Training unsupported sitting does not improve ability to sit in people with recently acquired paraplegia: a randomised trial

Question: Do people with recently acquired paraplegia benefit from a six-week motor retraining program aimed at improving their ability to sit unsupported? Design: A randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: 32 people with recently acquired paraplegia and limited ability to sit unsupported. Intervention: All participants undertook standard inpatient rehabilitation over a six-week period. Experimental participants received three additional 30-minute sessions per week of motor retraining directed at improving their ability to sit unsupported. Outcome measures: The three primary outcomes were the Maximal Lean Test, Maximal Sideward Reach Test, and the Performance Item of the Canadian Occupational Performance Measure (COPM). The secondary outcomes were the Satisfaction Item of the COPM, Participants' Impressions of Change, Clinicians' Impressions of Change, the T-shirt Test, and the Spinal Cord Injury Falls Concern Scale. Results: The mean between-group differences for the Maximal Lean Test, Maximal Sideward Reach Test and the Performance Item of the COPM were -20 mm (95% Cl -64 to 24), 5% arm length (95% Cl -3 to 13) and 0.5 points (95% Cl -0.5 to 1.5), respectively. The secondary outcomes did not differ significantly between groups. Conclusion: People with recently acquired paraplegia do not benefit from a six-week motor retraining program directed specifically at improving their ability to sit unsupported. Their ability to sit unsupported does, however, improve over time, suggesting that the practice of activities of daily living has important carry-over effects on unsupported sitting, rendering additional training redundant. Trial registration: ACTRN12608000464369. [Harvey LA, Ristev D, Hossain MS, Hossain MA, Bowden JL, Boswell-Ruys CL, Hossain MM, Ben M (2011) Training unsupported sitting does not improve ability to sit in people with recently acquired paraplegia: a randomised trial. Journal of Physiotherapy 57: 83-90]