Home and Community-Based Physical Activity for Individuals with Spinal Cord Injury: A Systematic Review

Home and community-based physical activity (HCPA) offer an accessible approach to enhancing functional recovery and independence in individuals with spinal cord injury (SCI). Despite its potential, evidence remains inconclusive due to heterogeneity in study designs, populations, and interventions. This review aimed to evaluate the variability in participant characteristics and intervention strategies in HCPA programs for SCI, assess their effectiveness, and identify research gaps. A systematic search was conducted in Cochrane, Medline, PubMed, ScienceDirect and Scopus for randomised controlled trials (RCTs) published between January 1994 and January 2024. Search terms combined Medical Subject Headings and free-text terms for SCI, home or community exercise and physical performance outcomes. From 8,370 records, eight RCTs met eligibility after rigorous screening. Study quality was assessed using the Physiotherapy Evidence Database scale. The included RCTs demonstrated moderate methodological quality and notable heterogeneity in demographic characteristics, injury profiles, interventions and outcome measures. Evidence suggests HCPA is feasible and yields moderate improvements in physical fitness and functional outcomes. Programs typically involved 2-4 sessions weekly, 30-60 minutes each, at moderate intensity, incorporating aerobic, resistance and wheelchair skills training. HCPA is practical and moderately effective for individuals with SCI. However, standardised, individualised protocols are urgently required. Future research should prioritise large-scale, high-quality RCTs to establish evidence-based guidelines for sustainable implementation in home and community rehabilitation contexts.