Abstract
Background: To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI).Method: Five electronic databases [PubMed, Scopus, Medline (Proquest), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)] were searched before September 2021. The human trials and studies of English language were only included. Two authors independently reviewed and extracted the searched studies. The primary outcome measure was spasticity assessed by Modified Ashworth Scale or Ashworth Scale for lower limbs. The secondary outcome measures were walking abilities, such as 6 Min Walk Test (6MWT), Timed Up and Go (TUG), and lower limbs muscle strength (LEMS). A subgroup analysis was performed to investigate the efficacious threshold number of training sessions. A meta-regression analysis was used to examine the linear relationship between the training sessions and the effect on spasticity.Results: A total of 764 studies were identified. After screening, 12 selected studies were used for the qualitative synthesis, in which eight of them were quantitatively analyzed. Eight studies included ninety-nine subjects in total with SCI (male: female = 83:16). The time since injury was from less than 4 weeks to 17 years. The age ranged from 20 to 67 years. American Spinal Injury Association (ASIA) impairment level of the number of participants was 59 for ASIA A, 11 for ASIA B, 18 for ASIA C, and 11 for ASIA D. There were 43 subjects with tetraplegia and 56 subjects with paraplegia. Spasticity decreased significantly (95% CI = − 1.538 to − 0.182, p = 0.013) in favor of FES-cycling training. The walking ability and LEMS also improved significantly in favor of FES-cycling training. The subgroup analysis showed that spasticity decreased significantly only in more than 20 training sessions (95% CI = − 1.749 to − 0.149, p = 0.020). The meta-regression analysis showed training sessions and spasticity were not significantly associated (coefficient = − 0.0025, SE = 0.0129, p = 0.849, R2 analog = 0.37).Conclusion: Functional electrical stimulation-cycling training can improve spasticity, walking ability, and the strength of the lower limbs in the individuals with SCI. The number of training sessions is not linearly related to the decrease of spasticity. Twenty sessions of FES-cycling training are required to obtain the efficacy to decrease spasticity.
Highlights
According to the National Spinal Cord Injury Statistics, the annual incidence of spinal cord injury (SCI) is 17,730 in the United States of America (National Spinal Cord Injury Statistical Center [NSCISC], 2017)
A total of 763 studies were identified from the electronic databases and one additional study from hand searching from references lists of available articles
Eight of them were quantitatively analyzed for meta-analysis (Sköld et al, 2002; Krause et al, 2008; Szecsi and Schiller, 2009; Mazzoleni et al, 2013, 2017; Ralston et al, 2013; Kuhn et al, 2014; Yasar et al, 2015), and four studies were excluded due to reasons, such as case report (n = 1) (Fattal et al, 2018), no Modified Ashworth Scales (MAS) result of post-test (n = 2) (Reichenfelser et al, 2012; Popovic-Maneski et al, 2018), and only lower limbs muscle strength (LEMS) data included (n = 1) (Sadowsky et al, 2013)
Summary
According to the National Spinal Cord Injury Statistics, the annual incidence of spinal cord injury (SCI) is 17,730 in the United States of America (National Spinal Cord Injury Statistical Center [NSCISC], 2017). SCI causes permanent changes in strength, sensation, and autonomic dysfunction below the level of the injury. SCI has a profound impact on the life of an individual. Exercise is recommended for able-bodied persons and for people with SCI. Recent rehabilitation strategies have focused on the early repetitive task-oriented approaches to facilitate central nervous system plasticity in people with SCI (Fouad and Tetzlaff, 2012). Improving the functional activities of this population is vital wherein locomotor training using functional electrical stimulation cycling (FES-cycling) has been provided in clinical rehabilitation. To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI)
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