Spinal cord injury & physiotherapy: What does the science say?

By Ana Espino | Published on september 9, 2025 | 2 min read

#SCI #Physiotherapy #ClinicalPracticeGuidelines  


Spinal cord injuries (SCI) cause severe impairments in motor, sensory, and autonomic functions, significantly compromising the functional independence of affected individuals. In the face of this complex condition, physiotherapy plays a fundamental role in recovery and the prevention of complications. However, clinical guidelines specific to this discipline remain fragmented. The available guidelines often focus on isolated aspects of the care pathway, without providing a comprehensive framework adapted to physiotherapy practice.  

The limitations of available data represent a major obstacle. Few high-quality clinical trials assess the effectiveness of physiotherapy-specific interventions, and the variability of practices in the absence of a common reference framework undermines the consistency of care. Added to this is a lack of methodological structure, with few recommendations based on rigorous processes such as the GRADE system.  

In this context, this study was initiated to develop a clinical practice guideline for the physiotherapeutic management of adults with SCI. It was based on a systematic review of the evidence and expert consensus, with the aim of harmonizing and improving clinical practice.  

What is the evidence for physiotherapy in SCI?

The methodology was based on the identification of more than 100 predefined PICO questions by a panel of clinicians, researchers, and patient representatives. Each question was addressed through a systematic review of the available data, including 76 randomized controlled trials (RCTs), the results of which led to 20 meta-analyses. The GRADE system was used to assess the quality of the evidence and to formulate the recommendations.  

The results show that only 14 recommendations are supported by evidence from RCTs, while the majority are based on expert opinion. Clinically relevant interventions include wheelchair skills training, virtual reality to improve sitting balance, prolonged stretching for joint mobility, TENS for neuropathic pain, and targeted muscle strengthening. Regarding physical fitness, arm or hand cycling and circuit training were found to be beneficial for cardiorespiratory health. Other areas, such as orthostatic hypotension, shoulder subluxation, or spasticity, were addressed through expert consensus due to insufficient data.  

So what’s next for rehabilitation?

Spinal cord injury leads to major functional deficits requiring specialized management. The diversity of practices, the lack of robust clinical trials, and the absence of targeted physiotherapy recommendations make standardizing care difficult. This study aimed to establish a clinical practice guideline based on evidence and expert consensus to guide the rehabilitation of adults with SCI.  

It represents a first step toward a more coherent, accessible approach aligned with real-world practice. However, the available data are limited, often of low quality, and the recommendations rely largely on expert opinion. The absence of an international panel and the exclusion of non-English studies also limit the scope of the guideline.  

Next steps include updating the recommendations, expanding the panel geographically, and most importantly, producing high-quality clinical trials focused on interventions that are actually used in practice. Greater involvement of clinicians and patients in setting research priorities will be essential to strengthen the clinical relevance of future recommendations.  

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About the author – Ana Espino
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.