Between 1940 and 2010, life expectancy doubled for people with spinal cord injury (SCI). In response to this survival trend, literature emerged examining how people grow older with SCI. While some authors posited that people with SCI age prematurely, others focused on the incidence of coexisting conditions over the course of an injury. These latter data are important in that they can help individuals with SCI, their care partners, and clinicians anticipate medical needs, but they fail to capture the subjective experience of aging with SCI. To date, no work has examined the complex health-related challenges that may attend longer standing injuries or whether and how the presentation and management of coexisting conditions change over time. Given this dearth of knowledge around the real-world experiences of aging with SCI, the authors hosted a community-focused, peer-led, Zoom-based conference addressing medical challenges specific to growing older with SCI. Focusing on bone health, chronic pain, blood pressure management, and neurogenic bladder, invited speakers presented cases and a moderator facilitated discussions between attendees. In this report, we summarize the concerns and questions that arose during the conference and propose topics for future investigation.
Background:Obstructive sleep apnea (OSA) is common among individuals with spinal cord injury (SCI). Whilst continuous positive airway pressure (CPAP) remains the primary treatment, adherence is low in SCI. Mandibular advancement devices (MADs) offer a viable alternative. Our prior research has demonstrated that MADs effectively treat moderate-to-severe OSA in chronic SCI. Objectives:To estimate adherence to MADs, report common side effects, and explore the barriers and enablers to using MADs from the perspectives of individuals with SCI. Methods:Individuals with chronic SCI with an apnea-hypopnea index (AHI) ≥15/hour received a custom-made MAD. They attended appointments at 1 week and 1, 3, and 6 months after treatment initiation. Questionnaires and semistructured interviews were completed to assess adherence and side effects and to explore the participants' experience of using MAD. Results:Forty participants were included, and 35 completed the study. After 1 month, 65% (26/40) met adherence criteria (≥4 hours/ night). At 6 months, adherence had increased to 70% (28/40). Adherent participants experienced significantly greater improvements in the AHI than nonadherent participants (19.4 ± 15.7 vs. 10.7 ± 5.2; P = .02). Motivating factors for accepting treatment included alleviating daytime fatigue and snoring and receiving care in the familiar rehabilitation facility. Temporary side effects, such as tooth discomfort or excessive salivation, were not reasons for discontinuation. Conclusion:MADs are an acceptable, well-tolerated treatment for OSA in SCI, with adherence rates approximately 3 times higher than reported for CPAP. Improving access to MADs could significantly increase the number of people with SCI being effectively treated for OSA.
Modern methods of data science have become powerful tools for analyzing complex, heterogeneous biomedical datasets, including those specific to spinal cord injury (SCI), enabling personalized predictions of recovery, identification of prognostic biomarkers, and insights into functional outcomes. This article summarizes the one-day Data Science Precourse, held at the 2025 annual scientific meeting of the American Spinal Injury Association (ASIA). The course was designed to illustrate advances in data science and their application to SCI research, while analyzing the unique challenges posed by SCI-specific data, such as sparse longitudinal measurements, variable injury characteristics, and diverse clinical and functional assessments. The precourse combined expert-led discussions with hands-on learning opportunities tailored for both clinical and data science audiences. Topics included addressing key challenges of artificial intelligence methods in SCI data analyses, such as learning from limited or incomplete datasets, implementing causal frameworks to understand recovery mechanisms, and ensuring robust and interpretable predictions for clinical decision-making. The event also showcased real-world applications of data science in SCI research, highlighting both solved and ongoing problems, including prognostic modeling, patient stratification, lesion analysis, and optimization of clinical trial design. The precourse culminated in the presentation by the winning teams of the 2025 ASIA Data Science Challenge.
Objectives:This study evaluated the feasibility and acceptability of an app-guided mindfulness meditation (MM) intervention compared to a health education (HE) control for individuals with spinal cord injury (SCI) and chronic pain. Methods:A pilot randomized controlled trial recruited 60 individuals with SCI and chronic pain from local SCI outpatient clinics, national registries, and community outreach. Participants were randomly assigned to MM or HE conditions. The intervention involved listening to either guided meditations or health-related talks on a mobile app for 10 minutes/day, 6 days/week, for 6 weeks. Feasibility was determined via benchmarks for recruitment (≥80% consent rate), adherence (≥70% use app ≥60 minutes/week for 6 weeks), and retention (≥70% complete follow-up assessments). Acceptability was determined if ≥70% of participants reported a score of ≥20 on a satisfaction questionnaire. Participants also completed ratings of pain intensity, interference, depression, and anxiety at baseline (T1), immediately post intervention (T2), and 6 weeks post intervention (T3). Results:A total of 93% of eligible participants consented, 76% completed T2, and 86% completed T3 assessments. Adherence rates fell below the benchmark for MM (63%) and HE (62%) but exceeded the benchmark when considering only participants who used the app at least once (MM, 71%; HE, 80%). Eighty-two percent of MM and 84% of HE scored ≥20 on the satisfaction questionnaire. Conclusion:A 6-week MM intervention using a no-cost, publicly available app is feasible and acceptable among people with SCI and chronic pain. Future research examining the efficacy of the MM intervention on pain and mood in this population is warranted.
The recently (2024) launched American Spinal Injury Association (ASIA) e-learning module UroSTeP: Urology course is getting a modern upgrade with artificial intelligence (AI)-based clinical cases developed to refine and cement knowledge acquisition. AI-based learning is not only accepted but is also required nowadays, and the conservatism of medicine is traditionally not conducive to early adoption. Here, we try to explain why and how it can be done.
Background:Wearables that allow core temperature to be monitored are an important development for athletes with spinal cord injury (SCI) due to their increased risk of suffering heat-related illness. Objectives:To assess the validity of the Calera® heat flux sensor compared to ingestible telemetric pills (BodyCap) for monitoring core temperature during a graded exercise test in individuals with SCI and non-SCI participants. Methods:Twenty-one participants were included (SCI, 12; non-SCI, 9). The participants conducted a graded exercise test that consisted of 3-minute stages with 1-minute rest intervals, and core temperature was continuously measured using ingestible telemetric pills and the Calera® heat flux sensor. Intraclass correlation coefficients (ICC) and bias were calculated to assess agreement between methods, with comparisons made between SCI and non-SCI groups. Results:In non-SCI participants, agreement between the methods was good [ICC = 0.65, P < .001; bias = 0.06 (0.22) °C; 95% CI 0.02 to 0.11 °C], while SCI participants showed poor agreement [ICC = -0.12, P = .93; bias = -0.11 (0.46) °C; 95% CI -0.19 to -0.03 °C]. The percentage of measurements where the mean difference between methods exceeded 0.3 °C was 15% in non-SCI participants and 42% in SCI participants. Conclusion:The Calera® heat flux sensor is not a valid tool for assessing core temperature in individuals with SCI in moderate thermal environments.
Background:Upper limb motor function is one of the most desired abilities of individuals with tetraplegia. Virtual reality-based exergaming is one of the advanced methods of supplementing conventional rehabilitation that enables the user to perform multiple repetitions of meaningful movements due to increased engagement and motivation, but adoption is often limited by high cost of procurement. Objectives:Due to a large user base of personal computers and smartphones, we tried to check the effectiveness of a novel computer-based exergame that can be administered using a personal computer and a smartphone. The computer is used to display the game, and the smartphone acts as a motion sensor-based controller for providing input to the game. Methods:Twenty individuals with spinal cord injury (C6-13, C7-7, AIS A = 14, AIS B = 3, AIS C = 1, AIS D = 2) with a mean age of 30.7 ± 12 years participated in the study. They were randomly allocated to 2 groups. Group A (n = 10) received 30 minutes of computer-based exergaming training 3 times a week for 4 weeks, and Group B (n = 10) received conventional rehabilitation only. Baseline and postintervention assessments were done using the American Spinal Injury Association upper extremity motor score (ASIA-UEMS), Jebsen-Taylor Hand Function Test (JTHFT), Capabilities of Upper Extremity Questionnaire (CUE-Q), Spinal Cord Independence Measure III (SCIM-III), and Spinal Cord Injury Quality of Life (SCI-QOL) by a blinded assessor, and results were analyzed using the IBM SPSS Statistics v30. Results:CUE-Q (P < .001), SCIM III (P < .001), SCI-QOL, and JTHFT lifting light objects and lifting heavy objects tasks in the dominant and nondominant hands and simulated feeding tasks in the dominant hand showed significant difference between the 2 groups. Exploratory analysis confirmed functional gains were independent of baseline severity or injury chronicity. However, no significant differences were seen in the ASIA-UEMS score (P = .060) and the fine motor function tasks of the JTHFT in the dominant and nondominant hands. Conclusion:The results of our study showed that computer-based exergaming is a safe and effective modality beneficial for improving gross upper limb motor function, functional independence, and quality of life in individuals with spinal cord injury as compared to conventional rehabilitation alone. Although, it produces similar results as conventional rehabilitation on upper extremity motor score and fine motor function.
Background:People with spinal cord injury (SCI) experience long-term physical, emotional, and social challenges. Although adaptive yoga may support physical function and psychosocial well-being, its integration into rehabilitation and community care remains limited. Objectives:To explore the experiences and perceptions of yoga for people with SCI, drawing perspectives from people with SCI, healthcare providers (HCPs), and certified yoga therapists. Methods:Using a qualitative descriptive approach, we conducted semi-structured interviews with 20 participants: people with SCI (n = 10), HCPs (n = 4), and certified yoga therapists (n = 6). Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Results:Four interconnected themes were identified. Breaking Barriers to Participation highlighted financial, transportation, and access-related challenges that limited engagement in adapted yoga. Meeting People Where They Are: Yoga Therapists' Adaptability in Action emphasized the importance of instructor adaptability and inclusive teaching practices, while also describing situations where limited instructor knowledge of SCI shifted the burden of adaptation onto participants. Perceiving Benefits of Doing Yoga captured participants' experiences of physical engagement, mind-body reconnection, emotional regulation, and social inclusion. Finally, Yoga as a Pathway to Long-Term Wellness and Community Integration reflected healthcare professionals' views of yoga as a potential bridge between rehabilitation and community living, alongside perceived barriers to confident recommendation and integration. Conclusion:Adaptive yoga was perceived as a promising person-centered and holistic approach for individuals with SCI. Addressing barriers related to training, access, and clinical pathways could support safer, more inclusive delivery. Cross-sector collaboration is key to embedding yoga into long-term wellness and rehabilitation systems.
Background:Young adults with spinal cord injury (SCI) face unique challenges during the transition to adulthood, including limited access to community-based programs that address participation, independence, and resilience. Objectives:To evaluate the pilot True Grit SCI program, a 5-day residential camp designed to support the transition to adulthood for young adults with SCI. Methods:This qualitatively driven, embedded mixed-methods study employed a realist evaluation framework guided by social cognitive theory. Six male participants with SCI (ages 16-20 years) attended the July 2024 pilot program. Quantitative measures included the Goal Attainment Scale (GAS), SCI-QOL Resilience Short Form, and Pediatric Measure of Participation (PMoP), administered at baseline and 3-month follow-up. Qualitative data were collected through semi-structured post-camp interviews. Data were analyzed descriptively and thematically, with integration through triangulation. Results:All participants demonstrated progress toward individualized goals, with mean GAS improvement of +1.67 (SD 0.82). Resilience outcomes varied, with 3 participants improving and 3 declining. Participation scores increased modestly, with the largest gains among those with lower baseline scores. Qualitative analysis identified 4 themes: building community and belonging, shared experiences foster confidence to try new things, overcoming barriers and redefining identity, and envisioning futures and inspiring others. Integration of findings demonstrated that peer-supported, structured programming both reinforced observed goal attainment and contextualized variable resilience outcomes. Conclusion:The evaluation of the True Grit SCI pilot suggests that short-term residential programming demonstrated the potential to promote resilience, participation, and self-efficacy among young adults with SCI. Variability in follow-up highlights the need for ongoing community supports to sustain gains.
Background:Assistive robots have the potential to mitigate the caregiver shortage crisis and increase independence for individuals with spinal cord injury (SCI). Advances in artificial intelligence (AI) have improved the capabilities of assistive robots, however they still lack evaluation outside of controlled laboratory settings. Objectives:To evaluate the technical performance, usability, and workload of an AI-enhanced robot-assisted feeding (RAF) system deployed in an inpatient SCI rehabilitation unit. Methods:RAF-HI, a system incorporating AI-based food detection, natural language communication, and mouth tracking, was integrated into a rehabilitation hospital. Two participants with SCI used the system to eat 8 modified hospital meals in their private rooms. System performance metrics (bite acquisition and transfer rates), usability (System Usability Scale [SUS]), workload (NASA Task Load Index [NASA-TLX]), and researcher interventions were recorded. Results:Across the meals, the system had an acquisition rate of 88.4% and a transfer rate of 87.4%, similar to state-of-the-art benchmarks. However, usability and workload scores among participants were poor (NASA-TLX 42.9, SUS 47.5), and frequent researcher interventions were required to keep the system operating (36 total, 4.5 per meal). Participants cited low adaptability and complex setup requirements as obstacles to usability and demonstrated responsibility over their comfort within the interaction. Conclusion:Our use of AI tools successfully achieved technical benchmarks in a hospital environment but fell short of achieving a truly independent meal. We argue advancing RAF systems toward human-inspired, situationally aware intelligence is necessary to translate technical capability into real-world clinical utility.
Background:While glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been effectively used for obesity management, their frequency of use has not been studied specifically in individuals with spinal cord injury (SCI). Objectives:This study aimed to determine if prescribing rates of GLP-1RAs in individuals with obesity differ between those with and without SCI. Design/Methods:This retrospective cohort study was conducted on the TriNetX, LLC platform with de-identified electronic health record data from over 60 US health care organizations. Two cohorts were analyzed for prescribing rates of GLP-1RAs within 5 years of meeting inclusion criteria. One group carried a diagnosis of obesity but not SCI while the other had obesity and SCI. Individuals with a prior history of bariatric surgery or GLP-1RA use were excluded. The 2 cohorts were balanced for age, gender, race, and type 2 diabetes mellitus. Results:In persons with obesity, SCI individuals had lower prescribing rates of GLP-1RAs (odds ratio [OR] 0.67, 95% CI 0.61-0.73) compared with non-SCI individuals. No significant differences in GLP-1RA prescribing rates were noted when comparing complete SCI or incomplete SCI individuals with persons without SCI. Individuals with complete SCI also had lower odds of receiving GLP-1RA prescriptions (OR 0.71, 95% CI 0.52-0.96) compared with incomplete SCI individuals. Conclusion:GLP-1RA prescribing rates are significantly lower in individuals with obesity and any degree of SCI compared with non-SCI individuals. Future studies will help elucidate factors that influence prescribing patterns.
Background: Recovery after spinal cord injury (SCI) is driven by a variety of factors, making SCI recovery prediction particularly suitable for data-driven modelling. The American Spinal Injury Association (ASIA) Engineering and Data Science Committee launched the first open SCI data science challenge focused on recovery prediction. Objectives: Hosted on Kaggle in 2025, the challenge addressed 2 tasks using data from the Sygen clinical trial ( N = 797): (1) predicting motor status as assessed by the International Standards for Neurological Classification of SCI (ISNCSCI; score: RMSE [root mean square error] between true and predicted motor scores), and (2) predicting walking function on the 8-point modified Benzel scale (score: Spearman's ρ ). Method: Eight teams participated in the motor status track and 14 in the walking function track. The winning solution (RMSE = 1.0) in the motor status track applied an ensemble of boosting models with multiple imputation and Bayesian hyperparameter optimization, whereas the winning solution in the walking function track (Spearman's ρ = 0.85) harnessed TabPFN, a pretrained transformer for tabular data, combined with feature engineering from early ISNCSCI assessments and auxiliary predictions of future motor scores. Results: Both approaches demonstrated competitive performance for SCI recovery prediction from acute phase assessments, despite modest dataset size and missing data. Both winning solutions further conducted an interpretability analysis, identifying key predictors consistent with clinical understanding of SCI recovery. Conclusion: This challenge highlights the value of publicly accessible formats, which encourage broader engagement of diverse audiences, for developing robust predictive models and provides a proof of concept for future initiatives leveraging larger, multicenter, multimodal datasets to improve personalized prognostication in SCI rehabilitation.
Background: Spinal cord injury (SCI) often leads to severe mobility impairments, necessitating intense rehabilitation to promote recovery and optimize outcomes. Overground robotic exoskeletons (ORE) are emerging gait training tools, but their capacity to elicit moderate-to-vigorous intensity (MVI) in subacute SCI is unclear. Objectives: To compare the intensity of usual care (UC) and ORE gait training in patients with subacute, motor incomplete SCI and examine the relationship between training intensity and walking function. Methods: A single-blind randomized controlled trial was conducted at an inpatient rehabilitation hospital. Patients ( n = 106) were age 51.5±18.5 years; 78.3% were male with severity of 17.9% AIS B, 28.3% AIS C, and 53.8% AIS D. Patients were randomized to UC or ORE gait training. Main outcomes were percentage of session time at MVI (>40% heart rate reserve [HRR]), rating of perceived exertion (RPE), step count, and change in Walking Index for Spinal Cord Injury (WISCI-II). Results: UC and ORE groups spent a similar percentage of session time in MVI (17.6% vs. 19.5%, P = .398) and had comparable step count (387.1 vs. 461.8 steps, P = .625). However, RPE was higher in UC (5.6 ± 1.9) versus ORE (4.5 ± 1.8, P = .003). Both groups increased step count over time with ORE achieving more steps early and UC later. Step count was moderately correlated with WISCI-II improvement ( r = 0.38-0.51, P < .001), while percentage of MVI demonstrated weak correlation ( r = 0.23, P = .032). Conclusions: UC and ORE provide similar physiologic dose, though ORE may offer intense training with less perceived effort. Step count appears to be an indicator of training intensity that correlates to functional recovery.
Background: Disease-specific registries that record patient data are crucial in supporting research, guiding best practices, and optimizing resource allocation. Since 2004, the Canadian Rick Hansen Spinal Cord Injury Registry (RHSCIR) has collected data from over 10,000 individuals with SCI. Objective: The primary objective of this study was to identify factors associated with consenting to RHSCIR and reasons for withdrawal to improve registry inclusivity and representativeness in persons with traumatic SCI (TSCI). Methods: This retrospective cohort study analyzed data from 4090 participants enrolled at RHSCIR acute facilities from 2009 to 2019. Participants were categorized into 3 groups: declined consent (DC), provided full consent (FC), or provided minimal consent and/or later withdrew consent (MWC). Due to the lack of available data for the DC group, descriptive and multivariable analyses focused on the FC and MWC groups to identify factors associated with full consent. Results: Of 4090 participants, 2998 (73.3%) were FC, and 856 (20.9%) were MWC. After adjusting for significant differences between the groups, older age and an absence of comorbidities were associated with a decreased likelihood of providing FC. Individuals living in the Atlantic provinces and Ontario showed a higher likelihood of FC than those in the Prairies. The primary reason for withdrawing was a lack of interest. Conclusion: This study identifies factors associated with participation and suggests strategies to increase recruitment and inclusivity in RHSCIR. By understanding registry participation, public health policies can be informed, resource allocation optimized, and patient care enhanced for individuals with TSCI.
Background: International Spinal Cord Injury (SCI) Data Sets have been developed and disseminated worldwide since 2006 to establish minimum standards for clinical data collection. Basic data sets (BDSs) are intended to ensure a uniform minimum level of information across clinical settings and research projects. In 2013, an International SCI Urinary Tract Infection (UTI) Basic Data Set was published. This BDS defined UTI using the 1992 US National Institute on Disability and Rehabilitation Research criteria: “new onset of symptoms plus bacteriuria, leukocyturia, and positive urine culture.” Since its publication, multiple new clinical and research definitions of UTI have emerged, creating the need for revision. Objectives: To update the International SCI UTI Basic Data Set to reflect contemporary consensus definitions and improve global consistency in clinical data collection. Methods: A qualitative, 3-phase revision process was conducted. Phase 1 involved a phenomenographic surface analysis of the content of the International SCI UTI, Lower Urinary Tract (LUT) Function, Urodynamics, and Core Data Sets, alongside items from the validated, patient-centered Urinary Symptom Questionnaires for Neurogenic Bladder (USQNB), which are differentiated by bladder management method (voiding, intermittent catheterization, and indwelling catheter). Phase 2 consisted of a member check-in during which preliminary findings from the surface analysis were reviewed and refined with a subject matter expert. Phase 3 involved structured discussion and consensus refinement by an international panel of subject matter experts. Results: The revision process produced an updated set of criteria for determining the likelihood of UTI in individuals with SCI, aligned with a recent (2024) international consensus study. A revised UTI Basic Data Set (version 2) was developed that includes 22 new variables intended to enhance the consistency and comparability of global clinical data collection; only 10 to 12 additional variables are required per case depending on bladder management method. Conclusion: The revised International SCI UTI Basic Data Set reflects contemporary consensus definitions and expands the scope of standardized variables, supporting more reliable and internationally harmonized clinical and research data collection for individuals with SCI.
Background:Spasticity is a common complication following traumatic spinal cord injury (TSCI) that impacts neurofunctional recovery. Objectives:This study aimed to determine the prevalence of acute and late spasticity and identify clinical predictors associated with spasticity onset within the first year after TSCI. Methods:We conducted a retrospective longitudinal cohort study involving 156 adults hospitalized for acute supraconal (C1-T12) TSCI at a level 1 trauma center from April 1, 2010, to December 31, 2021. Independent factors included demographic variables (age, sex, body mass index), trauma-related characteristics, and acute medical complications. Spasticity onset was categorized as acute (during acute hospitalization), late (after acute hospitalization within 1 year), or none. Multinomial logistic regression model was used to identify factors associated with the period of spasticity onset. Results:Among the patients, 57 (36.5%) developed acute spasticity (mean onset at 24.7 ± 13.7 days after admission), 55 (35.3%) experienced late spasticity, and 44 (28.2%) showed no spasticity within the first year. Higher AIS motor score at admission was associated with greater likelihood of either late or no spasticity (OR 1.05, P < .001; OR 1.02, P = .04). High-energy trauma increased the risk of developing acute spasticity (OR 0.37, P = .04). An AIS motor score below 50 (most severely impaired) at admission identified individuals at higher risk of acute spasticity, with 85.7% sensitivity and 71% overall accuracy. Conclusion:Greater injury severity and high-energy trauma are associated with early spasticity onset, highlighting the need for early risk stratification and personalized management strategies to optimize patient outcomes.
Objectives:To compare measures of pain intensity, pain interference, use of pain-coping strategies, conditioned pain modulation, inflammation, and subjective and social well-being in adults with spinal cord injury (SCI) and chronic neuropathic (NP) versus chronic musculoskeletal (MSK) pain. Methods:A natural groups, cross-sectional study design was used, with analyses of baseline data from the Exercise and Pain in Chronic Spinal Cord Injury (EPIC-SCI) trial (NCT04160858). The International Spinal Cord Injury Pain Basic Data Set (version 2.0) was administered during an interview to 35 men and 11 women with chronic SCI (M age 50.6, SD 14.1; M years post injury 16.5, SD 12.8). Participants completed standardized questionnaire measures of pain, pain coping, subjective well-being, and social well-being, provided a blood sample, and underwent conditioned pain modulation testing. Participants were grouped according to their primary pain problem: NP or MSK. Results:Participants whose primary pain problem was NP reported significantly greater pain intensity and pain-coping strategy use and showed more pain modulation and a different pattern of subjective well-being measures compared to participants with an MSK primary pain problem (Ps < .05). Differences in overall bodily pain and proinflammatory cytokine concentrations were medium to large, and differences in pain interference and social well-being were small and not statistically significant (Ps > .11). Conclusion:This is the first study to compare a comprehensive set of biopsychosocial variables across pain phenotypes in adults with chronic SCI. The results contribute to a deeper understanding of SCI pain phenotypes and their characteristics.
Background:Transcutaneous spinal cord stimulation (tSCS) is a noninvasive neuromodulation technique aimed at improving voluntary movement, autonomic function, spasticity, and other complications in individuals with spinal cord injury (SCI). Objectives:The objective of this scoping review is to evaluate reporting practices relating to safety, stimulation parameters, and outcomes among studies employing tSCS among persons living with SCI. Methods:CINAHL, EMBASE, PubMed, and Web of Science databases were searched for studies published up to December 2024. Eligible studies met these criteria: (1) full-length, English-language article; (2) SCI population aged 18+ years; and (3) tSCS intervention. Data extracted included study year, subject characteristics, design, outcomes, adverse events, and stimulation parameters. Results:Among 2267 studies retrieved from the search, 65 studies met inclusion criteria and were included for review. Of these, 13 (20%) were case studies, 14 (21.5%) were repeated measures, 18 (27.7%) were pre-post, and 20 (30.8%) were controlled trials. Missing stimulation parameters included total intervention time (20.0%), phase of tSCS (13.8%), and pulse width (12.3%). Less commonly omitted were stimulation frequency, time post SCI, total sessions, and session duration detail (all ≤4.6%). Repeated measures study design had the poorest overall reporting of parameters with intervention time missing in 57.1% (8 of 14) studies. Conclusion:These findings highlight a pattern of incomplete reporting across studies, particularly regarding intervention dosage parameters, which may limit the interpretability and reproducibility of results. A comprehensive reporting guide could improve study replication and ensure consistency in both research and clinical practice.
Introduction:Exercise intervention research involving people with spinal cord injury (SCI) has often excluded the perspectives and priorities of people with SCI, contributing to tokenism and misalignment between research and community needs. While consensus-based principles emphasize the importance of meaningful engagement, research teams lack concrete guidance on how to operationalize this engagement in practice. Objectives:To outline 7 consensus-based "how-to" recommendations that support research teams in meaningfully engaging research users, including people with SCI, throughout the design, delivery, evaluation, and dissemination of exercise intervention research. Methods:A multidisciplinary authorship team with extensive experience in SCI research and engagement co-developed the recommendations through a series of collaborative meetings. The team synthesized insights from lived experience, engagement literature, and pragmatic examples. Minimum expectations were defined through internal consensus using an online survey and iterative team discussions. Results:Seven recommendations were developed to emphasize flexibility and iteration: (1) adopt a principled and relational approach to engagement; (2) engage early and often with diverse research users; (3) commit to supporting a safe, welcoming, and inclusive environment; (4) establish shared decision-making processes; (5) recognize, compensate, and credit diverse forms of expertise; (6) utilize communication practices that are clear, accessible, and responsive; and (7) regularly reflect on, evaluate, and iterate engagement. Conclusion:These recommendations serve as baseline expectations to support research teams in avoiding tokenism and embedding meaningful engagement into exercise intervention research. Implementation requires individual, team, and system-level change. Sustained, non-tokenistic engagement depends not only on procedural guidance but also on institutional supports and shifts in academic culture.
