Musculoskeletal changes and treatments in paediatric spinal cord disorders: A scoping review.

This is a scoping review, not an effectiveness review, so it does not show whether any treatment works. The 45 included reports used very different designs, outcomes and populations, so results cannot be pooled or compared directly. Intervention studies were small, including a FES cycling study with 6 children and an FES walking study with 3 children, so many findings lacked power. Eighteen of the 45 reports came from research by Shriners Hospital for Children, which may bias the available evidence. Most reports focused on traumatic spinal cord injury, so children with non-traumatic spinal cord disorders are underrepresented. There are no clinical practice guidelines for musculoskeletal complications in children with spinal cord disorders, and the review found no standard mechanism or timeline.

The paper reports funding for the included studies: 17 received no funding, 16 were supported by grants from Shriners Hospitals for Children, 10 were funded by independent foundations and charities, and 2 were supported by both independent grants and a Shriners Hospitals for Children grant. No separate review funding or conflict-of-interest declaration is given in the paper.

Do not read the trends towards increased bone mineral density with functional electrical stimulation as evidence that it works. The review says these studies were small and lacked power, and a randomised trial found bone mineral density was not significantly affected by FES cycling, passive cycling or electrical stimulation.