The efficacy of gait rehabilitations for the treatment of incomplete spinal cord injury: a systematic review and network meta-analysis

Tanyaporn Patathong; Krongkaew Klaewkasikum; Patarawan Woratanarat; Sasivimol Rattanasiri; Thunyarat Anothaisintawee; Thira Woratanarat; Ammarin Thakkinstian

doi:10.1186/s13018-022-03459-w

The efficacy of gait rehabilitations for the treatment of incomplete spinal cord injury: a systematic review and network meta-analysis

J Orthop Surg Res. 2023 Jan 23;18(1):60. doi: 10.1186/s13018-022-03459-w.

Authors

Tanyaporn Patathong¹, Krongkaew Klaewkasikum¹, Patarawan Woratanarat², Sasivimol Rattanasiri³, Thunyarat Anothaisintawee⁴, Thira Woratanarat⁵, Ammarin Thakkinstian³

Affiliations

¹ Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400, Thailand.
² Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400, Thailand. pataraw@yahoo.com.
³ Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
⁴ Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
⁵ Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.

Abstract

Background: Recent pieces of evidence about the efficacy of gait rehabilitation for incomplete spinal cord injury remain unclear. We aimed to estimate the treatment effect and find the best gait rehabilitation to regain velocity, distance, and Walking Index Spinal Cord Injury (WISCI) among incomplete spinal cord injury patients.

Method: PubMed and Scopus databases were searched from inception to October 2022. Randomized controlled trials (RCTs) were included in comparison with any of the following: conventional physical therapy, treadmill, functional electrical stimulation and robotic-assisted gait training, and reported at least one outcome. Two reviewers independently selected the studies and extracted the data. Meta-analysis was performed using random-effects or fixed-effect model according to the heterogeneity. Network meta-analysis (NMA) was indirectly compared with all interventions and reported as pooled unstandardized mean difference (USMD) and 95% confidence interval (CI). Surface under the cumulative ranking curve (SUCRA) was calculated to identify the best intervention.

Results: We included 17 RCTs (709 participants) with the mean age of 43.9 years. Acute-phase robotic-assisted gait training significantly improved the velocity (USMD 0.1 m/s, 95% CI 0.05, 0.14), distance (USMD 64.75 m, 95% CI 27.24, 102.27), and WISCI (USMD 3.28, 95% CI 0.12, 6.45) compared to conventional physical therapy. In NMA, functional electrical stimulation had the highest probability of being the best intervention for velocity (66.6%, SUCRA 82.1) and distance (39.7%, SUCRA 67.4), followed by treadmill, functional electrical stimulation plus treadmill, robotic-assisted gait training, and conventional physical therapy, respectively.

Conclusion: Functional electrical stimulation seems to be the best treatment to improve walking velocity and distance for incomplete spinal cord injury patients. However, a large-scale RCT is required to study the adverse events of these interventions.

Trial registration: PROSPERO number CRD42019145797.

Keywords: Functional electrical stimulation; Physical therapy; Robotic-assisted gait training; Treadmill; Walking.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Exercise Therapy
Gait* / physiology
Humans
Network Meta-Analysis
Spinal Cord Injuries*
Walking / physiology