What does this paper focus on?

Our topical review focuses on the physiotherapy management of people with spinal cord injury (SCI) and takes an in-depth look at the important clinical issues facing physiotherapists, people with SCI and their caregivers. 

It updates the 2016 review published in Journal of Physiotherapy by summarising the classification of SCI, evidence-based management, common physiotherapy interventions and future directions for research and practice.

Which physiotherapy interventions were shown to be effective for SCI?

Some interventions provided by physiotherapists working in the area of SCI are supported by evidence from randomised controlled trials, systematic reviews and clinical practice guidelines. 

These include interventions to improve strength, respiratory function, cardiorespiratory fitness and motor skills. 

Other interventions have not been scrutinised within randomised controlled trials, which creates a larger challenge for clinicians, who may need to look for guidance from lower levels of evidence or consensus-based opinion. 

Recent clinical practice guidelines developed by our group in conjunction with Australian and New Zealand physiotherapists, academics and consumers go some way towards providing a summary of the current evidence for the physiotherapy management
of people with SCI. 

A panel from across Australia and New Zealand has made 14 evidence recommendations and over 80 consensus-based opinion statements about physiotherapy interventions after SCI. 

Many of these recommendations and statements are described and discussed in the topical review and can be viewed at sciptguide.com

Where should future research in this area go next?

The focus for future research should be on generating evidence to guide current practice and address the questions prioritised by physiotherapists and people with SCI. 

The number and quality of randomised controlled trials centred on physiotherapy management for people with SCI are steadily increasing. 

However, there is still a shortage of relevant, high-quality trials investigating commonly used treatments in clinical practice. 

Without this type of research, it is very difficult to develop new interventions that build on current physiotherapy practice. 

The best way to answer clinically important questions is with large multicentre randomised controlled trials. 

Of course, this is easier said than done. These trials require funding, extensive collaboration and determination. Despite the challenges, researchers are conducting multicentre trials and are adding to the knowledge base for physiotherapy management.

>>Joanne Glinsky APAM is a senior research fellow at the John Walsh Centre for Rehabilitation Research. She is also an associate professor in the Discipline of Physiotherapy at the University of Sydney. She works as a researcher and educator in the field of neurological physiotherapy.

>>Lisa Harvey APAM is a professor at the John Walsh Centre for Rehabilitation Research, University of Sydney. She
has 20 years of clinical experience and 20 years of academic experience in the physiotherapy management of people with spinal cord injuries.