Effects of body-weight supported treadmill training and electrical timulation on functional ambulation and strength in patients with incomplete traumatic spinal cord injury: A randomized controlled trial

Objectives: This study aims to evaluate the efficacy of body weight-supported treadmill training (BWSTT) combined with electrical stimulation (ES) in enhancing functional ambulation and lower limb strength. Methodology: This single-center, multi-arm randomized controlled trial with a parallel group design was conducted from July 2024 to February 2025 at the Paraplegic Center Peshawar (PCP). Eighty-one patients with incomplete traumatic spinal cord injury (SCI) were randomized into three groups: (I) BWSTT + ES + Conventional Therapy (CT), (II) BWSTT + CT and (III) CT only. Interventions were conducted for 12 weeks, with assessments at baseline, 6 weeks and 12 weeks using Walking Index for Spinal Cord Injury (WISCI-II), 6-Minute Walk Test, 10-Meter Walk Test, lower extremity muscle strength (LEMS) and spinal cord independence measure (SCIM). Repeated-measures ANOVA and post-hoc analyses with Bonferroni adjustment were performed. Results: All groups showed significant improvements in walking ability (WISCI-II) and functional independence (SCIM) (p < 0.001), with BWSTT + ES + CT demonstrating the greatest gains. At 12 weeks, this group had significantly higher WISCI-II scores than BWSTT + CT (p = 0.030) and CT only (p = 0.005). Strength and endurance improvements were greatest in the BWSTT + ES + CT group, but between-group differences were not statistically significant. Overall, the effects on the 6MWT, 10MWT, LEMS, and strength (measured via dynamometer) were higher in the BWSTT + ES + CT group; however, no significant differences were observed between groups. Conclusion: All three groups demonstrated improvements in ambulatory function and functional independence over time, with the BWSTT + ES + CT group showing the greatest overall gains. . Combining BWSTT with ES and CT showed superior results in walking ability and functional independence in individuals with incomplete SCI, while strength and endurance improvements were similar across different rehabilitation approaches.