How much and what type of exercises and training were provided to people with spinal cord injury as part of usual physiotherapy and occupational therapy in the SCI-MT Trial?

Why this study matters for people with spinal cord injury

After a spinal cord injury, many people and their families assume that “more therapy is always better.” A large international trial recently tested that idea by adding extra intensive exercise on top of usual rehabilitation, but found almost no additional benefit. To make sense of that surprising result, this study looked closely at what patients were already getting in their day‑to‑day physiotherapy and occupational therapy. Understanding how much therapy is provided, and what kinds of exercises fill those hours, can help patients, clinicians, and health systems decide how to organise rehabilitation time most effectively.

What the researchers set out to learn

The team analysed data from 220 people with recent spinal cord injuries treated at 15 specialist rehabilitation units across Europe and Australia. All had some movement below the level of injury and were in the first weeks of their hospital stay. Everyone received “usual care,” meaning standard physiotherapy and occupational therapy. Half also received an extra 12 hours per week of intensive motor training focused on practising specific movements with the weaker parts of the body. Because the main trial showed that this added program did not meaningfully improve movement or function compared with usual care alone, the authors of this paper wanted to know: how much therapy did people already receive as part of usual care, and how was that time used?

How therapy time was counted

Therapists recorded every scheduled and completed therapy session over a 10‑week period, including when sessions were missed and why. Within each session, they broke therapy time into five types of activity‑focused practice (such as sitting balance, standing, walking, and using the arms and hands) and two types of impairment‑focused work (strength and endurance training). These categories came from an international data set designed specifically for spinal cord rehabilitation, and time was logged in small blocks to capture what patients were actually doing. In total, more than 200 participants’ therapy schedules were tracked in detail, with data carefully entered and checked.

How much therapy people actually received

On average, participants attended about 8.3 hours per week of physiotherapy and occupational therapy combined. Roughly two‑thirds of sessions were delivered by physiotherapists and about one‑third by occupational therapists. People were scheduled for slightly more therapy than they attended, with a small share of sessions missed because of reasons such as medical appointments, illness, bladder or bowel issues, or fatigue. Importantly, about 70% of the time spent in therapy sessions was devoted to active exercise or training, rather than paperwork, equipment set‑up, or passive treatments. This suggests that therapists generally used face‑to‑face time with patients in a focused and purposeful way.

What kinds of exercises filled those hours

Of the 5.7 hours per week that participants spent actively exercising, around 3.8 hours were devoted to activity‑focused practice and 1.9 hours to impairment‑focused work. Activity‑focused exercises included learning to control the body in sitting or standing, practising walking or stair climbing when possible, and refining arm and hand movements. Impairment‑focused exercises targeted underlying problems like weakness and poor endurance. Despite this, the amount of pure strength training was modest—about 18 minutes per week on average—raising questions about whether muscle‑building efforts are intensive enough, given how crucial strength is for basic tasks like transferring, pushing a wheelchair, or using walking aids.

What these findings mean for patients and clinics

The study shows that in these 15 specialist units, people with new spinal cord injuries already received a substantial amount of active, targeted therapy. Under these conditions, adding another 12 hours per week of similar motor training did not lead to noticeably better outcomes, suggesting that there may be a threshold beyond which simply increasing the same type of exercise brings little extra benefit. At the same time, a quarter of participants had less than about six hours of therapy per week, and some potentially valuable elements, such as structured strength training, were relatively limited. The authors conclude that while time in therapy is used productively overall, the mix and total amount of different types of exercises may still need fine‑tuning. Their detailed numbers offer a benchmark for rehabilitation centres worldwide to compare their own practice and to design future studies that test not just “more versus less” therapy, but smarter ways to allocate limited rehabilitation time.

Citation: Chu, J., Glinsky, J.V., Liu, H. et al. How much and what type of exercises and training were provided to people with spinal cord injury as part of usual physiotherapy and occupational therapy in the SCI-MT Trial?. Spinal Cord 64, 317–323 (2026). https://doi.org/10.1038/s41393-026-01180-7

Keywords: spinal cord injury rehabilitation, physiotherapy intensity, occupational therapy, motor training, therapy dosage