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Balance Interventions to Improve Upright Balance Control and Balance Confidence in People With Motor-Incomplete Spinal Cord Injury or Disease: A Systematic Review and Meta-analysis.

Archives of physical medicine and rehabilitation
March 1, 2025
Natasha L Benn et al. (6 authors)
Journal ArticleSystematic ReviewMeta-AnalysisReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the efficacy, components, and dosage of interventions, including walking, for improving upright balance control, balance confidence, and reducing falls in adults with motor-incomplete spinal cord injury/disease (SCI/D).

Results Summary

Walking interventions and upright balance training with visual feedback showed clinically meaningful and significant effects on improving standing balance control. Only walking interventions significantly improved balance confidence, but no significant dosage response was found.

Population

Adults aged 18-74 with chronic, motor-incomplete SCI/D (males: females = 2.4:1).

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (8)
InterventionDirectionEndpointPopulationDosageImpactClaim #
Walking interventions
increase
standing balance control
adults with motor-incomplete spinal cord injury/disease (SCI/D)
-
had clinically meaningful and significant pooled effects on improving
#1
Upright balance training with visual feedback
increase
standing balance control
adults with motor-incomplete spinal cord injury/disease (SCI/D)
-
had clinically meaningful and significant pooled effects on improving
#2
Walking interventions
increase
balance confidence
adults with motor-incomplete spinal cord injury/disease (SCI/D)
-
had a significant pooled effect on improving
#3
Walking interventions
increase
upright balance control
adults with motor-incomplete spinal cord injury/disease (SCI/D)
-
had greater effects on
#4
Upright balance training with visual feedback
increase
upright balance control
adults with motor-incomplete spinal cord injury/disease (SCI/D)
-
had greater effects on
#5
Conventional physiotherapy
no change
upright balance control
adults with motor-incomplete spinal cord injury/disease (SCI/D)
-
had lesser effects on
#6
Balance interventions
no change
dosage response
adults with motor-incomplete spinal cord injury/disease (SCI/D)
-
had no significant findings on
#7
Balance interventions
neutral
occurrence of falls
adults with motor-incomplete spinal cord injury/disease (SCI/D)
-
were evaluated by few studies on the effects on
#8
Abstract

OBJECTIVES: To assist with clinical decision making, evidence syntheses are needed to demonstrate the efficacy of available interventions and examine the intervention components and dosage parameters. This systematic review and meta-analysis described the efficacy, components and dosage of interventions targeting upright balance control, balance confidence, and/or falls in adults with motor-incomplete spinal cord injury/disease (SCI/D). DATA SOURCES: A search strategy following the population, intervention, control, outcome framework was developed. Six databases were searched: APA PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Embase, Emcare Nursing, Web of Science CC, and Medline. STUDY SELECTION: Title, abstract, and full-text screening were conducted by 2 researchers independently. Inclusion criteria included the following: (1) adults with chronic, motor-incomplete SCI/D; (2) physical intervention targeting upright postural control; and (3) clinical and/or biomechanical measures of upright balance control and/or balance confidence and/or documentation of falls. DATA EXTRACTION: Participant characteristics, balance intervention details, adverse events, and study results were extracted. The Downs and Black Checklist was used to assess methodological quality. Meta-analyses on pre-post intervention outcomes and a meta-regression of dosage were completed. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to evaluate the quality of the evidence. DATA SYNTHESIS: The search returned 1664 unique studies; 26 were included. Methodological quality was moderate to good. Participants were 500 individuals with SCI/D, aged 18-74 years (males: females = 2.4:1). Minor adverse events were reported in 8 studies (eg, muscle soreness and fatigue). Walking interventions and upright balance training with visual feedback had clinically meaningful and significant pooled effects on improving standing balance control. Only walking interventions had a significant pooled effect on improving balance confidence. There were no significant findings on dosage response. Few studies evaluated the effects of balance interventions on the occurrence of falls. CONCLUSIONS: Walking interventions and upright balance training with visual feedback had greater effects on upright balance control than conventional physiotherapy; however, the quality of the evidence was very low.

Medical Subject Headings (MeSH)
HumansPostural BalanceSpinal Cord InjuriesAccidental FallsPhysical Therapy ModalitiesAdult
Study Links
Quality Scores
Safety85
Efficacy75/10
Quality80/10
Citation Metrics
Total Citations1
Citations/Year1.0
Research Impact Scores
APT Score0.50
Weight Score2.78
Normalized Score0.80
Related Supplements
Balance Interventions to Improve Upright Balance Control and... | Panacea Index