Hand Cycling (v no intervention) on cardiorespiratory fitness in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	Hand Cycling (v no intervention) on cardiorespiratory fitness in people with SCI
P	People with SCI	Evidence recommendation Weak for (88%)		Weak evidence recommendation FOR Hand cycling may be provided to improve cardiorespiratory fitness in people with SCI. Clinical note: Hand cycling for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse
I	Hand cycling	Evidence recommendation Weak for (88%)
C	No intervention	Consensus-based opinion statement No opinion statements
O	Cardiorespiratory Fitness
	SUMMARY	1 RCT (see reference)		Mean difference (95% CI): Cardiorespiratory fitness expressed as Vo2 Peak 5.9 (3.7 to 8.1) Favours hand cycling
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision No serious	Indirectness Serious	Publication bias Serious

HAND CYCLING ON CARDIORESPIRATORY FITNESS: 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

HAND CYCLING ON CARDIORESPIRATORY FITNESS: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
KIM 2015	Indoor hand cycling V No intervention (usual activities)	Indoor hand bike - 60 minutes per day, 3 days per week for 6 weeks	C5-T11 SCI	8/7	Vo2 peak	Some Concerns of Risk of Bias PEDro = 5/10

The Australian and NZ SCI Physiotherapy guideline committee recommends hand cycling to improve cardiorespiratory fitness in people with SCI. This is an evidence recommendation supported by the results of one randomised controlled trial. The guideline states:

Hand cycling may be provided to improve cardiorespiratory fitness in people with SCI.

This recommendation was formed by considering the results of one randomised controlled trial alongside other factors. The trial results indicate that hand cycling is better than no hand cycling to improve cardiorespiratory fitness. 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 hand cycling to improve cardiorespiratory fitness in people with SCI based on evidence.

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

Kim D-I, Lee H, Lee B-S, et al. Effects of a 6-Week Indoor Hand-Bike Exercise Program on Health and Fitness Levels in People with Spinal Cord Injury: A Randomized Controlled Trial Study. Archives of physical medicine and rehabilitation 2015; 96: 2033-2040.e2031.