The Effect of Non-Invasive, Non-Pharmacological Interventions on Autonomic Regulation of Cardiovascular Function in Adults with Spinal Cord Injury: A Systematic Review with Meta-Analysis

Autonomic regulation of cardiovascular function is often disrupted following a spinal cord injury (SCI). A systematic review was undertaken to evaluate the effect of non-invasive, non-pharmacological (NINP) interventions on cardiovascular autonomic biomarkers in adults with SCI. AMED, CENTRAL, CINAHL EMBASE, and MEDLINE were searched from inception to May 17, 2024. Randomized controlled trials (RCTs) of NINP interventions for cardiovascular autonomic biomarkers (heart rate variability [HRV], systolic blood pressure variability [SBPV], or baroreflex gain) in adults (>= 18 years of age) with SCI (>3 months) were included. Primary outcomes included HRV (low-frequency power [HRV-LF], high-frequency power [HRV-HF], root mean square of successive differences [RMSSD]), SBPV (low-frequency power [SBPV-LF]), and baroreflex sensitivity. The quality and certainty of the evidence were assessed using version 2 of the Cochrane risk of bias tool and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis tool, respectively. Of 2651 records identified, six RCTs were included (participants, n = 123). HRV-LF (four studies; participants, n = 69) and HRV-HF (five studies; participants, n = 93) showed no to small changes in favor of NINP interventions ([g = 0.25; 95% confidence interval [CI] = -0.23, 0.73; p = 0.31; I-2 = 0%], [g = 0.00; 95% CI = -0.41, 0.42; p = 0.98; I-2 = 0%], respectively). Limited evidence was available for RMSSD, SBPV-LF, and baroreflex gain. This review found that the evidence is inconclusive regarding the effect of NINP interventions on the included HRV, BPV, and BRS parameters in adults with SCI. Further research with strong methodological rigor is needed to provide greater insights in this area.