Improvement in function after spinal cord injury: the black-box entitled rehabilitation.

Rehabilitation can be referred to as a "black box" because little is known about what specific interventions comprise the rehabilitation process, including patients with spinal cord injury (SCI). Despite that rehabilitation professionals can "see" daily what rehabilitation looks like, the contribution of each intervention to the final outcome of rehabilitation remains unclear. Moreover, there is only limited evidence supporting the efficacy of those interventions. To determine the efficacy of these interventions with respect to the outcome of rehabilitation and general functional improvement, we need appropriate outcome measurements and we need to know how profiles of functional improvement look in patients with SCI. It is sometimes forgotten, but obviously profiles of recovery depend to a large extent on the assessment tool applied. International efforts have been made to select and recommend a number of assessments with good psychometric properties and some of these assessments have been applied to hundreds of patients with SCI providing us with patterns of functional improvement. Currently, information about the efficacy of specific interventions is still lacking. For the coming years, one focus of rehabilitation research should be to determine the contribution of each specific intervention to the overall outcome of the rehabilitation process. Only by applying well-controlled randomised trials or large-scale observational studies, the most effective interventions can be selected, improving the efficacy of rehabilitation and turning the black-box into a more translucent one.