Spinal Cord Injury Rehabilitation Evidence: Method of the SCIRE Systematic Review

Eng, Janice J.; Teasell, Robert; Miller, William C.; Wolfe, Dalton; Townson, Andrea; Aubut, Jo-Anne; Abramson, Caroline; Hsieh, Jane; Connolly, S; Konnyu, Kristin J.

doi:10.1310/sci1301-1

Cited by 152 publications

(123 citation statements)

References 5 publications

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“…Scores on the modified Downs and Black tool range from 0 to 28, with higher scores also indicating a higher-quality study. 14 Conflicting assessments were resolved through discussion with a third reviewer. Figure 1 Schematic diagram of the GI tract.…”

Section: Methodsmentioning

confidence: 99%

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

et al. 2010

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Study design: Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. Objective: To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. Setting: Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. Methods: Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. Results: A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. Conclusions: Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.

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Section: Methodsmentioning

confidence: 99%

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

et al. 2010

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“…Studies were selected on the basis of previously established Spinal Cord Injury Rehabilitation Evidence methodology. 18 Studies were only included for analysis if at least 50% of subjects had an SCI, there were at least three SCI subjects and if there was a definable intervention being studied. Only studies published in English language were included.…”

Section: Study Selectionmentioning

confidence: 99%

“…This review was conducted as part of the Spinal Cord Injury Rehabilitation Evidence project (http://www. icord.org/scire), 17 an evidence-based review of the literature assessing rehabilitation interventions in patients with SCI.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury

et al. 2010

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Study design: Systematic review. Objective: To conduct a systematic review of the effectiveness of interventions used to prevent and treat heterotopic ossification (HO) after spinal cord injury (SCI). Setting: St Joseph's Parkwood Hospital, London, Ontario, Canada. Methods: MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched for articles addressing the treatment of HO after SCI. Studies were selected by two reviewers and were only included for analysis if at least 50% of the subjects had an SCI, there were at least three SCI subjects and if the study subjects participated in a treatment or intervention. Study quality was assessed by two independent reviewers using the Downs and Black evaluation tool for all studies, as well as the PEDro assessment scale for randomized control trials only. Levels of evidence were assigned using a modified Sackett scale. Results: A total of 13 studies met the inclusion criteria. The selected articles were divided into prevention or treatment of post-SCI HO. Nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and pulse low-intensity electrogmagnetic field (PLIMF) therapy were reviewed as prophylactic measures. Bisphosphonates, radiotherapy and excision were reviewed as treatments of post-SCI HO. Conclusions: Pharmacological treatments of HO after SCI had the highest level of research evidence supporting their use. Of these, NSAIDs showed greatest efficacy in the prevention of HO when administered early after an SCI, whereas bisphosphonates were the intervention with strongest supportive evidence once HO had developed. Of the non-pharmacological interventions, PLIMF was supported by the highest level of evidence; however, more research is needed to fully understand its role.

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“…An evaluation of the methodological quality of each article was completed by two independent reviewers (AP, AC) and confirmed by a third reviewer with expertise in systematic reviews (DW) using either the 11-item PEDro Scale 42 (randomized controlled trials; RCT) or the Down and Black Tool 43 (non-RCTs). The highest and therefore most methodologically strong score attainable for a given research article is 10 for the PEDro Scale and 27 for the Down and Black Tool.…”

Section: Methodsmentioning

confidence: 99%

“…Higher points indicate a superior methodological quality. Further, the level of evidence was evaluated using a five-level scale 43 (simplified form of Sackett), 44 where level 1 Figure 1 Flow of studies through systematic review.…”

Section: Methodsmentioning

confidence: 99%

A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury

Phillips

Coté

2011

Spinal Cord

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Study design: All randomized controlled trials, prospective cohort, case-controlled, pre-post studies and case reports that assessed exercise interventions, which influence arterial structure and function after spinal cord injury (SCI), were included. Objective: To review systematically the evidence for exercise as a therapy to alter arterial function in persons with SCI. Setting: Literature searches were conducted for appropriate articles using several electronic databases (e.g. MEDLINE, EMBASE). Methods: Three independent reviewers evaluated each investigation's quality, using the Physiotherapy Evidence Database Scale for randomized controlled trials and Downs and Black Scale for all other studies. Results were tabulated and levels of evidence assigned. Results: A total of 283 studies were found through the systematic literature search. Upon review of the articles, 27 were included. The articles were separated into those investigating arterial benefits, resulting from either acute bouts of exercise or long-term exercise interventions. The ability of both acute and long-term exercise interventions to improve arterial structure and function in those with SCI was supported by limited to moderate methodological quality. Upper body wheeling is the most commonly examined exercise therapy for improving arterial function. It appears from the evidence that a variety of exercise interventions, including passive exercise, upper body wheeling, functional electrical stimulation and electrically stimulated resistance exercise, can improve arterial function in those living with SCI. Conclusions: Although the quality and volume of evidence is low, the literature supports exercise as a useful intervention technique for improving arterial function in those with SCI.

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Spinal Cord Injury Rehabilitation Evidence: Method of the SCIRE Systematic Review

Cited by 152 publications

References 5 publications

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury

A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury

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