Rehabilitation Interventions to modify endocrine-metabolic disease risk in Individuals with chronic Spinal cord injury living in the Community (RIISC): A systematic review and scoping perspective

Abstract

Context: Endocrine-metabolic disease (EMD) risk following spinal cord injury (SCI) is associated with significant multi-morbidity (i.e. fracture, diabetes, heart disease), mortality, and economic burden. It is unclear to what extent rehabilitation interventions can modify EMD risk and improve health status in community-dwelling adults with chronic SCI.

Objectives: To characterize rehabilitation interventions and summarize evidence on their efficacy/effectiveness to modify precursors to EMD risk in community-dwelling adults with chronic SCI.

Methods: Systematic searches of MEDLINE PubMed, EMBASE Ovid, CINAHL, CDSR, and PsychInfo were completed. All randomized, quasi-experimental, and prospective controlled trials comparing rehabilitation/therapeutic interventions with control/placebo interventions in adults with chronic SCI were eligible. Two authors independently selected studies and abstracted data. Mean differences of change from baseline were reported for EMD risk outcomes. The GRADE approach was used to rate the quality of evidence.

Results: Of 489 articles identified, 16 articles (11 studies; n=396) were eligible for inclusion. No studies assessed the effects of rehabilitation interventions on incident fragility fractures, heart disease, and/or diabetes. Individual studies reported that exercise and/or nutrition interventions could improve anthropometric indices, body composition/adiposity, and biomarkers. However, there were also reports of non-statistically significant between-group differences.

Conclusions: There was very low-quality evidence that rehabilitation interventions can improve precursors to EMD risk in community-dwelling adults with chronic SCI. The small number of studies, imprecise estimates, and inconsistency across studies limited our ability to make conclusions. A high-quality longitudinal intervention trial is needed to inform community-based rehabilitation strategies for EMD risk after chronic SCI.

Keywords:

• Endocrine and metabolic diseases
• Exercise
• Nutrition
• Rehabilitation
• Spinal cord injuries

Acknowledgements

We acknowledge the contributions of members of the Rehabilitation Interventions for Individuals with a SCI in the Community Research Team (RIISC Team) whom many engaged in different stages and to different extents during the preparation of this manuscript. In particular, we thank Krista Best, Cindy Gauthier, Jean-François Lemay, Masae Miyatani, and Mohammad Alavinia for assisting with abstract screening, data extraction, and/or quality assessment. We are greatly appreciative of Maureen Pakosh for performing the systematic search of electronic databases. We also acknowledge Eleni Patsakos for her administrative and project coordination duties.

Disclaimer statements

Contributors None.

Funding This work was supported by the Ontario Neurotrauma Foundation (ONF) and the Réseau provincial de recherche en adaptation-réadaptation du Québec (REPAR) through the grant entitled “Rehabilitation based research and knowledge translation activities to modify health risks for individuals living with chronic spinal cord injury” (2015-SCI-REPAR-1010). Dr. Jenna Gibbs is supported by a Canadian Institutes of Health Research Fellowship Award. Dr. Tomas Cervinka is supported by a Fellowship Salary Support Award of Spinal Cord Injury-Ontario.

Declarations of Interest The authors report no declarations of interest.

Conflicts of interest None.

Ethics approval None.

Supplementary material

Supplementary Material for this article available here: 10.1080/10790268.2017.1350341