Rehabilitation interventions to modify endocrine-metabolic disease risk in individuals with chronic spinal cord injury living in the community (RIISC): A systematic search and review of prospective cohort and case–control studies

Abstract

Context:

Endocrine-metabolic disease (EMD) is associated with functional disability, social isolation, hospitalization and even death in individuals living with a chronic spinal cord injury (SCI). There is currently very low-quality evidence that rehabilitation interventions can reduce EMD risk during chronic SCI. Non-randomized trials and alternative study designs are excluded from traditional knowledge synthesis.

Objective:

To characterize evidence from level 3–4 studies evaluating rehabilitation interventions for their effectiveness to improve EMD risk in community-dwelling adults with chronic SCI.

Methods:

Systematic searches of MEDLINE PubMed, EMBASE Ovid, CINAHL, Cochrane Database of Systematic Reviews, and PsychInfo were completed. All longitudinal trials, prospective cohort, case–control studies, and case series evaluating the effectiveness of rehabilitation/therapeutic interventions to modify/associate with EMD outcomes in adults with chronic SCI were eligible. Two authors independently selected studies and abstracted data. Mean changes from baseline were reported for EMD outcomes. The Downs and Black Checklist was used to rate evidence quality.

Results:

Of 489 articles identified, 44 articles (N = 842) were eligible for inclusion. Individual studies reported statistically significant effects of electrical stimulation-assisted training on lower-extremity bone outcomes, and the combined effects of exercise and dietary interventions to improve body composition and cardiometabolic biomarkers (lipid profiles, glucose regulation). In contrast, there were also reports of no clinically important changes in EMD outcomes, suggesting lower quality evidence (study bias, inconsistent findings).

Conclusion:

Longitudinal multicentre pragmatic studies involving longer-term exercise and dietary intervention and follow-up periods are needed to fully understand the impact of these rehabilitation approaches to mitigate EMD risk. Our broad evaluation of prospective cohort and case–control studies provides new perspectives on alternative study designs, a multi-impairment paradigm approach of studying EMD outcomes, and knowledge gaps related to SCI rehabilitation.

Keywords:

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

Acknowledgements

The authors acknowledge receipt of funding from Ontario Neurotrauma Foundation (ONF) and the Réseau provincial de recherche en adaptation-réadaptation du Québec (REPAR): ONF-REPAR Grant 2016-SCI/D-REPAR-1026 and the support and consultation from members of the Rehabilitation Interventions for Individuals with a SCI in the Community Research (RIISC) Team. Dr. Jenna Gibbs received a Canadian Institutes of Health Research Fellowship Award (2016-2018). Dr. Craven acknowledges support from the Toronto Rehab Foundation as the Toronto Rehabilitation Institute Chair in Spinal Cord Injury Rehabilitation.

Disclaimer statements

Contributors None.

Conflicts of interest Authors have no conflict of interests to declare.

Additional information

Funding

The authors acknowledge receipt of funding from Ontario Neurotrauma Foundation (ONF) and the Réseau provincial de recherche en adaptation-réadaptation du Québec (REPAR): ONF-REPAR Grant 2016-SCI/D-REPAR-1026 and the support and consultation from members of the Rehabilitation Interventions for Individuals with a SCI in the Community Research (RIISC) Team. Dr. Jenna Gibbs received a Canadian Institutes of Health Research Fellowship Award (2016–2018). Dr. Craven acknowledges support from the Toronto Rehab Foundation as the Toronto Rehabilitation Institute Chair in Spinal Cord Injury Rehabilitation.