A systematic review and meta-analysis assessing the effectiveness of physical activity behaviour change interventions in adults with spinal cord injury


The purpose of this study was to systematically review, critically appraise, and synthesise existing literature assessing the effectiveness of physical activity behaviour change interventions in adults with a spinal cord injury who are manual wheelchair users. A prospectively registered (PROSPERO, CRD42021245571) systematic search strategy of the scientific literature was employed. In total, 6,990 records were identified and subject to a three-stage screening process. Twenty-seven articles met the inclusion criteria and were included in the review. Across all studies, physical activity interventions were delivered either individually (n=21) or in a group (n=7), as well as in-person (n=19) and/or remotely from home (n=12) over a period of one- to 12-months. A meta-analysis could only be performed for randomised controlled trials (n=10) due to heterogeneity of outcomes, demonstrating that self-reported physical activity significantly improved in the intervention group relative to controls (Z=4.80, p<.001). Individual studies also demonstrated that behaviourally measured physical activity, functional fitness, physiological measures, psychosocial wellbeing, and quality of life improved pre- to post-intervention. Adverse effects such as shoulder pain, fatigue and upper extremity were noted and significantly reduced post-intervention. However, the included evidence was judged low-to-high quality and subject to bias due to limitations in the design, reducing certainty and confidence in findings. Nevertheless, interventions that aim to improve physical activity in adults with spinal cord injuries that use a manual wheelchair appear to be effective, at least in the short-term. Future studies should investigate whether delivering different interventions (e.g., individual/group; in-person/remote) can result in longer-term benefits beyond 12-months.

Acknowledgments: The authors would like to thank the authors included in this review who kindly provided data and clarification.