FES cycling (v no intervention) on atrophy (prevention) in people with SCI and paralysis of the lower limbs | SCI Physiotherapy Clinical Practice Guidelines

	FES cycling (v no intervention) on atrophy (prevention) in people with SCI and paralysis of the lower limbs
P	People with SCI who have paralysis of the lower limbs	Evidence recommendation Weak for (100%)		Weak evidence recommendation FOR FES cycling may be provided to decrease atrophy in people with SCI and paralysis of the lower limbs
I	FES cycling	Evidence recommendation Weak for (100%)
C	No intervention	Consensus-based opinion statement No opinion statements
O	Atrophy
	SUMMARY	2 RCTs (see references)		Standardised Mean Difference (95% CI) 3 (2 to 4) Favours FES cycling
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Very serious	Inconsistency No serious	Imprecision Serious	Indirectness Serious	Publication bias Serious

FES CYCLING ON ATROPHY: 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

FES CYCLING ON ATROPHY: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
BALDI 1998	FES cycle ergometry V No intervention	FES cycle ergometer 3 x per week for 3 weeks	C5-T12 Frankel A and B SCI	9/9	Atrophy Total body mass (gluteal)	High Risk of Bias PEDro = 4/10
DEMCHAK 2005	FES cycle ergometry V No intervention	FES cycle ergometer 3 x per week for 13 weeks	AIS A and B SCI	5/5	Atrophy – Muscle fibre cross sectional area	High Risk of Bias PEDro = 5/10

The Australian and NZ SCI Physiotherapy guideline committee recommends FES cycling to decrease atrophy in people with SCI and paralysis of the lower limbs. This is an evidence recommendation supported by the results of two randomised controlled trials. The guideline states:

FES cycling may be provided to decrease atrophy in people with SCI and paralysis of the lower limbs.

This recommendation was formed by considering the results of two randomised controlled trials alongside other factors. The trial results indicate that FES cycling is better than no FES cycling to prevent atrophy. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.

This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend FES cycling to decrease atrophy in people with SCI and paralysis of the lower limbs based on evidence.

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

Demchak TJ, Linderman JK, Mysiw WJ, Jackson R, Suun J, Devor ST. Effects of functional electric stimulation cycle ergometry training on lower limb musculature in acute sci individuals. J Sport Sci Med 2005;4(3):263–71.
Baldi JC, Jackson RD, Moraille R and Mysiw WJ. Muscle atrophy is prevented in patients with acute spinal cord injury using functional electrical stimulation. Spinal cord 1998; 36: 463.