Vol. 2, Issue 2, Part A (2025)

Background: Incomplete traumatic spinal cord injury (SCI) is associated with substantial long-term disability, yet offers considerable potential for recovery when rehabilitation is timely and intensive. Physiotherapy is central to SCI rehabilitation, but the optimal timing and dose of therapy remain incompletely defined.

Methods: This prospective cohort study included 76 adults (18-65 years) with traumatic incomplete SCI (AIS C-D) admitted to a specialised rehabilitation unit within 60 days of injury. Participants received either early intensive physiotherapy (≥90 minutes of individual physiotherapy per day, ≥5 days/week, initiated within 14 days of rehabilitation admission) or standard-intensity physiotherapy (approximately 45-60 minutes/day, 5 days/week). Neurological status was classified using ISNCSCI, and functional outcomes were assessed with the Spinal Cord Independence Measure (SCIM III) and Functional Independence Measure (FIM; motor subscale) at admission, discharge and 3-month post-discharge. Primary outcome was change in SCIM III total score from admission to discharge. Between-group differences were analysed using t-tests or non-parametric equivalents, and multivariable linear regression was used to examine the independent association between physiotherapy dose and functional change.

Results: Baseline demographic and clinical characteristics were comparable between cohorts, except for a shorter median time from injury to rehabilitation in the early intensive group. Both cohorts showed significant gains in SCIM III and FIM motor scores from admission to discharge (p < 0.001), but improvements were significantly greater in the early intensive group (mean SCIM III change 26.7±9.4 vs 14.1±8.7; mean FIM motor change 27.1±9.1 vs 15.1±8.9; both p < 0.001). A higher proportion of early intensive participants achieved predefined clinically meaningful improvements in SCIM III and FIM motor scores. In adjusted regression models, higher weekly physiotherapy dose was independently associated with greater SCIM III and FIM motor gains. Length of stay did not differ significantly between cohorts.

Conclusion: Early intensive physiotherapy, characterised by earlier initiation and substantially higher therapy dose within a specialised inpatient programme, is associated with superior functional recovery compared with standard-intensity physiotherapy in adults with incomplete traumatic SCI, without increasing length of stay. These findings support prioritising early transfer to specialised centres, implementing higher daily physiotherapy doses, and systematically monitoring therapy dose as part of routine SCI rehabilitation practice.