Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute SCI.
Methods: A systematic review of the literature was conducted to address the following questions: (1) Does the time interval between injury and commencing rehabilitation affect outcome? (2) What is the comparative effectiveness of different rehabilitation strategies? (3) Are there patient or injury characteristics that impact the efficacy of rehabilitation? (4) What is the cost-effectiveness of various rehabilitation strategies? A multidisciplinary guideline development group used this information, in combination with their clinical expertise, to develop recommendations for the type and timing of rehabilitation. The benefits and harms, financial impact, acceptability, feasibility and patient preferences of each recommendation were carefully considered.
Results: The conclusions from the review included: (1) there was no difference between body weight supported treadmill training (BWSTT) and conventional rehabilitation with respect to improvements in FIM-L and LEMS scores; and (2) functional electric stimulation (FES) resulted in slightly better FIM Motor, FIM Self-Care and SCIM Self-Care subscores compared with conventional occupational therapy. Our recommendations were: (1) We suggest rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tolerate required rehabilitation intensity; (2) We suggest BWSTT as an option for ambulation training in addition to conventional overground walking, dependent on resource availability, context, and local expertise; (3) We suggest that individuals with acute and subacute cervical SCI be offered FES as an option to improve hand and upper extremity function; and (4) Based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incorporated in standard rehabilitation.
Conclusions: These guidelines should be implemented to improve outcomes and reduce morbidity in patients with SCI by encouraging clinicians to make evidence-informed decisions.
Patient Care: This guideline will ensure that patients are treated with appropriate rehabilitation strategies.
Learning Objectives: To summarize rehabilitation strategies in patients with SCI.