Limitations
Sample sizes are known to be rather small in exercise
training studies involving subjects with chronic spinal
cord injury [67]. This study unfortunately is no exception.
Larger sample sizes would have led to greater statistical
power. Additionally, due to the high number of
(exploratory) outcome measures, this study is also prone
to type I and type II errors. Generalizability of the findings
is limited to people with the narrowly defined criteria
applied in this study and as all participants agreed
to take part in this intensive training program, we cannot
exclude a motivational bias. In anticipation of the
low number of participants, we chose a cross-over design.
This has the advantage that each participant acts as
its own control, which is specifically valuable in a group
with high inter-individual variation. However, there is
the disadvantage of possible carry-over. Carry-over and
treatment by period interaction are generally thought to
be hard to objectify in training studies (especially in this
study with its small statistical power) and are highly
inter-individual. Therefore, we abstained from introducing
a wash-out period, which reduced the load for participants,
but this might have also influenced the results.
The absolute effectiveness of the interventions could be
overestimated, as repeated exposure to the testing protocol
or natural recovery over time might have induced
functional improvements, despite including patients with
a chronic iSCI only.
LimitationsSample sizes are known to be rather small in exercisetraining studies involving subjects with chronic spinalcord injury [67]. This study unfortunately is no exception.Larger sample sizes would have led to greater statisticalpower. Additionally, due to the high number of(exploratory) outcome measures, this study is also proneto type I and type II errors. Generalizability of the findingsis limited to people with the narrowly defined criteriaapplied in this study and as all participants agreedto take part in this intensive training program, we cannotexclude a motivational bias. In anticipation of thelow number of participants, we chose a cross-over design.This has the advantage that each participant acts asits own control, which is specifically valuable in a groupwith high inter-individual variation. However, there isthe disadvantage of possible carry-over. Carry-over andtreatment by period interaction are generally thought tobe hard to objectify in training studies (especially in thisstudy with its small statistical power) and are highlyinter-individual. Therefore, we abstained from introducinga wash-out period, which reduced the load for participants,but this might have also influenced the results.The absolute effectiveness of the interventions could beoverestimated, as repeated exposure to the testing protocolor natural recovery over time might have inducedfunctional improvements, despite including patients witha chronic iSCI only.
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