Exercise rehabilitation interventions for people with spinal cord injury and their health benefits: a systematic review of systematic reviews based on ICD-11 and ICF / 中国康复理论与实践

ABSTRACT

ObjectiveBased on the International Classification of Diseases, Eleventh Revision (ICD-11) and the International Classification of Functioning, Disability and Health (ICF), systematic reviews about the effects of different types of exercise rehabilitation and related interventions on body structure and function, activity and participation, and quality of life in people with spinal cord injury (SCI) were systematically reviewed. MethodsSystematic reviews of exercise rehabilitation and health benefits in patients with spinal cord injury were searched from PubMed, Embase, EBSCO, Web of Science and CNKI, from January, 2015 to January, 2023. ResultsEight English articles were included, from Canada, the United States, South Korea, Australia, Brazil and Netherlands, derived from the fields of physical medicine and rehabilitation, neuromedicine and rehabilitation, and exercise intervention, with the publication date mainly concentrated from 2015 to 2021. A total of 165 randomized controlled trials were involved, with 2 746 participants, aged 18 to 65 years. The diseases were mainly spinal cord injury (complete or incomplete), quadriplegia, paraplegia (thoracic, lumbar and sacral injuries), and motor neuron injury (upper and lower). There were three main types of interventions: passive intervention, using sports assistive devices, such as powered exoskeleton-assisted robots, electric bicycles, etc., and functional electrical stimulation; active interventions, such as stepping exercises; training on flat ground, outdoor walking, and activities of daily living; mixed intervention (active & passive), such as combination of exercise and functional electrical stimulation, combination of exercise and motor assistive devices. The frequency of intervention was ten to 240 minutes a time, two to 18 times a week, with the intensity of low to vigorous, for one to 456 weeks. The intervention sites mainly involved families, community health service centers and sports venues. The health impact mainly involved improving cardiovascular and increasing blood flow velocity in the legs; improving musculoskeletal structure, as well as muscle strength, tolerance and flexibility; relieving spasms and improving reflex excitability of the nervous system; increasing gait speed and walking distance; improving functional independence, such as bowel regularity; improving physical health, such as reducing spasticity and drug use (e.g., baclofen), increasing the immune response to infection, and reducing the risk of disease (vascular dementia and respiratory disease); and improving psychological condition. ConclusionBased on ICD-11 and ICF, this study constructed a research framework for active or passive exercise rehabilitation and related interventions in patients with spinal cord injury. Patients with spinal cord injury can improve their body structure and function, increase their activity and participation, and improve their quality of life and well-being through passive interventions (using motor assistive devices, functional electrical stimulation), active interventions (such as stepping exercises, outdoor walking, etc.), and mixed interventions (combining exercise and functional electrical stimulation, exercise and sports assistive devices).