Best-evidence summary of pulmonary rehabilitation strategies for adult patients with cervical spinal cord injury: a systematic review
Abstract
To systematically sort out the relevant evidence on pulmonary rehabilitation in patients with cervical spinal cord injury (CSCI) at home and abroad, and provide evidence-based basis for clinical staff. The PIPOST (Population, Intervention, Professional, Outcome, Setting, Type of evidence) method was used to identify evidence-based questions. According to the “6S” pyramid evidence model, we systematically searched major Chinese and international databases, including MJ Best Practice, UpToDate, the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and SinoMed. Inclusion criteria were adult patients (18 years or older) with CSCI and study types including expert consensus, clinical guidelines, evidence summaries, systematic reviews, randomized controlled trials (RCTs), and clinical decisions published in Chinese or English. Exclusion criteria were conference papers, guideline interpretations, and articles with unobtainable full text. Two team members independently completed quality assessment using corresponding evaluation tools from the Joanna Briggs Institute, extracted relevant evidence, and summarized and graded the evidence according to the Joanna Briggs Institute evidence grading system. The search time limit was from database establishment to December 31, 2025. A total of 19 articles were included: 1 expert consensus, 1 guideline, 9 RCTs, 1 clinical decision, and 7 systematic reviews. After comprehensive analysis, 29 pieces of best evidence were extracted, covering 9 aspects including pulmonary rehabilitation team establishment, timing of rehabilitation, assessment methods, positioning management, and exercise training. Evidence level distribution: Level 1b ( n = 2), Level 1c ( n = 2), Level 2c ( n = 4), Level 4 ( n = 1), Level 5b ( n = 14), and Level 5c ( n = 1). The best evidence for pulmonary rehabilitation in patients with CSCI summarized in this study is scientific and practical, which can provide a reference for clinical practice. CRD420261376955.