Female participation in randomized controlled trials of motor rehabilitation after spinal cord injury: a systematic review

Systematic Review

The objective of this study was to investigate female participation in spinal cord injury (SCI) motor rehabilitation randomized controlled trials (RCTs) which included the overall proportion of female participants and how this proportion changed with time post-injury (TPI), study quality and the intervention investigated.

Systematic searches were conducted in MEDLINE, Embase, PsycInfo and CINAHL databases inclusive to December 31, 2024. Study eligibility included RCTs or RCT crossovers published in English and investigated an intervention for motor rehabilitation on adult participants with traumatic and/or non-traumatic SCI. Data from the RCTs was extracted and summarized using online Excel, with statistical analyses conducted in RStudio.

Overall, 252 RCTs met the inclusion criteria and were included in the dataset. Of these, 237 RCTs reported the sex of participants. The overall proportion of female participants was 22.4%, with no significant changes between 2000 and 2024. No significant differences were found between the proportion of female participants and TPI. High quality studies had significantly higher female participation compared to low quality studies (p = 0.008). Significantly higher female participation was found in RCTs investigating technology-based interventions (p < 0.001), with no significant differences found in pharmacological or non-technology-based interventions.

The underrepresentation of female participants in studies of SCI motor rehabilitation limits the generalizability of research results and potentially hinders the availability of rehabilitation strategies for female individuals. Understanding what challenges may be preventing higher enrollment and implementing recruitment strategies may aid in increasing the number of female participants in SCI rehabilitation RCTs.