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The effect of early mobilisation (< 14 days) on pathophysiological and functional outcomes in animals with induced spinal cord injury: a systematic review with meta-analysis

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posted on 2024-04-05, 10:38 authored by Natalie Gray, Junaid Shaikh, Alison Cowley, Vicky Goosey-TolfreyVicky Goosey-Tolfrey, Pip Logan, Nasir Quraishi, Vicky Booth

Introduction: The optimum time to mobilise (standing, walking) following spinal cord injury (SCI) is unknown but may have implications for patient outcomes. There are no high-quality experimental studies that examine this issue, with a paucity of guidance for clinicians. Pre-clinical studies lead research in this field and can contribute to knowledge and support future clinical practice. Objective: to evaluate the effect of early compared to no mobilisation on pathophysiological and functional outcomes in animals with induced SCI.

Methods: A systematic review with meta-analysis was conducted by searching pre-clinical literature in MEDLINE (PubMed), Embase (Ovid), Web of Science, OpenGrey, and EThOS (June 2023). Studies were included of any research method giving numerical results comparing pathophysiological and functional outcomes in rats and mice mobilised within 14-days of induced SCI to those that did not mobilise. Data were synthesised using random-effects meta-analyses. The quality of the evidence was assessed using the CAMARADES checklist. The certainty of findings was reported using the GRADE approach. This study is registered on PROSPERO (CRD42023437494).

Results: Seventeen studies met the inclusion criteria. Outcomes found that Brain Derived Neurotrophic Factor levels were greater in those that initiated mobilisation within 14-days of SCI compared to the groups that did not. Mobilisation initiated within 14-days of SCI was also associated with statistically significant functional gains: (Basso, Beattie and Bresnahan locomotor rating score (BBB) = 2.13(0–21), CI 1.43, 2.84, Ladder Rung Walking Task = − 12.38(0–100), CI 20.01, − 4.76). Meta-analysis identified the greatest functional gains when mobilisation was initiated within 3 days of SCI (BBB = 3.00, CI 2.31–3.69, p < 0.001), or when delivered at low intensity (BBB = 2.88, CI 2.03–3.70, p < 0.001). Confidence in the findings from this review was low to moderate due to the risk of bias and mixed methodological quality.

Conclusion: Mobilisation instigated within 14-days of injury, may be an effective way of improving functional outcomes in animal models following SCI, with delays potentially detrimental to recovery. Outcomes from this study support further research in this field to guide future clinical practice.

Funding

National Rehabilitation Centre (NRC), Loughborough, UK

History

School

  • Sport, Exercise and Health Sciences

Published in

BMC Neuroscience

Volume

25

Publisher

BMC

Version

  • VoR (Version of Record)

Rights holder

© The Author(s)

Publisher statement

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Acceptance date

2024-03-11

Publication date

2024-03-25

Copyright date

2024

ISSN

1471-2202

eISSN

1471-2202

Language

  • en

Depositor

Prof Vicky Tolfrey. Deposit date: 19 March 2024

Article number

20

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