OBJECTIVES: To assist with clinical decision-making, evidence syntheses are needed to demonstrate the efficacy of available interventions, and examine the intervention components and dosage parameters. This systematic review and meta-analysis describes the efficacy, components and dosage of interventions targeting upright balance control, balance confidence and/or falls in adults with motor incomplete spinal cord injuries/diseases (SCI/D). DATA SOURCES: A search strategy following the PICO framework was developed. Six databases were searched: APA PsychInfo, CINAHL, Embase, Emcare Nursing, Web of Science CC, and Medline. STUDY SELECTION: Title, abstract and full-text screening were conducted by two researchers independently. Inclusion criteria included: (1) adults with chronic, motor-incomplete SCI/D; (2) physical intervention targeting upright postural control; and (3) clinical and/or biomechanical measures of upright balance control and/or balance confidence and/or documentation of falls. DATA EXTRACTION: Participant characteristics, balance intervention details, adverse events and study results were extracted. The Downs and Black Checklist assessed methodological quality. Meta-analyses on pre-post intervention outcomes and a meta-regression of dosage were completed. The GRADE approach was used to evaluate the quality of the evidence. DATA SYNTHESIS: The search returned 1,664 unique studies; 26 were included. Methodological quality was moderate to good. Participants were 500 individuals with SCI/D, aged 18 to 74 years (males: females, 2.4:1). Minor adverse events were reported in eight studies (eg, muscle soreness, fatigue). Walking interventions and upright balance training with visual feedback had clinically meaningful and significant pooled effects on improving standing balance control. Only walking interventions had a significant pooled effect on improving balance confidence. There were no significant findings on dosage response. Few studies evaluated the effects of balance interventions on the occurrence of falls. CONCLUSIONS: Walking interventions and upright balance training with visual feedback had greater effects on upright balance control than conventional physiotherapy; however, the quality of the evidence was very low.

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