Physical therapy after spinal cord injury: A systematic review of treatments focused on participation

Abstract

Context

Over the last four decades, the focus of spinal cord injury (SCI) rehabilitation has shifted from medical management to issues that affect quality of life and community participation. Physical therapists (PTs) need to design and implement interventions that result in maximal participation to provide an individual with SCI an effective rehabilitation program.

Objective

The aim of this review is to assess the extent, content, and outcomes of physical therapy (PT) interventions focused on improving the participation of individuals with SCI.

Methods

A search was conducted in Medline, Embase, CENTRAL, CINAHL, PEDro, and PsycINFO. We included studies, of all designs, focused on improving the participation of individuals with SCI using PT interventions.The primary author and a reviewer independently selected articles for inclusion, assessed articles quality, and extracted the data.

Results

Five studies met the inclusion criteria. The interventions applied were 9- and 12-month body weight-supported treadmill training in two studies, a supervised 9-month exercise program, a 12-week home exercise program, and a 10-week multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain. Four of five PT interventions positively impacted the individual's perceived participation and satisfaction with participation.

Conclusion

The body of research by PTs on interventions to improve participation is limited. PTs must document the effects of interventions with a valid outcome tool to enable more research that examines participation. Expanding participation research will allow PTs to meet the needs of individuals with SCI and identify what interventions best facilitate integration into the community.

Keywords:

• Physical therapy modalities
• Rehabilitation
• Review
• Social participation
• Spinal cord injuries

Acknowledgments

We would like to acknowledge the contribution of Vanessa Lazar, a student in the Columbia University Doctorate of Physical Therapy Program (New York), and Dr. Mercè Sitjà-Rabert, Professor at Ramon Llull University (Barcelona, Spain) Physical Therapy program, for their assistance as independent reviewers.