A pragmatic randomized controlled trial testing the effects of the international scientific SCI exercise guidelines on SCI chronic pain: protocol for the EPIC-SCI trial

Abstract

Study design Protocol for a pragmatic randomized controlled trial (the Exercise guideline Promotion and Implementation in Chronic SCI [EPIC-SCI] Trial).Primary objectives To test if home-/community-based exercise, prescribed according to the international SCI exercise guidelines, significantly reduces chronic bodily pain in adults with SCI. Secondary objectives To investigate: (1) the effects of exercise on musculoskeletal and neuropathic chronic pain; (2) if reduced inflammation and increased descending inhibitory control are viable pathways by which exercise reduces pain; (3) the effects of chronic pain reductions on subjective well-being; and (4) efficiency of a home-/community-based exercise intervention. Setting Exercise in home-/community-based settings; assessments in university-based laboratories in British Columbia, Canada. Method Eighty-four adults with chronic SCI, reporting chronic musculoskeletal or neuropathic pain, and not meeting the current SCI exercise guidelines, will be recruited and randomized to a 6-month Exercise or Wait-List Control condition. Exercise will occur in home/community settings and will be supported through behavioral counseling. All measures will be taken at baseline, 3-months and 6-months. Analyses will consist of linear mixed effect models, multiple regression analyses and a cost-utility analysis. The economic evaluation will examine the incremental costs and health benefits generated by the intervention compared with usual care. Ethics and dissemination The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-01650). Using an integrated knowledge translation approach, stakeholders will be engaged throughout the trial and will co-create and disseminate evidence-based recommendations and messages regarding the use of exercise to manage SCI chronic pain. Trial registration ClinicalTrials.gov identifier NCT04160858.

Dissonance in views between healthcare professionals and adults with a spinal cord injury with their understanding and interpretation of exercise intensity for exercise prescription

“…Moreover, a mobile App (WHEELS) has also incorporated these bespoke SCI exercise prescription guidelines to target behaviour change to overcome additional social barriers using mobile health technologies. 8 While encouraging, that the 2018 international guidelines are now in use in Europe and in Canada for studies aimed to understand neuropathic pain, 9 they have been updated to include published studies from Asia to obtain greater global reach. 10 Fundamental to the scientific guidelines is the prescription of exercise intensity using the terms 'moderate to vigorous', as intensity serves as a key stimulus for beneficial health and fitness adaptations.…”

Exercise training augments brain function and reduces pain perception in adults with chronic pain: A systematic review of intervention studies

“…Finally, exercise, particularly resistance training and Tai Chi, can exert a direct effect on the area or sources of pain by strengthening the bones, muscles, tendons, and ligaments ( United Kingdom National Health Service, 2022 ). Future CP research is investigating the relationship between exercise, inflammation, and pain to understand what governs the relationship and, therefore, shape future CP treatments ( Martin Ginis et al, 2020 ).…”

Cultural validation and language translation of the scientific SCI exercise guidelines for use in Indonesia, Japan, Korea, and Thailand

“…Scientists can then test the effects of this prescription on specified outcomes, including outcomes that are not currently addressed by the SEG-SCI 1 due to a lack of evidence (e.g. bone health, psychological well-being, pain 20 ). Scientists can also compare the effects of other exercise prescriptions (e.g.…”

“…Given the limited supervised exercise settings available to people with SCI, and the countless environmental barriers to exercise experienced by people with SCI, it will be important to test the effectiveness of the SCI-SEG 1 when exercise is performed in unsupervised home and community settings. 20 Finally, adverse events were rarely documented in the reviewed studies. Going forward, it is important for researchers to track and report adverse events in order to provide further assessment of the risks and benefits associated with exercise interventions.…”