A Systematic Review of the Management of Orthostatic Hypotension Following Spinal Cord Injury

Arch Phys Med Rehabil, 2009 · DOI: 10.1016/j.apmr.2009.01.009 · Published: May 1, 2009

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

Orthostatic hypotension (OH) is defined as a significant drop in blood pressure when moving from lying down to standing, and it's common after spinal cord injury (SCI). This review examines existing treatments for OH in people with SCI. The review found that while many treatments are suggested for OH in general, few have been thoroughly tested specifically for people with SCI. More research is needed to find effective treatments. Midodrine and functional electrical stimulation (FES) showed some promise in managing OH following SCI, but further research is required to confirm these findings and explore other potential treatments.

Study Duration

Not specified

Participants

26 studies were reviewed

Evidence Level

Systematic Review

Key Findings

1
Only one low-quality randomized controlled trial (RCT) supported the use of midodrine for OH management following SCI, providing Level 2 evidence.
2
Functional electrical stimulation (FES) was identified as one of the few non-pharmacological interventions with some Level 2 evidence supporting its utility.
3
The review highlights the overall poor quality of evidence in the literature regarding OH management in SCI patients.

Research Summary

This systematic review assessed the evidence for managing orthostatic hypotension (OH) in individuals with spinal cord injuries (SCI). The review identified 8 pharmacological and 21 non-pharmacological studies, but noted the limited number of high-quality RCTs. The authors conclude that more research is needed to determine the efficacy of various treatments for OH specifically in the SCI population.

Practical Implications

Clinical Practice

Healthcare professionals should be aware of the limited evidence supporting current OH management strategies in SCI and consider midodrine as a potential option.

Future Research

Prioritize high-quality research, especially RCTs, to evaluate both pharmacological and non-pharmacological interventions for OH in SCI.

Treatment Strategies

Explore and rigorously evaluate the effectiveness of FES as a non-pharmacological approach to manage OH in individuals with SCI.

Study Limitations

1
Limited number of high-quality randomized controlled trials (RCTs).
2
Small sample sizes in many of the included studies.
3
Difficulty in determining the effects of individual medications in combination therapies.

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