Essential training variables of arm-hand training in people with cervical spinal cord injury: a systematic review.
Nele Bertels, Henk Seelen, Justine Dembele and 1 others
PMID 37930130WHAT IT FOUND
Arm-hand training programmes for cervical spinal cord injury showed better before-after gains in programmes that used skill practice, real-life tasks, both hands and lasted at least 8 weeks.
Key findings
01Six included programmes showed a small before-after improvement in arm-hand function, and seven showed a moderate before-after improvement in arm-hand skill performance.
02In the in-depth analysis, programmes that included skill training, functional movements, clear goals, real-life object manipulation, multiple movement planes, bimanual practice, or training for 8 weeks or more showed moderate before-after improvements in arm-hand skill performance.
03Programmes did not report subjective task difficulty or exertion, and most did not describe personal motivation components.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The quantitative analysis used only seven studies and ten training programmes, and only two studies had more than 30 participants. The before-after changes cannot separate the effect of training from natural recovery or from usual care, because control comparisons were not the basis of the quantitative analysis and eight programmes added usual care without describing its dose. Included studies mixed randomized trials, controlled trials and case series, with different lesion levels, AIS grades and rehabilitation phases, so results may not apply to a specific patient group. Many therapy dose dimensions were not reported, especially session density, episode length, subjective difficulty, subjective intensity and usual-care dose. This makes it hard to know what to prescribe. The in-depth analysis of training variables used only eight programmes, and some variables had too few programmes to analyse separately. Arm-hand skill performance outcomes were varied and not subdivided into basic and complex activities. The review excluded studies with high risk of bias, but the remaining evidence still came from small heterogeneous programmes.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that skill training, bimanual practice or an 8-week duration causes better arm-hand recovery. The review pooled before-after changes from small, mixed studies, and the authors state that the effect of training cannot be separated from natural recovery.