Exercise therapy can effectively improve trunk performance and sitting balance in spinal cord injury: a systematic review and meta-analysis

Abstract

Objective: To determine the effects of exercise on trunk performance and balance in patients with spinal cord injury (SCI).

Methods: We searched the databases MEDLINE, Cochrane Library, EMBASE, Physiotherapy Evidence Database, Web of Science, PsycINFO, and CINAHL from inception to June 2020. Our search targeted studies such as randomized or non-randomized controlled trials and randomized crossover trials that evaluated the effects of exercise on trunk performance and balance in patients with SCI.

Results: Seventeen eligible studies with 432 patients with SCI were included in the meta-analysis. The exercise significantly improved several measures: Berg Balance Scale (mean differences [MD] = 4.58; 95% confidence intervals [CI], 0.35, 8.8; p = 0.03), Modified Functional Reach Test (MD = 5.29; 95% CI, 4.16, 6.42; p < 0.01), T-shirt test (MD = 5.62; 95% CI, - 3.82, - 7.42; p < 0.01), Timed Up and Go (MD = - 1.70; 95% CI, - 0.23, - 3.16; p = 0.02). Improvements were also noted in total static sitting balance (standardized mean differences [SMD] = 1.21; 95% CI, 0.79, 1.63; p < 0.01), and total dynamic sitting balance (SMD = 1.01; 95% CI, 0.30, 1.73; p < 0.01). In the subgroup analysis, exercise with sensory input enhancement significantly improved total static (SMD = 1.37; 95% CI, 0.64, 2.11; p < 0.01) and total dynamic sitting balance (SMD = 1.78; 95% CI, 0.28, 3.29; p = 0.02).

Conclusions: Exercise may improve sitting balance in patients with SCI. Moreover, enhancement of sensory input had an add-on effect in improving sitting balance.

Registration: PROSPERO (CRD42020185904).

Keywords: Exercise; Meta-analysis; Rehabilitation; Sitting balance; Spinal cord injury; Trunk.