FES cycling (v no intervention) on spasticity in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	Electrically stimulated cycling (v no intervention) on spasticity in people with SCI
P	People with SCI	Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence.		Weak opinion statement FOR FES cycling may be provided to treat spasticity in people with SCI.
I	Electrically stimulated cycling
C	No intervention	Consensus-based opinion statement Weak for (100%)
O	Spasticity	Consensus-based opinion statement Weak for (100%)
	SUMMARY	1 RCT (see reference)		¬Mean difference (95% CI): Spasticity on the Ashworth Scale -2 (-4 to 1) Favours FES cycling
	GRADE Very low certainty ⨁◯◯◯	Risk of bias No serious	Inconsistency Serious	Imprecision Serious	Indirectness Serious	Publication bias Serious

ELECTRICALLY STIMULATED CYCLING ON SPASTICITY: GRADE Evidence to Decision
PROBLEM	No	Probably no	Probably yes	Yes		Don't know
DESIRABLE EFFECTS	Trivial	Small	Moderate	Large		Don't know
UNDESIRABLE EFFECTS	Large	Moderate	Small	Trivial		Don't know
CERTAINTY OF EVIDENCE	Very low	Low	Moderate	High		No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME	Important uncertainty or variability	Possibly important uncertainty or variability	Probably no important uncertainty or variability	No important uncertainty or variability
BALANCE OF EFFECTS	Favours the Control	Probably favours the Control	Does not favour either the intervention (I) or the comparison (C)	Probably favours the I	Favours the I	Don't know
RESOURCES REQUIRED	Large costs	Moderate costs	Negligible costs and savings	Moderate savings	Large savings	Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES	Very low	Low	Moderate	High		No included studies
COST EFFECTIVENESS	Favours the comparison	Probably favours the comparison	Does not favour either the intervention or the comparison	Probably favours the intervention	Favours the intervention	No included studies
EQUITY	Reduced	Probably reduced	Probably no impact	Probably increased	Increased	Don't know
ACCEPTABILITY	No	Probably no	Probably yes	Yes		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes		Don't know

ELECTRICALLY STIMULATED CYCLING ON SPASTICITY: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
RALSTON 2013	ES cycling V No intervention	Four x a week for two weeks (30-45 minutes)	C4 to T10 SCI	14/14	Spasticity - Ashworth	Low Risk of Bias PEDro = 8

The Australian and NZ SCI Physiotherapy guideline committee recommends FES cycling may be provided to treat spasticity in people with SCI. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:

FES cycling may be provided to treat spasticity in people with SCI.

This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.

This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend FES cycling to treat spasticity in people with SCI. based on opinion.

To learn more about this recommendation go to the research summary.

Ralston KE, Harvey LA, Batty J, et al. Functional electrical stimulation cycling has no clear effect on urine output, lower limb swelling, and spasticity in people with spinal cord injury: a randomised cross-over trial [with consumer summary]. Journal of Physiotherapy 2013 Dec;59(4):237-243