Efficacy and safety of 9 nonoperative regimens for the treatment of spinal cord injury: A network meta-analysis

Abstract

Objective: This network meta-analysis aims to compare the efficacy and safety of 9 nonoperative regimens (placebo, pregabalin, GM-1 ganglioside, venlafaxine extended-release [venlafaxine XR], fampridine, conventional over-ground training [OT], body-weight-supported treadmill training [BWSTT], robotic-assisted gait training [RAGT] + OT and body-weight-supported over-ground training [BWSOT]) in treating spinal cord injury (SCI).

Methods: Clinical controlled trials of 9 nonoperative regimens for SCI were retrieved in the electronic database. Traditional pairwise and Bayesian network meta-analyses were performed to compare the efficacy and safety of 9 nonoperative regimens for the treatment of SCI. Weighted mean difference (WMD), odds ratios (OR), and surface under the cumulative ranking curve (SUCRA) were calculated using the Markov Chain Monte Carlo engine Open BUGS (V.3.4.0) and R (V.3.2.1) package gemtc (V.0.6).

Results: A total of 9 clinical controlled trials meeting the inclusion criteria were selected in this meta-analysis. On the aspect of efficacy, the results of pairwise meta-analysis indicated that the RAGT + OT and BWSOT might have the best efficacy in SCI patients in terms of a lower extremity motor score (LEMS) compared with conventional OT; the efficacy of RAGT + OT on SCI patients was relatively better than that of conventional OT in terms of walking index for spinal cord injury (WISCI). With the aspect of safety, the constipation rate of placebo on SCI patients was relatively higher than that of venlafaxine XR; however, with respect to headache and urinary tract infection, there was no significant difference in the safety of placebo, pregabalin, GM-1 ganglioside, venlafaxine XR, and fampridine on SCI patients. The results of SUCRA values suggested that BWSOT had the highest SUCRA value (75.25%) of LEMS; RAGT + OT had the highest SUCRA value (88.50%) of WISCI; venlafaxine XR had the highest SUCRA value (94.00%) of constipation; venlafaxine XR had the highest SUCRA value (80.00%) of headache; GM-1 ganglioside had the highest SUCRA value (87.75%) of urinary tract infection.

Conclusion: Our results provide evidence that the RAGT + OT and BWSOT might have the best efficacy in the treatment of SCI, and the venlafaxine XR and GM-1 ganglioside showed adequate safety for SCI.

Figure 1

Physiotherapy Evidence Database (PEDro) scale for the quality assessment of enrolled studies.

Figure 2

Funnel plot for publication bias of included studies. BWSOT = body-weight-supported over-ground training, BWSTT = body-weight-supported treadmill training, LEMS = lower extremity motor score, OT = over-ground training, RAGT = robotic-assisted gait training, WISCI = walking index for spinal cord injury.

Figure 3

Evidence diagrams for the efficacy and safety of 9 nonoperative regimens on patients with spinal cord injury. BWSOT = body-weight-supported over-ground training, BWSTT = body-weight-supported treadmill training, LEMS = lower extremity motor score, OT = over-ground training, RAGT = robotic-assisted gait training, WISCI = walking index for spinal cord injury.

Figure 4

Surface under the cumulative ranking curve plots for the efficacy and safety of 9 nonoperative regimens on patients with spinal cord injury. BWSOT = body-weight-supported over-ground training, BWSTT = body-weight-supported treadmill training, LEMS = lower extremity motor score, OT = over-ground training, RAGT = robotic-assisted gait training, WISCI = walking index for spinal cord injury.