Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK.
The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 OAH, UK.
J Neuroeng Rehabil. 2021 Jun 12;18(1):99. doi: 10.1186/s12984-021-00882-8.
The objective of this review was to summarize and appraise evidence on functional electrical stimulation (FES) cycling exercise after spinal cord injury (SCI), in order to inform the development of evidence-based clinical practice guidelines.
PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, SPORTDiscus, and CINAHL were searched up to April 2021 to identify FES cycling exercise intervention studies including adults with SCI. In order to capture the widest array of evidence available, any outcome measure employed in such studies was considered eligible. Two independent reviewers conducted study eligibility screening, data extraction, and quality appraisal using Cochranes' Risk of Bias or Downs and Black tools. Each study was designated as a Level 1, 2, 3 or 4 study, dependent on study design and quality appraisal scores. The certainty of the evidence for each outcome was assessed using GRADE ratings ('High', 'Moderate', 'Low', or 'Very low').
Ninety-two studies met the eligibility criteria, comprising 999 adults with SCI representing all age, sex, time since injury, lesion level and lesion completeness strata. For muscle health (e.g., muscle mass, fiber type composition), significant improvements were found in 3 out of 4 Level 1-2 studies, and 27 out of 32 Level 3-4 studies (GRADE rating: 'High'). Although lacking Level 1-2 studies, significant improvements were also found in nearly all of 35 Level 3-4 studies on power output and aerobic fitness (e.g., peak power and oxygen uptake during an FES cycling test) (GRADE ratings: 'Low').
Current evidence indicates that FES cycling exercise improves lower-body muscle health of adults with SCI, and may increase power output and aerobic fitness. The evidence summarized and appraised in this review can inform the development of the first international, evidence-based clinical practice guidelines for the use of FES cycling exercise in clinical and community settings of adults with SCI. Registration review protocol: CRD42018108940 (PROSPERO).
本综述旨在总结和评价脊髓损伤（SCI）后功能性电刺激（FES）自行车运动的证据，以便为制定基于证据的临床实践指南提供信息。
检索了 PubMed、Cochrane 对照试验中心注册库、EMBASE、SPORTDiscus 和 CINAHL，截至 2021 年 4 月，以确定包括 SCI 成人在内的 FES 自行车运动干预研究。为了获取最广泛的现有证据，任何在这些研究中使用的结果测量都被认为是合格的。两名独立的审查员使用 Cochrane 的偏倚风险或 Downs 和 Black 工具进行研究资格筛选、数据提取和质量评估。每项研究根据研究设计和质量评估评分被指定为 1 级、2 级、3 级或 4 级研究。使用 GRADE 评分（“高”、“中”、“低”或“极低”）评估每个结果的证据确定性。
92 项研究符合纳入标准，共纳入 999 名 SCI 成人，代表所有年龄、性别、受伤时间、损伤水平和损伤完整性分层。在肌肉健康方面（例如肌肉质量、纤维类型组成），4 项 1 级-2 级研究中有 3 项、32 项 3 级-4 级研究中有 27 项（GRADE 评级：“高”）发现了显著改善。尽管缺乏 1 级-2 级研究，但在几乎所有 35 项 3 级-4 级研究中，FES 自行车运动测试的峰值功率和摄氧量等功率输出和有氧运动能力也发现了显著改善（GRADE 评级：“低”）。
目前的证据表明，FES 自行车运动可改善 SCI 成人的下肢肌肉健康，并可能提高功率输出和有氧运动能力。本综述总结和评价的证据可用于制定第一个国际、基于证据的临床实践指南，以在 SCI 成人的临床和社区环境中使用 FES 自行车运动。注册审查方案：CRD42018108940（PROSPERO）。
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