Pub Date : 2025-08-18DOI: 10.1038/s41393-025-01113-w
Samuel David Williamson, Maria Zofia Geisler, Randi Kjær Steensgaard, Knærke Søgaard, Søren Steen Nielsen, Line Trine Dalsgaard, Sophie Lykkegaard Ravn
Systematic scoping review. Pressure injuries (PI) are a serious but mostly preventable complication associated with living with spinal cord injuries (SCI). This review aims to identify and summarize evidence concerning self-managed digital technologies for preventing PI in the SCI population. A systematic search was performed across seven databases—Embase, Medline, PsycInfo, Web of Science, Scopus, CENTRAL, and CINAHL. To be eligible, studies had to be peer-reviewed and report original findings on self-managed digital technologies for PI prevention in adults (≥18 years) with SCI. Supplementary searches were conducted using Google Scholar, PEDro, and citation tracking to locate relevant studies not identified by the systematic search. Data from the included studies were extracted and synthesized. The systematic search identified 9797 unique studies. After screening and excluding 8939 records at the title-and-abstract level, 858 full-text records were assessed, and 12 met the inclusion criteria. The included studies fell into categories: (i) technology-driven feedback systems that provide real-time pressure distribution data and (ii) digital self-management and educational systems aimed at improving adherence to PI-preventive measures. Feedback systems were associated with improved pressure-relieving behaviours, though adherence to reminder-based interventions remained a challenge. Digital self-management tools were shown to enhance knowledge and confidence related to PI prevention. Self-managed digital technologies increased awareness, confidence, and engagement in pressure relief behaviours among individuals with SCI. However, their direct impact on PI prevention remains inconclusive. Difficulties relating to adherence indicate that such technologies should complement, rather than replace, traditional prevention strategies.
研究设计：系统的范围评估。目的：压迫性损伤（PI）是一种严重但大多可预防的与脊髓损伤（SCI）相关的并发症。本综述旨在识别和总结有关自我管理数字技术在SCI人群中预防PI的证据。方法：在embase、Medline、PsycInfo、Web of Science、Scopus、CENTRAL和CINAHL 7个数据库中进行系统检索。为了符合资格，研究必须经过同行评审，并报告SCI成人（≥18岁）自我管理数字技术预防PI的原始发现。使用谷歌Scholar、PEDro和引文跟踪进行补充检索，以定位未被系统检索识别的相关研究。从纳入的研究中提取并合成数据。结果：系统检索发现9797个独特的研究。在标题和摘要水平筛选并排除8939条记录后，评估了858条全文记录，其中12条符合纳入标准。纳入的研究分为以下几类：(i)提供实时压力分布数据的技术驱动的反馈系统；（ii）旨在提高遵守pi预防措施的数字自我管理和教育系统。反馈系统与改善的减压行为有关，尽管坚持以提醒为基础的干预措施仍然是一个挑战。数字自我管理工具被证明可以增强与PI预防相关的知识和信心。结论：自我管理的数字技术提高了SCI患者减压行为的意识、信心和参与度。然而，它们对预防PI的直接影响仍不确定。与坚持有关的困难表明，这些技术应该补充而不是取代传统的预防战略。
{"title":"Self-managed digital technologies for pressure injury prevention in individuals with spinal cord injury: a systematic scoping review","authors":"Samuel David Williamson, Maria Zofia Geisler, Randi Kjær Steensgaard, Knærke Søgaard, Søren Steen Nielsen, Line Trine Dalsgaard, Sophie Lykkegaard Ravn","doi":"10.1038/s41393-025-01113-w","DOIUrl":"10.1038/s41393-025-01113-w","url":null,"abstract":"Systematic scoping review. Pressure injuries (PI) are a serious but mostly preventable complication associated with living with spinal cord injuries (SCI). This review aims to identify and summarize evidence concerning self-managed digital technologies for preventing PI in the SCI population. A systematic search was performed across seven databases—Embase, Medline, PsycInfo, Web of Science, Scopus, CENTRAL, and CINAHL. To be eligible, studies had to be peer-reviewed and report original findings on self-managed digital technologies for PI prevention in adults (≥18 years) with SCI. Supplementary searches were conducted using Google Scholar, PEDro, and citation tracking to locate relevant studies not identified by the systematic search. Data from the included studies were extracted and synthesized. The systematic search identified 9797 unique studies. After screening and excluding 8939 records at the title-and-abstract level, 858 full-text records were assessed, and 12 met the inclusion criteria. The included studies fell into categories: (i) technology-driven feedback systems that provide real-time pressure distribution data and (ii) digital self-management and educational systems aimed at improving adherence to PI-preventive measures. Feedback systems were associated with improved pressure-relieving behaviours, though adherence to reminder-based interventions remained a challenge. Digital self-management tools were shown to enhance knowledge and confidence related to PI prevention. Self-managed digital technologies increased awareness, confidence, and engagement in pressure relief behaviours among individuals with SCI. However, their direct impact on PI prevention remains inconclusive. Difficulties relating to adherence indicate that such technologies should complement, rather than replace, traditional prevention strategies.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 9","pages":"492-498"},"PeriodicalIF":2.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1038/s41393-025-01088-8
Joanne V. Glinsky, Lisa A. Harvey, Keira E. Tranter, Leanne Rees, Mark McDonald, Brooke Wadsworth, Emilie Gollan, Verna Stavric, Jo Nunnerley, Jennifer Dunn, Deanne Wilson, Australian and New Zealand Clinical Practice Guidelines Consortium
Development of a Clinical Practice Guideline (CPG). To develop a CPG for the physiotherapy management of people with Spinal Cord Injuries (SCI). Australia and New Zealand. Systematic reviews of randomised controlled trials (RCTs) of physiotherapy interventions for adults with SCI were conducted to address over 100 clinical questions. Questions were decided a priori and written in PICO format (Participant, Intervention, Comparison and Outcome). Meta-analyses were conducted across trials that made similar comparisons. A Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence certainty and formulate recommendations. A Guideline panel made evidence recommendations and consensus-based opinion statements based on a standardised process that included voting. Seventy-six RCTs met the inclusion criteria for the systematic reviews. These RCTs informed 20 meta-analyses that were used in the development of the CPG. More than one hundred evidence recommendations and consensus-based opinion statements across 13 categories of physiotherapy interventions were made by the panel. The Australian and New Zealand CPG for the Physiotherapy Management of people with SCI provide clear and readily accessible guidance to physiotherapists based on evidence and consensus of clinical experts. The Guideline is available at www.sciptguide.com .
{"title":"An Australian and New Zealand clinical practice guideline for the physiotherapy management of people with spinal cord injuries","authors":"Joanne V. Glinsky, Lisa A. Harvey, Keira E. Tranter, Leanne Rees, Mark McDonald, Brooke Wadsworth, Emilie Gollan, Verna Stavric, Jo Nunnerley, Jennifer Dunn, Deanne Wilson, Australian and New Zealand Clinical Practice Guidelines Consortium","doi":"10.1038/s41393-025-01088-8","DOIUrl":"10.1038/s41393-025-01088-8","url":null,"abstract":"Development of a Clinical Practice Guideline (CPG). To develop a CPG for the physiotherapy management of people with Spinal Cord Injuries (SCI). Australia and New Zealand. Systematic reviews of randomised controlled trials (RCTs) of physiotherapy interventions for adults with SCI were conducted to address over 100 clinical questions. Questions were decided a priori and written in PICO format (Participant, Intervention, Comparison and Outcome). Meta-analyses were conducted across trials that made similar comparisons. A Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence certainty and formulate recommendations. A Guideline panel made evidence recommendations and consensus-based opinion statements based on a standardised process that included voting. Seventy-six RCTs met the inclusion criteria for the systematic reviews. These RCTs informed 20 meta-analyses that were used in the development of the CPG. More than one hundred evidence recommendations and consensus-based opinion statements across 13 categories of physiotherapy interventions were made by the panel. The Australian and New Zealand CPG for the Physiotherapy Management of people with SCI provide clear and readily accessible guidance to physiotherapists based on evidence and consensus of clinical experts. The Guideline is available at www.sciptguide.com .","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 9","pages":"470-476"},"PeriodicalIF":2.2,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-09DOI: 10.1038/s41393-025-01112-x
Chien-Po Liu, Shin-Liang Pan
Retrospective cohort study. To assess the relative risk of osteoarthritis (OA) in individuals with newly diagnosed spinal cord injury (SCI) compared to a matched non-SCI group. Taiwan’s Longitudinal Health Insurance Database. We identified 1373 individuals aged 20–69 years with newly diagnosed SCI between 2002 and 2005 as the SCI group. A propensity-score-matched non-SCI group (N = 5492) with similar baseline demographic and clinical characteristics was selected for comparison. Both groups were followed until December 2011. OA-free survival was analyzed via Kaplan-Meier curves, and the association between SCI and OA risk was evaluated via stratified Cox proportional-hazards regression. To assess temporal risk variations, we performed landmark analysis with a 1-year cutoff, dividing follow-up into early (0–1 year) and long-term (≥1 year) periods. The respective incidence rates of OA for the SCI and non-SCI groups were 45.4 per 1000 person-years (95% confidence interval [CI], 40.1–50.1) and 31.6 per 1000 person-years (95% CI, 29.8–33.4). The hazard ratio of OA for the SCI group, as compared to the non-SCI group, was 1.52 (95% CI 1.34–1.72, p < 0.0001). This population-based longitudinal follow-up study indicates that there is an increased long-term risk of OA in persons with SCI, underscoring the need for clinical vigilance and early diagnostic measures in this population. Further research is needed to explore the mechanisms underlying the association between these two conditions.
{"title":"Increased risk of osteoarthritis in persons with spinal cord injury: a population-based longitudinal follow-up study in Taiwan","authors":"Chien-Po Liu, Shin-Liang Pan","doi":"10.1038/s41393-025-01112-x","DOIUrl":"10.1038/s41393-025-01112-x","url":null,"abstract":"Retrospective cohort study. To assess the relative risk of osteoarthritis (OA) in individuals with newly diagnosed spinal cord injury (SCI) compared to a matched non-SCI group. Taiwan’s Longitudinal Health Insurance Database. We identified 1373 individuals aged 20–69 years with newly diagnosed SCI between 2002 and 2005 as the SCI group. A propensity-score-matched non-SCI group (N = 5492) with similar baseline demographic and clinical characteristics was selected for comparison. Both groups were followed until December 2011. OA-free survival was analyzed via Kaplan-Meier curves, and the association between SCI and OA risk was evaluated via stratified Cox proportional-hazards regression. To assess temporal risk variations, we performed landmark analysis with a 1-year cutoff, dividing follow-up into early (0–1 year) and long-term (≥1 year) periods. The respective incidence rates of OA for the SCI and non-SCI groups were 45.4 per 1000 person-years (95% confidence interval [CI], 40.1–50.1) and 31.6 per 1000 person-years (95% CI, 29.8–33.4). The hazard ratio of OA for the SCI group, as compared to the non-SCI group, was 1.52 (95% CI 1.34–1.72, p < 0.0001). This population-based longitudinal follow-up study indicates that there is an increased long-term risk of OA in persons with SCI, underscoring the need for clinical vigilance and early diagnostic measures in this population. Further research is needed to explore the mechanisms underlying the association between these two conditions.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 9","pages":"508-513"},"PeriodicalIF":2.2,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-06DOI: 10.1038/s41393-025-01111-y
Jasmin L. Mahler, Judith J. W. van Beek, Jens Wöllner, Jörg Krebs, Jürgen Pannek
Systematic review. To create an overview of standardized assessments to evaluate sexuality after SCI/D in a systematic literature review. Furthermore, we explored the various dimensions of sexuality assessed by these tools and analyzed sex and gender differences. In a systematic review (PROSPERO CRD42023416855), we reviewed published assessments of sexuality in individuals with SCI/D with a focus on differences between women and men. The comprehensive search was conducted in PUBMED, Medline, CINAHL and psychINFO in March 2023. The extracted publications were grouped and analyzed according to their objectives. A total of 264 papers were included in the analysis and divided into three categories: “physiological aspects of sexuality”, “psychological aspects of sexuality”, and “sexual adjustment”. Most assessments of sexuality after SCI/D concern physiological aspects (n = 176, 66.7%). Fewer studies focus on psychological aspects (n = 49, 18.6%), and sexual adjustment (n = 39, 14.8%) is the least investigated topic. More research has been published on men’s compared to women’s sexuality (n = 195, 73.9% versus n = 125, 47.3%). In men, the most frequently used standardized assessment is the International Index for Erectile Function (IIEF). In women, the equivalent to the IIEF, the Female Sexual Function Index (FSFI), is most frequently used. Most assessments focus primarily on sexual function in men. New assessments are needed to address other aspects of sexuality as well. Furthermore, more research on female sexuality is needed.
{"title":"Sexual function is the most commonly investigated aspect of sexuality in individuals with spinal cord injury or disease – a systematic review","authors":"Jasmin L. Mahler, Judith J. W. van Beek, Jens Wöllner, Jörg Krebs, Jürgen Pannek","doi":"10.1038/s41393-025-01111-y","DOIUrl":"10.1038/s41393-025-01111-y","url":null,"abstract":"Systematic review. To create an overview of standardized assessments to evaluate sexuality after SCI/D in a systematic literature review. Furthermore, we explored the various dimensions of sexuality assessed by these tools and analyzed sex and gender differences. In a systematic review (PROSPERO CRD42023416855), we reviewed published assessments of sexuality in individuals with SCI/D with a focus on differences between women and men. The comprehensive search was conducted in PUBMED, Medline, CINAHL and psychINFO in March 2023. The extracted publications were grouped and analyzed according to their objectives. A total of 264 papers were included in the analysis and divided into three categories: “physiological aspects of sexuality”, “psychological aspects of sexuality”, and “sexual adjustment”. Most assessments of sexuality after SCI/D concern physiological aspects (n = 176, 66.7%). Fewer studies focus on psychological aspects (n = 49, 18.6%), and sexual adjustment (n = 39, 14.8%) is the least investigated topic. More research has been published on men’s compared to women’s sexuality (n = 195, 73.9% versus n = 125, 47.3%). In men, the most frequently used standardized assessment is the International Index for Erectile Function (IIEF). In women, the equivalent to the IIEF, the Female Sexual Function Index (FSFI), is most frequently used. Most assessments focus primarily on sexual function in men. New assessments are needed to address other aspects of sexuality as well. Furthermore, more research on female sexuality is needed.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 10","pages":"523-529"},"PeriodicalIF":2.2,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1038/s41393-025-01109-6
Phantira Techaworarak, Aitthanatt C. Eitivipart, Sintip Pattanakuhar, Pooriput Waongenngarm
Psychometric study. To introduce a novel, simple, tele-assessment tool designed to report the level and severity of spinal cord injury (SCI) and to assess its reliability and validity. Two academic-affiliated rehabilitation facilities in Thailand. The Tele-Neurological Assessment for the level, severity, and completeness of Spinal Cord Injury (TNASCI) was designed to assess the SCI level and severity according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) using telecommunication. This study comprised three phases: (1) the development process involving three experts using the Delphi method, (2) a face validity examination of each TNASCI item’s comprehension and suitability, and (3) an evaluation of the concurrent validity, intra-rater reliability, and inter-rater reliability using data from 40 participants with chronic SCI (>12 months post-injury). The Thai version of TNASCI, was developed to contain four sections, including sensory, motor, anorectal function, and summary sections to determine the SCI level and severity grade. The assessment tool exhibited good face validity. When compared with the ISNCSCI, the TNASCI showed good to excellent inter-rater and intra-rater reliability, with an intraclass correlation coefficient (ICC) (2,1) of 0.791–0.941 and an ICC (3,1) of 0.785–1.00, and good to excellent validity in almost all sections except for the sensory-related components (r = 0.764–0.986). Our TNASCI tool, which was assessed by trained clinicians, demonstrated acceptable inter-rater and intra-rater reliability, face validity, and concurrent validity. It serves as an alternative tool to evaluate the SCI level and severity predominantly in people with chronic, motor-complete SCI who cannot be evaluated using the hands-on ISNCSCI in person. However, this study is an initial step in validating a novel tele-assessment tool, with future studies needed to confirm its utility in other conditions and settings.
{"title":"Development of the tele-neurological assessment for the level, severity, and completeness of spinal cord injury (TNASCI): reliability and validity","authors":"Phantira Techaworarak, Aitthanatt C. Eitivipart, Sintip Pattanakuhar, Pooriput Waongenngarm","doi":"10.1038/s41393-025-01109-6","DOIUrl":"10.1038/s41393-025-01109-6","url":null,"abstract":"Psychometric study. To introduce a novel, simple, tele-assessment tool designed to report the level and severity of spinal cord injury (SCI) and to assess its reliability and validity. Two academic-affiliated rehabilitation facilities in Thailand. The Tele-Neurological Assessment for the level, severity, and completeness of Spinal Cord Injury (TNASCI) was designed to assess the SCI level and severity according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) using telecommunication. This study comprised three phases: (1) the development process involving three experts using the Delphi method, (2) a face validity examination of each TNASCI item’s comprehension and suitability, and (3) an evaluation of the concurrent validity, intra-rater reliability, and inter-rater reliability using data from 40 participants with chronic SCI (>12 months post-injury). The Thai version of TNASCI, was developed to contain four sections, including sensory, motor, anorectal function, and summary sections to determine the SCI level and severity grade. The assessment tool exhibited good face validity. When compared with the ISNCSCI, the TNASCI showed good to excellent inter-rater and intra-rater reliability, with an intraclass correlation coefficient (ICC) (2,1) of 0.791–0.941 and an ICC (3,1) of 0.785–1.00, and good to excellent validity in almost all sections except for the sensory-related components (r = 0.764–0.986). Our TNASCI tool, which was assessed by trained clinicians, demonstrated acceptable inter-rater and intra-rater reliability, face validity, and concurrent validity. It serves as an alternative tool to evaluate the SCI level and severity predominantly in people with chronic, motor-complete SCI who cannot be evaluated using the hands-on ISNCSCI in person. However, this study is an initial step in validating a novel tele-assessment tool, with future studies needed to confirm its utility in other conditions and settings.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 9","pages":"499-507"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-23DOI: 10.1038/s41393-025-01110-z
Toby O. Smith, Christopher Newton, Ayshea Farrell, Jithy Boby, Jonathan Dove, Fiona Dove, Kelly Turner, Benjamin M. Davies
Systematic Literature Review & Patient-Information Scoping Review To assess the evidence on prehabilitation and post-operative rehabilitation interventions for people undergoing surgery for degenerative cervical myelopathy (DCM) and to determine what publicly accessible information is provided to patients from the NHS surrounding DCM surgery. A systematic literature review was searched from inception to 19 May 2025. Studies reporting pain, function, disability or quality of life for prehabilitation or post-operative rehabilitation interventions for people undergoing DCM surgery were eligible. Downs and Black appraisal tool was used to assess study quality. Data were analysed in a narrative analysis. Secondary, a review of UK NHS Patient Information Documents (PID) was searched using a Google platform assessment. PID reporting prehabilitation or post-operative information for people awaiting DCM surgery were included. The type of information being provided were extracted and descriptive statistics were used to report frequency of information provision. From 5218 screened studies, six studies (n = 685) met the eligibility criteria. The evidence was low to moderate in quality. Rehabilitation offered demonstrated improved clinical outcomes but there was limited evidence compared to non-rehabilitation or superiority between different rehabilitation strategies. The PID review identified 38 documents. This indicates education and guidance is commonly offered on returning to work (68%), driving (76%) and normal activities of daily living (63%). There remains uncertainty on what should be and is offered to patients with DCM in respect to prehabilitation or post-operative rehabilitation. Robust clinical trial evidence on rehabilitation approaches for this population is needed. PROSPERO (CRD42024604184).
{"title":"Rehabilitation for degenerative cervical myelopathy: systematic review and scoping review of UK patient information","authors":"Toby O. Smith, Christopher Newton, Ayshea Farrell, Jithy Boby, Jonathan Dove, Fiona Dove, Kelly Turner, Benjamin M. Davies","doi":"10.1038/s41393-025-01110-z","DOIUrl":"10.1038/s41393-025-01110-z","url":null,"abstract":"Systematic Literature Review & Patient-Information Scoping Review To assess the evidence on prehabilitation and post-operative rehabilitation interventions for people undergoing surgery for degenerative cervical myelopathy (DCM) and to determine what publicly accessible information is provided to patients from the NHS surrounding DCM surgery. A systematic literature review was searched from inception to 19 May 2025. Studies reporting pain, function, disability or quality of life for prehabilitation or post-operative rehabilitation interventions for people undergoing DCM surgery were eligible. Downs and Black appraisal tool was used to assess study quality. Data were analysed in a narrative analysis. Secondary, a review of UK NHS Patient Information Documents (PID) was searched using a Google platform assessment. PID reporting prehabilitation or post-operative information for people awaiting DCM surgery were included. The type of information being provided were extracted and descriptive statistics were used to report frequency of information provision. From 5218 screened studies, six studies (n = 685) met the eligibility criteria. The evidence was low to moderate in quality. Rehabilitation offered demonstrated improved clinical outcomes but there was limited evidence compared to non-rehabilitation or superiority between different rehabilitation strategies. The PID review identified 38 documents. This indicates education and guidance is commonly offered on returning to work (68%), driving (76%) and normal activities of daily living (63%). There remains uncertainty on what should be and is offered to patients with DCM in respect to prehabilitation or post-operative rehabilitation. Robust clinical trial evidence on rehabilitation approaches for this population is needed. PROSPERO (CRD42024604184).","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 9","pages":"482-491"},"PeriodicalIF":2.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-18DOI: 10.1038/s41393-025-01104-x
Amir Azimi, Amirmohammad Toloui, Mohammadhossein Mozafarybazargany, Mohammad Kiah, Hamed Zarei, Parsa Paridari, Sajjad Jabermoradi, Donya Pourkand, Hamzah Adel Ramawad, Alexander R. Vaccaro, Mostafa Hosseini, Mahmoud Yousefifard, Vafa Rahimi-Movaghar
An Umbrella Review and Meta-analysis. This umbrella review and meta-analysis aims to evaluate the efficacy of stem cell therapy for locomotion recovery and neuropathic pain alleviation in rodent models of spinal cord injury (SCI). A comprehensive literature search was conducted in Medline, Embase, Scopus, and Web of Science until May 2024 to identify systematic reviews/meta-analyses on stem cell therapy for SCI. Original studies from these reviews were screened based on the predefined inclusion criteria. Data on locomotion, thermal hyperalgesia, and mechanical allodynia were extracted. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated and pooled to determine overall effect sizes. Subgroup analyses and meta-regressions were performed to investigate the optimal conditions for efficacy in each stem cell type. 31 systematic reviews/meta-analyses with 323 original studies (516 experiments, 11,290 rodents) were included. Significant locomotion recovery was observed across stem cell types, with umbilical cord-derived mesenchymal stem cells (U-MSCs) (SMD = 2.34, 95% CI 1.76–2.93) and oligodendrocyte progenitor cells (OPCs) (SMD = 2.14, 95% CI 1.24–3.03) demonstrating superior efficacy. Only bone marrow-derived mesenchymal stem cells (BM-MSCs) alleviated mechanical allodynia (SMD = 1.33, 95% CI 0.61–2.05). Subgroup analysis showed that the efficacy of stem cell therapy is dependent on injury models, injury to treatment interval, stem cell dosage, and use of antibiotics/immunosuppressants. The certainty of evidence assessment showed high certainty for U-MSC in locomotion recovery, medium for BM-MSC in pain alleviation, and low for OPCs in locomotion recovery. With moderate-to-high certainty, our study demonstrated superior efficacy of mesenchymal stem cells, particularly U-MSCs, when administered immediately post-injury at lower doses without antibiotics for locomotion recovery and BM-MSCs for pain alleviation. These findings suggest further clinical investigation of these stem cell types under optimal conditions.
研究设计：概括性回顾和荟萃分析。目的：本综述和荟萃分析旨在评估干细胞治疗对脊髓损伤（SCI）啮齿动物运动恢复和神经性疼痛缓解的疗效。方法：在Medline， Embase， Scopus和Web of Science中进行全面的文献检索，直到2024年5月，以确定干细胞治疗SCI的系统综述/荟萃分析。根据预先确定的纳入标准对这些综述中的原始研究进行筛选。提取运动、热痛觉过敏和机械异常性痛的数据。计算95%置信区间（ci）的标准化平均差（SMD）并汇总以确定总体效应大小。进行亚组分析和元回归，以研究每种干细胞类型的最佳疗效条件。结果：纳入31项系统综述/荟萃分析，涉及323项原始研究（516项实验，11,290只啮齿动物）。不同类型的干细胞均可显著恢复运动能力，其中脐带来源的间充质干细胞（U-MSCs） （SMD = 2.34, 95% CI 1.76-2.93）和少突胶质细胞祖细胞（OPCs） （SMD = 2.14, 95% CI 1.24-3.03）表现出较好的疗效。只有骨髓间充质干细胞（BM-MSCs）能缓解机械异常性痛（SMD = 1.33, 95% CI 0.61-2.05）。亚组分析显示，干细胞治疗的疗效取决于损伤模型、损伤治疗间隔、干细胞剂量和抗生素/免疫抑制剂的使用。证据评估的确定性显示，U-MSC在运动恢复方面的确定性为高，BM-MSC在缓解疼痛方面的确定性为中等，OPCs在运动恢复方面的确定性为低。结论：在中等至高的确定性下，我们的研究证明了间充质干细胞，特别是U-MSCs，在损伤后立即给予低剂量无抗生素的运动恢复和BM-MSCs缓解疼痛的卓越功效。这些发现提示在最佳条件下对这些干细胞类型进行进一步的临床研究。
{"title":"Stem cell therapy for locomotion recovery and neuropathic pain alleviation in spinal cord injury: an umbrella review and meta-analysis","authors":"Amir Azimi, Amirmohammad Toloui, Mohammadhossein Mozafarybazargany, Mohammad Kiah, Hamed Zarei, Parsa Paridari, Sajjad Jabermoradi, Donya Pourkand, Hamzah Adel Ramawad, Alexander R. Vaccaro, Mostafa Hosseini, Mahmoud Yousefifard, Vafa Rahimi-Movaghar","doi":"10.1038/s41393-025-01104-x","DOIUrl":"10.1038/s41393-025-01104-x","url":null,"abstract":"An Umbrella Review and Meta-analysis. This umbrella review and meta-analysis aims to evaluate the efficacy of stem cell therapy for locomotion recovery and neuropathic pain alleviation in rodent models of spinal cord injury (SCI). A comprehensive literature search was conducted in Medline, Embase, Scopus, and Web of Science until May 2024 to identify systematic reviews/meta-analyses on stem cell therapy for SCI. Original studies from these reviews were screened based on the predefined inclusion criteria. Data on locomotion, thermal hyperalgesia, and mechanical allodynia were extracted. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated and pooled to determine overall effect sizes. Subgroup analyses and meta-regressions were performed to investigate the optimal conditions for efficacy in each stem cell type. 31 systematic reviews/meta-analyses with 323 original studies (516 experiments, 11,290 rodents) were included. Significant locomotion recovery was observed across stem cell types, with umbilical cord-derived mesenchymal stem cells (U-MSCs) (SMD = 2.34, 95% CI 1.76–2.93) and oligodendrocyte progenitor cells (OPCs) (SMD = 2.14, 95% CI 1.24–3.03) demonstrating superior efficacy. Only bone marrow-derived mesenchymal stem cells (BM-MSCs) alleviated mechanical allodynia (SMD = 1.33, 95% CI 0.61–2.05). Subgroup analysis showed that the efficacy of stem cell therapy is dependent on injury models, injury to treatment interval, stem cell dosage, and use of antibiotics/immunosuppressants. The certainty of evidence assessment showed high certainty for U-MSC in locomotion recovery, medium for BM-MSC in pain alleviation, and low for OPCs in locomotion recovery. With moderate-to-high certainty, our study demonstrated superior efficacy of mesenchymal stem cells, particularly U-MSCs, when administered immediately post-injury at lower doses without antibiotics for locomotion recovery and BM-MSCs for pain alleviation. These findings suggest further clinical investigation of these stem cell types under optimal conditions.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"393-409"},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-14DOI: 10.1038/s41393-025-01106-9
Han Jiao, Jarne Jermei, Delaram Poormoghadam, Milan Dorscheidt, Sanne Wiekard, Andries Kalsbeek, Chun-Xia Yi
This study utilized male Wistar rats to investigate the effects of time-restricted feeding (TRF) on high-fat diet (HFD)-induced alterations in neuron-glial interactions and gene expression levels in the spinal cord (T5-T9). To evaluate whether TRF mitigates HFD-induced alterations in microglial morphology, astrocyte numbers, perineuronal net (PNN) integrity, purinergic receptor expression, inflammation and circadian rhythm-related gene expression in the spinal cord. Amsterdam University Medical Centers, location AMC, The Netherlands. Male Wistar rats were initially fed either a standard chow diet or a HFD ad libitum for 4 weeks. After this period, rats in the HFD group were further divided into two subgroups: continued HFD ad libitum or HFD with TRF for an additional 4 weeks. Rats in the chow group continued with ad libitum feeding throughout the experimental period. At the end of the intervention, spinal cords (T5–T9) were collected for analysis. Microglial morphology, astrocyte cell numbers, and PNN integrity were assessed in the spinal cord. Expression levels of purinergic receptors, inflammation and clock genes were analyzed to investigate neuron-glial interactions and circadian rhythm stabilization. TRF reduced microglial activation, preserved PNN integrity, suppressed HFD-induced upregulation of purinergic receptors, and stabilized circadian clock gene expression. These findings suggest that TRF is a promising non-pharmacological strategy to counteract obesogenic diet-induced perineuronal net degradation and neuroinflammation, highlighting its potential as a lifestyle-based intervention for pain management.
{"title":"Time-restricted feeding modulates neuron-glial interactions and circadian rhythm in the spinal cord of male Wistar rats fed a high-fat diet","authors":"Han Jiao, Jarne Jermei, Delaram Poormoghadam, Milan Dorscheidt, Sanne Wiekard, Andries Kalsbeek, Chun-Xia Yi","doi":"10.1038/s41393-025-01106-9","DOIUrl":"10.1038/s41393-025-01106-9","url":null,"abstract":"This study utilized male Wistar rats to investigate the effects of time-restricted feeding (TRF) on high-fat diet (HFD)-induced alterations in neuron-glial interactions and gene expression levels in the spinal cord (T5-T9). To evaluate whether TRF mitigates HFD-induced alterations in microglial morphology, astrocyte numbers, perineuronal net (PNN) integrity, purinergic receptor expression, inflammation and circadian rhythm-related gene expression in the spinal cord. Amsterdam University Medical Centers, location AMC, The Netherlands. Male Wistar rats were initially fed either a standard chow diet or a HFD ad libitum for 4 weeks. After this period, rats in the HFD group were further divided into two subgroups: continued HFD ad libitum or HFD with TRF for an additional 4 weeks. Rats in the chow group continued with ad libitum feeding throughout the experimental period. At the end of the intervention, spinal cords (T5–T9) were collected for analysis. Microglial morphology, astrocyte cell numbers, and PNN integrity were assessed in the spinal cord. Expression levels of purinergic receptors, inflammation and clock genes were analyzed to investigate neuron-glial interactions and circadian rhythm stabilization. TRF reduced microglial activation, preserved PNN integrity, suppressed HFD-induced upregulation of purinergic receptors, and stabilized circadian clock gene expression. These findings suggest that TRF is a promising non-pharmacological strategy to counteract obesogenic diet-induced perineuronal net degradation and neuroinflammation, highlighting its potential as a lifestyle-based intervention for pain management.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"437-443"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retrospective comparative study. To compare the surgical and clinical outcomes of ventral intradural extramedullary (IDEM) schwannomas to those of dorsal/lateral IDEM schwannomas. The single institution in Japan. This study included 94 patients with cervical or thoracic IDEM schwannomas who underwent tumor resection via a posterior approach between 2012 and 2022. Patients were categorized into Ventral (n = 12) and Dorsal/Lateral (n = 82) groups based on tumor localization. Demographic and surgical data, including surgical time and intraoperative motor evoked potential (MEP) changes, as well as clinical outcomes such as Japanese Orthopaedic Association (JOA) scores and gait function (modified McCormick scale, MMCS), were evaluated. The Ventral group had a significantly longer surgical time (p = 0.039) and was more likely to experience a temporary decrease in intraoperative MEP waveforms (p = 0.008) compared to the Dorsal/Lateral group. However, there were no significant differences between the groups in age at surgery, sex, level, tumor size, estimated blood loss, JOA score improvement, JOA recovery rate, or gait function at the final follow-up. Gross total resection (GTR) was achieved in all cases. Despite longer surgical times and more likely to experience a temporary decrease in intraoperative MEP waveforms, ventral IDEM schwannomas do not result in significantly worse surgical or clinical outcomes compared to dorsal/lateral IDEM schwannomas. These findings suggest that even if the surgical procedure requires longer, gross total resection of ventral schwannomas via a posterior approach is resulting in favorable treatment outcomes.
{"title":"Surgical and clinical outcomes of ventral versus dorsal/lateral intradural extramedullary schwannomas: a retrospective comparative study","authors":"Toshiki Okubo, Narihito Nagoshi, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1038/s41393-025-01105-w","DOIUrl":"10.1038/s41393-025-01105-w","url":null,"abstract":"Retrospective comparative study. To compare the surgical and clinical outcomes of ventral intradural extramedullary (IDEM) schwannomas to those of dorsal/lateral IDEM schwannomas. The single institution in Japan. This study included 94 patients with cervical or thoracic IDEM schwannomas who underwent tumor resection via a posterior approach between 2012 and 2022. Patients were categorized into Ventral (n = 12) and Dorsal/Lateral (n = 82) groups based on tumor localization. Demographic and surgical data, including surgical time and intraoperative motor evoked potential (MEP) changes, as well as clinical outcomes such as Japanese Orthopaedic Association (JOA) scores and gait function (modified McCormick scale, MMCS), were evaluated. The Ventral group had a significantly longer surgical time (p = 0.039) and was more likely to experience a temporary decrease in intraoperative MEP waveforms (p = 0.008) compared to the Dorsal/Lateral group. However, there were no significant differences between the groups in age at surgery, sex, level, tumor size, estimated blood loss, JOA score improvement, JOA recovery rate, or gait function at the final follow-up. Gross total resection (GTR) was achieved in all cases. Despite longer surgical times and more likely to experience a temporary decrease in intraoperative MEP waveforms, ventral IDEM schwannomas do not result in significantly worse surgical or clinical outcomes compared to dorsal/lateral IDEM schwannomas. These findings suggest that even if the surgical procedure requires longer, gross total resection of ventral schwannomas via a posterior approach is resulting in favorable treatment outcomes.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"410-417"},"PeriodicalIF":2.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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