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Study design:This is a rapid evidence review.Objectives:The objective of this study was to gain an overview of the volume, nature and findings of studies regarding priorities for spinal cord injury (SCI) research.Setting:A worldwide literature search was conducted.Methods:Six medical literature databases and Google Scholar were searched for reviews in which the primary aim was to identify SCI research priorities.Results:Two systematic reviews were identified-one of quantitative and one of qualitative studies. The quality of the reviews was variable. Collectively, the reviews identified 31 primary studies; 24 quantitative studies totalling 5262 participants and 7 qualitative studies totalling 120 participants. Despite the difference in research paradigms, there was convergence in review findings in the areas of body impairments and relationships. The vast majority of literature within the reviews focused on the SCI patient perspective.Conclusion:The reviews inform specific research topics and highlight other important research considerations, most notably those pertaining to SCI patients' perspectives on quality of life, which may be of use in determining meaningful research outcome measures. The views of other SCI research stakeholders such as researchers, clinicians, policymakers, funders and carers would help shape a bigger picture of SCI research priorities, ultimately optimising research outputs and translation into clinical practice and health policy change. Review findings informed subsequent activities in developing a regional SCI research strategy, as described in two companion papers.Sponsorship:This project was funded by the Victorian Transport Accident Commission and the Australian and New Zealand SCI Network. [ABSTRACT FROM AUTHOR]

Study design:A systematic review.Objectives:The aim of this systematic review was to establish whether combined aerobic training and muscle strength training is effective in improving aerobic fitness, muscle strength, function and/or quality of life (QoL) in people with spinal cord injury (SCI).Settings:Faculty of Health Sciences. University of Sydney, NSW, Australia.Methods:A search was conducted for randomized controlled trials (RCTs), controlled trials, uncontrolled clinical trials, case series and cross-over studies involving exercise interventions that included a combination of aerobic and strength components, either in circuit-mode or in sequence for people with SCI. Methodological quality was independently rated using the PEDro scale and key findings were extracted from trials by two reviewers.Results:The search identified 7981 abstracts, from which nine trials met the inclusion criteria. From the nine selected trials, seven reported aerobic outcomes, two of which showed a statistically significant within-group difference in aerobic fitness. Five studies reported muscle strength outcomes, four of them showed a statistically significant within-group mean difference on at least one outcome measure. Two studies looked at QoL, one of them found a statistically significant between-group difference on one outcome measure.Conclusion:Our systematic review showed that literature on SCI population is scarce, of low quality and findings of existing studies are inconsistent. Thus, further RCTs with larger number of participants are needed to make a definite conclusion about the influence of combined aerobic and muscle strength training on aerobic fitness, muscle strength and QoL in people with SCI. [ABSTRACT FROM AUTHOR]

Study design:Systematic review.Objectives:To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI).Setting:British Columbia, Canada.Methods:EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers.Results:No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point.ConclusionChemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions. [ABSTRACT FROM AUTHOR]

Study Design:Systematic literature review.Objective:The primary aim of this study was to evaluate interventions aimed at improving employment outcomes for individuals with spinal cord injuries (SCI).Methods:An electronic search of Medline/PubMed, EMBASE, Cochrane database, CINAHL, PsycINFO, Social Science Abstracts and Social Work Abstract databases was performed on 31 December 2013. To be included in the review, studies needed to investigate interventions among individuals with SCI where employment was an outcome. Exclusion criteria include (i) reviews, (ii) studies not published in English and (iii) non-peer reviewed publications.Results:Fourteen studies met the inclusion criteria, two were randomized controlled trials. The strongest evidence finds that supported employment can improve employment outcomes among individuals with SCI. The use of service dogs has also been shown to improve employment outcomes. The remaining 12 studies are observational and predominantly focus on vocational rehabilitation programs.Conclusion:There is a dearth of high-quality intervention research that targets employment outcomes in individuals with SCI. Consequently, conclusions are mostly based on evidence from observational studies. Vocational rehabilitation programs are the primary focus of this evidence, but conclusions may be confounded, as individuals may be self-selecting for these programs. Additional randomized trials on employment interventions are needed to overcome these limitations. Studies should aim to identify which components of these programs have the greatest influence on employment outcomes. [ABSTRACT FROM AUTHOR]

Objectives:Spinal cord injury (SCI) research has highlighted links between psychological variables and employment outcome; however, there remains a need to consolidate the available heterogenous data.Methods:Meta-analytic techniques were used to examine and quantify differences in psychological functioning and employment status among adults with an acquired SCI. Fourteen observational studies (N=9, 868 participants) were identified from an electronic database search. Standardised mean difference scores between employed and unemployed groups were calculated using Cohen's d effect sizes. Additionally, 95% confidence intervals, fail-safe Ns, percentage overlap scores and heterogeneity statistics were used to determine the significance of d.Results:Moderate to large and positive weighted effects were noted across three broad psychological constructs: affective experience or feelings (dw=3.16), quality of life (dw=1.06) and life satisfaction (dw=0.70). However, the most compelling non-heterogeneous finding was associated with life satisfaction, a finding that was also not subject to publication bias. Inconsistent and weak associations between employment and individual measures of vocational attitude, self-efficacy, locus of control, adjustment and personality were also noted.Conclusion:Psychological factors and attributes are linked to employment post-SCI; however, the available data are limited in quantity. Longitudinal research is also needed to determine whether these variables can help to preserve employment over time. [ABSTRACT FROM AUTHOR]