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. 2016 Mar 1;33(5):425-38.
doi: 10.1089/neu.2014.3812. Epub 2016 Jan 20.

A Systematic Review of Experimental Strategies Aimed at Improving Motor Function after Acute and Chronic Spinal Cord Injury

Joyce Gomes-Osman  1 , Mar Cortes  2 , James Guest  3 , Alvaro Pascual-Leone  1
Affiliations

A Systematic Review of Experimental Strategies Aimed at Improving Motor Function after Acute and Chronic Spinal Cord Injury

Joyce Gomes-Osman et al. J Neurotrauma. .

Abstract

While various approaches have been proposed in clinical trials aimed at improving motor function after spinal cord injury in humans, there is still limited information regarding the scope, methodological quality, and evidence associated with single-intervention and multi-intervention approaches. A systematic review performed using the PubMed search engine and the key words "spinal cord injury motor recovery" identified 1973 records, of which 39 were selected (18 from the search records and 21 from reference list inspection). Study phase ( clinicaltrials.org criteria) and methodological quality (Cochrane criteria) were assessed. Studies included proposed a broad range of single-intervention (encompassing cell therapies, pharmacology, electrical stimulation, rehabilitation) (encompassing cell therapies, pharmacology, electrical stimulation, rehabilitation) and multi-intervention approaches (that combined more than one strategy). The highest evidence level was for Phase III studies supporting the role of multi-intervention approaches that contained a rehabilitation component. Quality appraisal revealed that the percentage of selected studies classified with high risk of bias by Cochrane criteria was as follows: random sequence generation = 64%; allocation concealment = 77%; blinding of participants and personnel = 69%; blinding of outcome assessment = 64%; attrition = 44%; selective reporting = 44%. The current literature contains a high proportion of studies with a limited ability to measure efficacy in a valid manner because of low methodological strength in all items of the Cochrane risk of bias assessment. Recommendations to decrease bias are discussed and include increased methodological rigor in the study design and recruitment of study participants, and the use of electrophysiological and imaging measures that can assess functional integrity of the spinal cord (and may be sufficiently sensitive to detect changes that occur in response to therapeutic interventions).

Keywords: cell transplantation; electrophysiology; human studies; rehabilitation; spinal cord injury.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Flow chart displaying the search strategy.
<b>FIG. 2a.</b>
FIG. 2a.
Risk of bias graph: review authors' judgments about each risk of bias item (random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, other) presented as percentages across all included studies. Color image is available online at www.liebertpub.com/neu
<b>FIG. 2b.</b>
FIG. 2b.
Risk of bias summary: review authors' judgments about each risk of bias item for each included study. Color image is available online at www.liebertpub.com/neu
<b>FIG. 3.</b>
FIG. 3.
Distribution of studies included in the review separated into acute/subacute spinal cord injury (SCI) (light grey) and chronic SCI (dark grey) and included in the review according to the study phase (I-III, see Methods).
<b>FIG. 4.</b>
FIG. 4.
Distribution of studies in acute/subacute and chronic spinal cord injury (SCI) groups divided per phase (see Methods) for all categories (cell therapy, pharmacology, rehabilitation, electrical stimulation/neuroelectric device, combinatorial). Color image is available online at www.liebertpub.com/neu
See this image and copyright information in PMC

References

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