Effectiveness of Transcutaneous Spinal Cord Stimulation for Lower Limb Rehabilitation in Spinal Cord Injury: Protocol for a Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Spinal cord injury (SCI) affects millions of people worldwide and often results in impaired lower limb function and reduced mobility. Transcutaneous spinal cord stimulation (tSCS) has emerged as a promising neuromodulation technique for enhancing motor recovery and walking ability in individuals with SCI. Objective: This systematic review and meta-analysis will determine the effectiveness of tSCS, compared with sham stimulation, no intervention, or other active interventions, for improving lower limb motor function in individuals with SCI. Secondary objectives are to evaluate tSCS effects on walking ability, spasticity, quality of life, and safety outcomes. Methods: This systematic review will be conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. We will search electronic databases (PubMed, Web of Science, Embase, CINAHL, MEDLINE, Cochrane Library, Physiotherapy Evidence Database, and Scopus) from inception to August 2025, along with gray literature, trial registries, and hand-searching of key journals. We will include randomized controlled trials (RCTs), quasi-RCTs, and nonrandomized studies (case series with ≥5 participants) that evaluate the effects of tSCS applied over the spinal region on lower limb rehabilitation outcomes in adults with traumatic or nontraumatic SCI. The primary outcome will be lower limb motor function assessed by validated measures such as the Lower Extremity Motor Score. Secondary outcomes will include walking ability, balance, functional independence, spasticity, quality of life, and adverse events. Two reviewers will independently screen studies, extract data, and assess risk of bias using version 2 of the Cochrane Risk of Bias tool for RCTs and Risk of Bias in Non-randomized Studies of Interventions tool. Data will be synthesized using random-effects meta-analysis if appropriate, with subgroup analyses examining injury level, completeness, stimulation site, and cointervention effects, and sensitivity analyses. Evidence certainty will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: This protocol paper presents strategy development and protocol registration, with results expected by October 2025. Conclusions: This comprehensive systematic review and meta-analysis will address an important evidence gap, providing the first focused evaluation of tSCS effectiveness for lower limb rehabilitation in SCI. Results will inform clinical practice guidelines and guide future research directions.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.052 | 0.082 |
| Meta-epidemiology (narrow) | 0.008 | 0.005 |
| Meta-epidemiology (broad) | 0.028 | 0.038 |
| Bibliometrics | 0.011 | 0.011 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.008 | 0.007 |
| Open science | 0.006 | 0.005 |
| Research integrity | 0.007 | 0.007 |
| Insufficient payload (model declined to judge) | 0.052 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".