Impact of treadmill gait training with neuromuscular electrical stimulation on the urodynamic profile of patients with high cervical spinal cord injury

Effects of Exercise-Based Interventions on Urogenital Outcomes in Persons with Spinal Cord Injury: A Systematic Review and Meta-Analysis

In this systematic review, objectives were to investigate dropout rates, adverse events, and effects of exercise-based therapies on urogenital function and quality of life (QoL) in persons with spinal cord injury (SCI). Database searches were conducted on MEDLINE, EMBASE, and CINAHL for studies examining any form of exercise intervention on urogenital function and/or QoL in adults with SCI. Quality of publications was evaluated using the Joanna Briggs Institute critical evaluation tools. When possible, Hedges' g was calculated for overall effect sizes. Subgroup analyses were conducted on sex and injury severity. Ten studies (228 participants) were included in this review. Three studies examined pelvic floor muscle training, and seven studies examined locomotor training. Overall quality of evidence was low because of small sample sizes and non-randomized designs in most studies. Dropout rates ranged from 12% to 25%, and adverse events were reported only in some studies investigating locomotor training. For lower urinary tract (LUT) outcomes, urodynamic findings were mixed despite moderately positive changes in maximum bladder capacity (g = 0.50) and bladder compliance (g = 0.37). Fairly consistent, but small, improvements were observed in LUT symptoms, primarily bladder awareness and incontinence. LUT QoL improved in most cases. Fewer data were available for sexual outcomes, and only minor improvements were reported. Subgroup analyses, based on sex and severity of injury, were inconclusive. There is some indication for the potential benefit of exercise on urogenital outcomes in persons with SCI, but there is insufficient evidence given the number of studies and heterogeneity of outcome measures.