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Non-Pharmacologic Therapy: Prevention (within 12 Months of Injury)

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Table 7: Studies of Rehabilitation Modalities for Prevention of Bone Loss in the First Year after SCI

Discussion

Evidence for non-pharmacological prevention of sublesional osteoporosis includes data from sixteen investigations (n=264 participants).  This includes four RCTs (80 participants), five non-randomized controlled trials (116 participants) and three pre-post studies (22 participants) (Table 7). As with pharmacological studies, there were difficulties with interpretation because of low numbers of participants and variability with the primary outcome measures. For each of the five different modalities there is limited evidence available and there was variability in the selection of the primary outcomes. The therapeutic ultrasound study by Warden and coworkers (2001) found no significant improvement in bone health after a 6 week intervention. Although prospective observational data (Frey-Rindova et al. 2000) highlight the loss of bone in the early phase (first 6-months post SCI), there was no significant influence of self-reported physical activity level.  Overall, the evidence suggests that rehabilitation modalities did not prevent bone mass decline in the acute phase after SCI.

Conclusion

There is level 1 evidence (from one RCT) (Warden et al. 2001) that short-term (6 weeks) ultrasound is not effective for treating bone loss after SCI.

There is level 2 evidence (from 1 non-randomized prospective controlled trial) (Shields et al. 2006a) that ES reduced the decline in BMD in the leg.

There is level 2 evidence (from 1 non-randomized prospective controlled trial) (Eser et al. 2003) that FES cycling did not improve or maintain bone at the tibial midshaft in the acute phase.

There is level 4 evidence (from 1 pre-post study) (Giangregorio et al. 2005) that walking and level 1 evidence (from 1 RCT) (Ben et al. 2005) that standing in the acute phase did not differ from immobilization for bone mass decline at the tibia.

There is level 4 evidence (from 1 pre-post study) (Astorino et al. 2013) that activity-based training 2-3 hours/day for a minimum of 2 days a week for 6 months increased spine BMD.

  • Short term (6 weeks) therapeutic ultrasound is not effective for preventing
    bone loss after SCI.

    FES-cycling does not improve or maintain bone at the tibial midshaft in the acute phase.

    Activity-based training (6 months) is effective for increasing spine BMD.