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-totreat 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% CI -64 to 24), 5% arm length (95% CI -3 to 13) and 0.5 points (95% CI -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.