The journal of spinal cord medicine
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Context/objective: To determine current barriers for clinical implementation of epidural stimulation for functional improvement after spinal cord injury and highlight applicable ethical constructs to approach future research. Design: Survey of spinal cord injury medicine physicians, January 2019. Setting: Spinal cord injury model systems hospital sites across the United States. ⋯ Numerous current barriers to clinical implementation were identified, including need for additional efficacy studies (92.9%), lack of clear guidelines on stimulation parameters (83.3%), and inability to identify which patients will benefit (76.2%). Conclusions: With multiple barriers to clinical implementation currently identified, evaluating this research with an eye toward the ethical construct of equipoise is increasingly relevant. Addressing these barriers may require modifications in both physician expectations and how researchers approach this work.