Post-processing Peak Oxygen Uptake Data Obtained During Cardiopulmonary Exercise Testing in Individuals With Spinal Cord Injury: A Scoping Review and Analysis of Different Post-processing Strategies

Objectives: To review the evidence regarding the most common practices adopted with cardiopulmonary exercise testing (CPET) in individuals with spinal cord injury (SCI), with the following specific aims to (1) determine the most common averaging strategies of peak oxygen uptake (V?O2peak), (2) review the endpoint criteria adopted to determine a valid V?O2peak, and (3) investigate the effect of averaging strategies on V?O2peak values in a convenience sample of individuals with SCI (between the fourth cervical and sixth thoracic spinal segments). Data Sources: Searches for this scoping review were conducted in MEDLINE (PubMed), EMBASE, and Web Science.Study Selection: Studies were included if (1) were original research on humans published in English, (2) recruited adults with traumatic and non -traumatic SCI, and (3) V?O2peak reported and measured directly during CPET to volitional exhaustion. Full-text review identified studies published before April 2021 for inclusion.Data Extraction: Extracted data included authors name, journal name, publication year, participant characteristics, and comprehensive informa-tion relevant to CPET.Data Synthesis: We extracted data from a total of 197 studies involving 4860 participants. We found that more than 50% of studies adopted a 30-s averaging strategy. A wide range of endpoint criteria were used to confirm the attainment of maximal effort. In the convenience sample of individ-uals with SCI (n=30), the mean V?O2peak decreased as epoch (ie, time) lengths increased. Reported V?O2peak values differed significantly (P<.001) between averaging strategies, with epoch length explaining 56% of the variability. Conclusions: The adoption of accepted and standardized methods for processing and analyzing CPET data are needed to ensure high-quality, reproducible research, and inform population-specific normative values for individuals with SCI. Archives of Physical Medicine and Rehabilitation 2023;104:965-81 & COPY; 2023 by the American Congress of Rehabilitation Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)