A systematic review of physical interventions for the rehabilitation of upright balance control and balance confidence in people with chronic, motor incomplete spinal cord injury/disease

Objective(s): To assist with clinical decision-making, evidence syntheses are needed to demonstrate the efficacy of available interventions and guide who and how the intervention can be applied. This systematic review describes the efficacy and dosage of interventions targeting upright balance control and/or balance confidence in adults with motor incomplete spinal cord injuries/diseases (SCI/D).

Data Sources: A search strategy following the PICO framework was developed. Six databases were searched: APA PsychInfo, CINAHL, Embase, Emcare Nursing, Web of Science CC, and Medline.

Study Selection: Title, abstract and full-text screening were conducted by two researchers independently. Inclusion criteria were: 1) adults with chronic, motor-incomplete SCI/D; 2) physical intervention targeting standing and/or walking; and 3) clinical and/or biomechanical measures of upright balance control and/or balance confidence.

Data Extraction: Participant characteristics, balance intervention details, adverse events and study results were extracted. The Downs and Black Checklist assessed methodological quality.

Data Synthesis: The search returned 1,664 unique studies; 28 were included. The majority of methodological quality was fair and good. Participants were 520 individuals with SCI/D, aged 18-74 years (males: females = 2.4:1). Clinically significant improvements in Berg Balance Scale (BBS) score were seen with Body-Weight Supported Treadmill Training, Functional Electrical Stimulation (FES) Cycling, Standing/Walking Virtual Reality, Visual Feedback Balance Training (with or without FES), and Underwater Treadmill Training. Community-Specific and Robotic Ambulation interventions resulted in clinically significant improvements in the Activities-specific Balance Confidence Scale. Minor adverse events were reported in eight studies (e.g. muscle soreness, fatigue).

Conclusions: Several interventions resulted in clinically significant improvements in standing balance control. However, skill-specific training may be needed to improve balance confidence.

Author(s) Disclosures: None