Title : Exercise-based therapies provide the most consistent benefits for upper limb recovery after spinal cord injury: A systematic review
Abstract:
Introduction: Spinal Cord Injury (SCI) has dramatically increased and is associated with significant long-term disability, with loss of upper limb function representing a major determinant of independence and quality of life. Optimising recovery of arm and hand function, alongside pain control, remains a key goal of orthopaedics and rehabilitation. However, management is challenging as evidence guiding treatment selection is heterogeneous and often limited to small, single-centre studies. A systematic review of randomised controlled trials was conducted to evaluate interventions aimed at improving upper limb motor function and pain following SCI.
Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. The protocol was registered on PROSPERO (CRD42024611561). Interventions were categorised as follows: exercise-based, pharmacological, robotic/AI-assisted, and electrical stimulation. Qualitative synthesis and quantitative aggregation of p-values performed.
Results: Twenty studies (n=792) were included. Exercise-based rehabilitation demonstrated the most consistent improvements in motor outcomes, particularly in strength and endurance (p=0.008), and showed benefit in pain reduction (WUSPI, p=0.002). Robotic-assisted therapies improved motor ability, particularly when combined with exercise programs (SCIM p<0.01, UEMS p=0.003). Of pharmacological agents tested, riluzole showed targeted benefits (UEMS, P=0.01) though results were variable. There was no robust evidence supporting standalone use of electrical stimulation for motor recovery or pain control.
Conclusion: Based on the evidence, exercise regimens should be utilised as first-line therapy to enhance both upper limb motor ability and pain control. Robotic/AI-assisted therapies and pharmacological adjuncts may offer targeted benefits, though this requires further validation. Future research should prioritise multi-centre studies with standardised treatment protocols and longer follow-up times to establish evidence-based rehabilitation pathways.
