Introduction Falls are detrimental to the well-being of individuals with spinal cord injury (SCI). To establish effective fall prevention initiatives, a comprehensive understanding of falls after SCI is needed. Objectives To report the incidence proportion of falls and summarize the factors contributing to falls in individuals with SCI. Study design Systematic review and meta-analysis. Methods Eight databases were searched. Abstracts/full articles were screened by two researchers independently. Data concerning study design, participant characteristics, and the incidence proportion, factors, and consequences of falls were extracted. Risk of bias was assessed using a domain-based approach that considered sampling and measurement bias. The incidence proportions of falls were pooled for ambulators and wheelchair users separately using random-effects metaanalyses, and compared descriptively for inpatients and community-dwelling individuals. Fall-related factors were organized according to the Biological, Behavioral, Social & Economic and Environmental Model of fall risk. Results The search resulted in 1706 articles; 24 unique studies were included. The risk of sampling bias was high. All but one study focused on community-dwelling individuals; 78% (95% confidence interval 73-83%, I 2 = 0%) of ambulators and 69% (95% confidence interval 60-76%, I 2 = 59%) of wheelchair users fell ≥1 over 12 months. In contrast, only 13% of inpatients fell. Most fall-related factors were categorized as biological (e.g., muscle weakness), behavioral (e.g., inattentiveness) or environmental (e.g., uneven surfaces). Conclusions Falls are frequent among community-dwelling individuals with SCI. A variety of biological, behavioral, and environmental factors contribute to falls, some of which are modifiable and may be addressed through SCI-specific fall prevention initiatives.

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Background/Objectives: To identify and compare effective means of managing obesity in individuals with chronic spinal cord injury (SCI). Methods/Overview: This review included English and non-English articles, published prior to January 2017 found in PubMed/Medline, Embase, Cinahl, Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy alone or in combination including diet therapy, physical exercises, passive exercises such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were declines in waist circumference, body weight, body mass index and Total Fat Mass (TFM) and increases in total lean body mass (TLBM). From 3553 retrieved titles and abstracts, 34 articles underwent full-text review and 23 articles selected for data abstraction. Weight loss due to inflammation, cancer or B12 deficiency was excluded. The quality of the selected studies was evaluated by Downs and Black tool and found to be generally poor to medium with 4 exceptions. Results: Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally NMES and pharmacotherapy did not reduce weight but improved body composition (increases in TLBM and reductions in TFM). Conclusions: Due to link between adiposity and all-cause mortality; obesity is a legitimate therapeutic target. A trial of diet and exercise therapy is recommended prior to definitive bariatric surgery.