Scientists, journals, funders, clinicians and patients are hungry for optimism in spinal cord injury (SCI) and want to see the development of interventions which promise recovery and the potential to walk. The recent interest and media attention around locomotor training programs for people with AIS A and AIS B lesions is a good example. Locomotor training programs in which very disabled patients spend hours a day exercising and walking on treadmills with 3 or 4 therapists moving the legs, is an expensive intervention involving costly equipment and high staff to patient ratios. In addition, it requires patients to devote many hours to locomotors therapy and may deleteriously affect other aspects of their lives and divert attention from standard rehabilitation which focuses on optimizing independence and re-integration into society. Often patients delay return to work and engagement with family and the community in the pursuit of these programs. In some cases, patients do not learn to be independent from a seated position because of fears that this will negate potential for neurological recovery and the potential to walk. In addition, patients have been known to make enormous financial sacrifices to pursue locomotor training programs outside their own countries. This includes selling assets to travel abroad where the programs are heavily marketed through enticing websites promising recovery and access to the latest equipment and technology.
Of course patients are free to choose whatever kind of therapy they desire. However, professionals and the scientific community have a responsibility to provide accurate and evidence-based information about the efficacies of these interventions and it is not appropriate that locomotors training programs be advocated to highly disabled patients on the results of animal studies, single case studies or pre to post studies without control groups. These later types of research are appropriate for exploring the potential of locomotor training programs but we must hold off advocating and providing these interventions to the public until we have completed high quantity randomized controlled trials (RCT) and ensured that any benefits justify the substantial costs. In a following editorial page we will talk about RCT's in SCI research.
