# Rehabilitation of the lower extremities, standing and walking function in people with spinal cord injury or disease: Guideline of the German-Speaking Medical Society for Spinal Cord Injury

## TL;DR

This guideline updates recommendations for rehabilitating standing and walking in people with spinal cord injuries or diseases, based on the latest evidence and expert consensus.

## Contribution

The paper provides an updated clinical practice guideline with 25 recommendations for rehabilitation of lower extremities in SCI/D patients.

## Key findings

- Nine thousand eight hundred seventy-one studies were reviewed, with four systematic reviews and eleven primary studies used for recommendations.
- Twenty recommendations were based on literature, while five were based on expert consensus due to limited evidence for interventions.
- There is a lack of scientific evidence supporting many clinically used rehabilitation interventions.

## Abstract

According of the level and severity of the spinal cord injury or disease (SCI/D), and the impairment of motor, sensory, and autonomic functions, individuals with SCI/D recover some standing and walking capabilities. To increase quality of rehabilitation and use newest evidence, the clinical practice guideline (CPG) “S2e-Guideline Rehabilitation of lower extremities, standing and walking function in people with SCI/D” of the German speaking Medical Association for Paraplegiology (DMGP) was updated.

Following a multi-tiered approach systematic searches were conducted to identify appropriate literature. For this purpose, the Databases PubMed, EMBASE, Cochrane Library and PEDro were searched. Recommendations on assessments were grouped to the categories “activity and participation” or “body functions/body structures”. Recommendations on interventions were labeled with outcomes standing, walking, strength, range of motion, pain and muscle tonus.

In total, 9,871 studies were identified during the search. Of these, four systematic reviews and eleven primary studies were utilized in composing the recommendations. A total of 25 recommendations were made, with 20 derived from the literature and 5 based on expert consensus. In total 14 functional assessments and 11 rehabilitation interventions became compiled. The assembled recommendations regarding assessments could be well built on published literature, while overall there is a paucity of literature proofing the evidence of specific interventions used in clinical practice. Therefore, the expertise of the international expert group and input from patient representatives were pivotal.

The method of an evidence-based guideline was sufficient for the recommendation of functional assessments but showed the need scientific clarification in the field of clinically established interventions.