Application of technology in the management of spinal cord injury: Findings from a systematic literature review

Objective: Determine scope and use of technological applications to promote quality-of-life after spinal cord injury (SCI).

Background: Rehabilitative improvements have stemmed from technological enhancements. Studying rehabilitative outcomes is incomplete without considering quality-of-life issues. Overlap between quality of life and technology is unclear. This study seeks to determine scope and use of technological applications to promote quality-of-life after SCI.

Methods/Design: Systematic search of multiple electronic databases including MEDLINE, CINAHL, EMBASE and PSYCINFO. Searches limited to humans, English, and time period: January 1996-September 2007. No additional limits (study design, research) were applied. Keywords and expert searches were combined.

Results: 824 abstracts were identified after removal of duplicates. Publications focused on technology have steadily increased over the past decade. Quality-of-life is mostly undefined and rarely involves consumer views. Most identified publications were commentaries or discussion papers. None of the studies exceeded Phase I trial levels. Technological applications were mostly discussed in terms of acute and rehabilitative medical management (drug, pain, respiratory, bladder management). Few publications focused on technology in advancing psychological coping, adjustment and community integration. Some publications emphasized potential of technology for supporting social development, health promotion, and healthy aging. Little cross-disciplinary research was found.

Conclusion: The evidence base for technological applications in SCI rehabilitation is scarce. There is tremendous scope to expand research into the role and use of technology in community-based rehabilitation settings aimed at enhancing quality-of-life. While community-based RCTs may be difficult to implement, feasible, well-operationalized pre-trial research studies (Mixed-Method studies; multiple baseline case studies) are needed.