Precision Rehabilitation in Spinal Cord Injury: A Systematic Review of Omics Applications for Intervention Monitoring in Spinal Cord Injury.

Twenty-two of the 23 studies were rated at moderate risk of bias, mostly because papers did not report how patients were allocated, who was blinded, or why the sample size was chosen, so the molecular changes cannot be attributed to the intervention with confidence. The quality tool used was designed for clinical trials, not for omics work, so it does not judge how well the molecular measurements themselves were done, and no validated omics-specific quality criteria exist yet. The reviewers did not calculate a formal agreement statistic, so how closely the two independent quality ratings matched is not known. The studies could not be pooled: participants differed in injury completeness, time since injury and baseline health, and interventions and omics methods differed too, so comparisons between studies are weak. Most included studies were small and short-term, so nothing is known about longer-term molecular adaptation; individual studies were mostly single-group before-and-after designs without a control group. Sampling and analysis methods were not standardised across studies, and different platforms, databases or analysis tools can interpret the same raw omics data differently. The authors state that omics is currently limited in clinic by cost, the expertise needed and turnaround time, and that outcomes such as strength, muscle mass and functional independence can already be measured reliably with standard clinical tools. The authors note that most omics work in this area re-analyses stored data from completed studies rather than monitoring rehabilitation prospectively.

The supplied text contains no funding statement and no competing-interest declaration, so who paid for this review and what the authors declared cannot be reported. The only disclosure in the text is that the graphical summary figure was created in BioRender. Several included trials tested commercial or patented products (growth hormone, melatonin, a probiotic, probenecid, stem cell therapy, Lactobacillus rhamnosus GG), but funding sources for those trials are not given in this paper.

Do not read this review as evidence that exercise, electrical stimulation, diet, hormones or cell therapy improves function after spinal cord injury. The studies were mostly small, short and rated at moderate risk of bias, the outcomes reported were molecular markers rather than patient function, and the authors themselves say omics is not yet ready to guide routine clinical decisions.