Therapeutic Effects of Noninvasive Technology Modalities on Lower-Limb Motor Function in Spinal Cord Injury: A Systematic Review.
Siti Ainun Marufa, Hung-Yen Chin, Bor-Shing Lin and 9 others
PMID 41477092WHAT IT FOUND
Results for noninvasive stimulation in incomplete spinal cord injury are mixed.
Motor scores and walking improved in some trials, but others showed no difference versus sham. Effects varied by technique and protocol, so no single modality can be recommended as standard care.
Key findings
01The review included 11 randomized trials with 224 adults, mostly with incomplete spinal cord injury, testing transcranial, transspinal, and peripheral stimulation or robotic feedback.
02Motor score outcomes were inconsistent: one trial found significant improvement with intermittent theta burst stimulation and another with repetitive transcranial magnetic stimulation, while trials of functional electrical stimulation rowing and robotic walking with biofeedback showed no significant between-group difference.
03Walking ability outcomes were also mixed, with some trials reporting within-group gains but no significant between-group differences, and one small trial reporting clinically relevant speed gains without a reported between-group P value.
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 review included only 11 small trials, with sample sizes ranging from 4 to 43 participants, so the evidence base is limited. Study designs, intervention doses, session frequencies, and durations varied widely, making it difficult to compare results across trials. Most participants had incomplete spinal cord injury, so findings should not be generalized to people with complete injuries. Risk of bias was not uniformly low: 2 trials were rated high risk, 3 raised some concerns, and several had incomplete reporting of randomization, blinding, or outcome measurement. Adverse effects and tolerability were not systematically assessed, so safety information is limited. Because of heterogeneity, results were synthesized narratively rather than statistically pooled, which reduces the ability to estimate overall treatment effects.
Declared interests
The investigators reported no financial or nonfinancial disclosures.
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