|Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis
|Wadsworth BM, Haines TP, Cornwell PL, Paratz JD
The review concluded that the available evidence was not sufficient to support or discourage the use of an abdominal binder in people who have suffered a spinal cord injury, and that further research is needed. The authors' conclusions are appropriately cautious in reflecting the limited evidence available and are likely to be reliable.
To evaluate the effects of abdominal binder use on breathing, speech, and cardiovascular function in people who have suffered a spinal cord injury.
MEDLINE, EMBASE, CINAHL, PEDro, and the Cochrane Library databases were searched for studies in English from inception to March 2008; search terms were reported. Reference lists of obtained articles were also searched.
Randomised controlled trials (including crossover and within-subject trials) of the use of an abdominal binder in three or more patients with spinal cord injury, that reported cardiovascular, speech, or respiratory outcomes, were eligible for inclusion. Studies using an abdominal binder together with a lower limb pressure garment were excluded.
The mean age of participants was 42 years and around 85% were male. Most studies included participants with tetraplegia. Post-injury times ranged from 17 days to 38 years. Most studies compared elastic or non-elastic (e.g. corset or girdle) binders with no abdominal binder in the sitting, tilt or supine position. All but one of the studies investigated immediate outcome effects in different postures.
Two reviewers independently selected studies for inclusion, with disagreements resolved by discussion or by a third reviewer.
Assessment of study quality
Two reviewers independently assessed study quality using the PEDro scale, with disagreements resolved by discussion. Randomisation, allocation concealment, blinding, drop-outs and analysis variables were among the criteria assessed. Since patient and therapist blinding was not possible, studies received a score out of 8.
Data were extracted in order to calculate mean differences and 95% confidence intervals (CI). Authors were contacted when intervention details were unclear.
The authors did not state how many reviewers extracted data.
Methods of synthesis
Meta-analyses using a fixed-effect model were conducted where at least three studies reported an outcome, with heterogeneity assessed using the Q and I2 statistics. A narrative synthesis was used when meta-analysis was not possible.
Results of the review
Eleven studies were included in the review (n=152 patients); seven crossover and four within-patient. Sample sizes ranged from 3 to 27 patients. PEDro scores ranged from 3 to 7 out of 8 (mean 4.3). No studies reported using concealed allocation. The authors also noted that drop-outs and use of intention-to-treat analysis were not really an issue, since nearly all studies were of immediate effects.
All studies reported an overall increase in vital capacity using an abdominal binder when seated, although this was statistically significant in only six studies; the meta-analysis of six studies resulted in a mean difference of 0.32 litres (95% CI 0.09 to 0.55; I2=0%). Functional residual capacity decreased by 0.41 litres (95% CI -0.14 to -0.67; four studies; I2=22%) and total lung capacity decreased by 0.33 litres (95% CI -0.81 to 0.15, not statistically significant; three studies; I2=0%) after abdominal binder use. Functional residual capacity, residual volume, and expiratory reserve volume all decreased with an abdominal binder when not lying on the back. Further results for respiratory outcomes were reported.
Only one study reported speech outcomes and one reported haemodynamic outcomes (results reported in the review).
Available evidence was not sufficient to support or discourage the use of an abdominal binder in people who have suffered a spinal cord injury, and further methodologically rigorous studies are required.
The review addressed a clear question and was supported by appropriate inclusion criteria. Attempts to identify relevant studies were undertaken by searching electronic databases and checking references, but the restriction to English studies, coupled with no search for unpublished studies, meant that relevant studies may have been missed and the review may have been subject to publication or language bias. However, suitable methods were employed to reduce the risks of reviewer error and bias during study selection and quality assessment (although the authors did not report on whether such methods were used to extract data).
Study quality was assessed and was used in interpreting the results of the review (overall, the quality of studies was poor). Sufficient study details were provided and meta-analyses and a narrative synthesis of the data were undertaken. However, the decision to pool data from studies with differing study designs was questionable.
The authors' conclusions are appropriately cautious in reflecting the limited evidence available and are likely to be reliable.
Implications of the review for practice and research
Practice: The authors stated that available evidence is not yet sufficient to support or discourage the use of an abdominal binder in people who have suffered a spinal cord injury.
Research: The authors stated that future studies should be homogeneous with respect to injury classification and time since injury, and should consider the effects of abdominal binder use over time. The authors also outlined further quality and standardisation issues, and suggested studying the effects abdominal binders have on digestion, pneumonia, atelectasis, fatigue and daily living. The authors also suggested assessing the effects of wearing an abdominal binder daily in patients with acute or chronic spinal cord injury.
Queensland Health Allied Health Research Sponsorship.
Wadsworth BM, Haines TP, Cornwell PL, Paratz JD. Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis. Spinal Cord 2009; 47(4): 274-285
Subject indexing assigned by NLM
Abdomen /physiopathology; Databases, Bibliographic /statistics & numerical data; Elasticity; Humans; Respiration; Restraint, Physical /methods; Spinal Cord Injuries /physiopathology /psychology /rehabilitation
Database entry date
This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.