2
A significant proportion of studies had methodological limitations, including high risk of bias in random sequence generation, allocation concealment, and blinding.
3
Few studies incorporated measures of spinal cord integrity and residual connectivity, limiting the ability to assess the impact of interventions on spinal cord structure and function.

Research Summary

This systematic review evaluated various strategies for improving motor function after spinal cord injury (SCI), including single-intervention and multi-intervention approaches. The review found that multi-intervention approaches that included a rehabilitation component had the highest level of evidence supporting their effectiveness. The review also identified methodological weaknesses in many studies, such as a high risk of bias and a lack of measures assessing spinal cord integrity, which limits the confidence in the reported results.

Practical Implications

Combination Therapies

Future clinical trials should focus on combinatorial approaches, integrating rehabilitation with novel therapeutic strategies like neurostimulation or pharmacotherapy.

Methodological Rigor

Increased methodological rigor is needed in study designs, including improved randomization, allocation concealment, and blinding procedures.

Assessment of Spinal Cord Integrity

Future studies should incorporate measures of spinal cord integrity and residual connectivity to better understand the impact of interventions on spinal cord structure and function.

Study Limitations

1
Inclusion of highly heterogeneous samples in the reviewed studies.
2
Lack of randomization and concealed allocation procedures in many studies.
3
The search strategy may not have captured all published studies for each approach (cell therapies, pharmacology, electrical stimulation, rehabilitation).

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