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A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With
Amanda McIntyre1, Cristina Sadowsky2,3, Andrea Behrman4,5
1Parkwood Institute Research, Parkwood Institute, London, Canada.
Insights
The scientific evidence for rehabilitation in pediatric spinal cord injury (SCI) is very limited, with most studies offering low-level evidence. Future research needs novel designs to address sample size and heterogeneity issues in pediatric SCI rehabilitation.
Area of Science:
- Pediatric Rehabilitation Medicine
- Spinal Cord Injury Research
- Evidence-Based Practice
Background:
- Pediatric-onset spinal cord injury (SCI) presents unique challenges for rehabilitation and habilitation.
- A comprehensive understanding of the existing scientific literature is crucial for advancing care.
- Current evidence synthesis is needed to identify gaps and guide future research.
Objectives:
To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI).
Methods:
A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures.
Results:
One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported.
Conclusion:
The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.
