TRADITIONAL PHYSIOTHERAPY, FUNCTIONAL ELECTRICAL STIMULATION, AND ROBOTIC-ASSISTED THERAPY IN SPINAL CORD INJURY REHABILITATION: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Comparative evidence on traditional physiotherapy, functional electrical stimulation (FES), and robotic-assisted therapy for spinal cord injury (SCI) rehabilitation remains limited, particularly from South Asian settings. Objective: To compare the effectiveness of traditional physiotherapy, FES-augmented physiotherapy, and robotic-assisted physiotherapy on motor recovery and functional independence in chronic incomplete SCI. Methods: In this three-arm parallel-group randomized controlled trial, 90 participants with chronic incomplete SCI (AIS B–D) were randomized 1:1:1 to Group A (FES + physiotherapy), Group B (robotic-assisted therapy + physiotherapy), or Group C (traditional physiotherapy alone), each for 12 weeks. Co-primary outcomes were the ASIA Motor Score and the Spinal Cord Independence Measure (SCIM). Between-group differences in change scores were analyzed with one-way ANOVA and Tukey's HSD post-hoc tests. Results: All groups improved significantly from baseline to week 12 (p < .001). Mean ASIA Motor Score gains were 16.4 ± 1.1 (Group A), 20.7 ± 1.4 (Group B), and 5.6 ± 0.5 (Group C) points; mean SCIM gains were 19.8 ± 2.5, 24.3 ± 2.0, and 5.7 ± 1.0 points, respectively. Between-group ANOVA was significant for both outcomes (ASIA Motor: F(2,87) = 1579.1, p < .001, η² = .97; SCIM: F(2,87) = 762.5, p < .001, η² = .95), and Tukey's HSD confirmed Group B > Group A > Group C for all pairwise comparisons (p < .001). Conclusion: Robotic-assisted therapy produced the greatest gains in motor recovery and functional independence, followed by FES, both exceeding traditional physiotherapy alone. Technology-assisted adjuncts should be prioritized where available, while conventional physiotherapy remains an effective foundation of SCI rehabilitation.