Evaluating functional electrical stimulation (FES) cycling on cardiovascular, musculoskeletal and functional outcomes in adults with multiple sclerosis and mobility impairment: a systematic review

Jennifer B. Scally, Julien S. Baker, Jean Rankin, Linda Renfrew, Nicholas Sculthorpe

Research output: Contribution to journalArticle

Abstract

Background
People with Multiple Sclerosis (PwMS) are at an increased risk of diseases associated with low levels of physical activity (PA). Deconditioning may lead to an acceleration in the development of secondary complications from MS, impairing physical function and exacerbating disease progression. Functional Electrical Stimulation (FES) Cycling may provide a suitable lower limb exercise intervention for PwMS with mobility impairment. The effects of FES cycling on cardiovascular, musculoskeletal and functional outcomes for PwMS with mobility impairment are yet to be investigated to date.

Objective

The objective of this review was to systematically examine the outcomes of PwMS with mobility impairment following FES cycling intervention.

Methods
A systematic search of four electronic databases (MEDLINE, Web of Science, CINAHL and PEDro) from their inception to 8th January 2019 was performed. Inclusion criteria was 1) include human participants with definite diagnosis of MS 2) participants had to be aged 18 years or older 3) include participants with mobility impairment (determined as an average participant EDSS ≥ 6.0) 4) evaluate FES cycling as an intervention study.

Results
Initial searches found 1163 studies. 9 of which met the full inclusion criteria: 5 pre-post studies with no control group, 2 randomised controlled trials (RCTs), 1 retrospective study and 1 case study. Two studies had the same participant group and intervention but reported different outcomes. Outcome data was available for n=76 unique participants, with n=82 completing a FES cycling intervention. Of the n=4 papers with clear dropout rates, pooled dropout rate was 25.81%. Two papers reported non-significant improvements in aerobic capacity following a FES cycling intervention. Four papers reported no change in lower limb strength and two papers reported significant reductions in spasticity post training. Four studies failed to provide information regarding adverse events with the other studies reporting n=10 adverse events across 36 participants.

Conclusion
Findings suggest FES cycle training may reduce CVD risk alongside trends for a reduction in spasticity post training, however the low quality of the literature precludes any definitive conclusions. FES cycle training appears to be well tolerated in PwMS with mobility impairment, with no serious adverse events.
Original languageEnglish
Article number101485
Number of pages13
JournalMultiple Sclerosis and Related Disorders
Volume37
Early online date30 Oct 2019
DOIs
Publication statusPublished - 31 Jan 2020

Fingerprint

Electric Stimulation
Multiple Sclerosis
Lower Extremity
MEDLINE
Disease Progression
Randomized Controlled Trials
Retrospective Studies
Databases
Control Groups

Keywords

  • Multiple sclerosis
  • Mobility impairment
  • Functional electrical stimulation
  • Functional electrical stimulation cycling
  • High EDSS

Cite this

@article{f6d4d9c33a634de1a5c28dc9ab03cbc4,
title = "Evaluating functional electrical stimulation (FES) cycling on cardiovascular, musculoskeletal and functional outcomes in adults with multiple sclerosis and mobility impairment: a systematic review",
abstract = "BackgroundPeople with Multiple Sclerosis (PwMS) are at an increased risk of diseases associated with low levels of physical activity (PA). Deconditioning may lead to an acceleration in the development of secondary complications from MS, impairing physical function and exacerbating disease progression. Functional Electrical Stimulation (FES) Cycling may provide a suitable lower limb exercise intervention for PwMS with mobility impairment. The effects of FES cycling on cardiovascular, musculoskeletal and functional outcomes for PwMS with mobility impairment are yet to be investigated to date.ObjectiveThe objective of this review was to systematically examine the outcomes of PwMS with mobility impairment following FES cycling intervention.MethodsA systematic search of four electronic databases (MEDLINE, Web of Science, CINAHL and PEDro) from their inception to 8th January 2019 was performed. Inclusion criteria was 1) include human participants with definite diagnosis of MS 2) participants had to be aged 18 years or older 3) include participants with mobility impairment (determined as an average participant EDSS ≥ 6.0) 4) evaluate FES cycling as an intervention study.ResultsInitial searches found 1163 studies. 9 of which met the full inclusion criteria: 5 pre-post studies with no control group, 2 randomised controlled trials (RCTs), 1 retrospective study and 1 case study. Two studies had the same participant group and intervention but reported different outcomes. Outcome data was available for n=76 unique participants, with n=82 completing a FES cycling intervention. Of the n=4 papers with clear dropout rates, pooled dropout rate was 25.81{\%}. Two papers reported non-significant improvements in aerobic capacity following a FES cycling intervention. Four papers reported no change in lower limb strength and two papers reported significant reductions in spasticity post training. Four studies failed to provide information regarding adverse events with the other studies reporting n=10 adverse events across 36 participants.ConclusionFindings suggest FES cycle training may reduce CVD risk alongside trends for a reduction in spasticity post training, however the low quality of the literature precludes any definitive conclusions. FES cycle training appears to be well tolerated in PwMS with mobility impairment, with no serious adverse events.",
keywords = "Multiple sclerosis, Mobility impairment, Functional electrical stimulation, Functional electrical stimulation cycling, High EDSS",
author = "Scally, {Jennifer B.} and Baker, {Julien S.} and Jean Rankin and Linda Renfrew and Nicholas Sculthorpe",
year = "2020",
month = "1",
day = "31",
doi = "10.1016/j.msard.2019.101485",
language = "English",
volume = "37",
journal = "Multiple Sclerosis and Related Disorders",
issn = "2211-0348",
publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - Evaluating functional electrical stimulation (FES) cycling on cardiovascular, musculoskeletal and functional outcomes in adults with multiple sclerosis and mobility impairment

T2 - a systematic review

AU - Scally, Jennifer B.

AU - Baker, Julien S.

AU - Rankin, Jean

AU - Renfrew, Linda

AU - Sculthorpe, Nicholas

PY - 2020/1/31

Y1 - 2020/1/31

N2 - BackgroundPeople with Multiple Sclerosis (PwMS) are at an increased risk of diseases associated with low levels of physical activity (PA). Deconditioning may lead to an acceleration in the development of secondary complications from MS, impairing physical function and exacerbating disease progression. Functional Electrical Stimulation (FES) Cycling may provide a suitable lower limb exercise intervention for PwMS with mobility impairment. The effects of FES cycling on cardiovascular, musculoskeletal and functional outcomes for PwMS with mobility impairment are yet to be investigated to date.ObjectiveThe objective of this review was to systematically examine the outcomes of PwMS with mobility impairment following FES cycling intervention.MethodsA systematic search of four electronic databases (MEDLINE, Web of Science, CINAHL and PEDro) from their inception to 8th January 2019 was performed. Inclusion criteria was 1) include human participants with definite diagnosis of MS 2) participants had to be aged 18 years or older 3) include participants with mobility impairment (determined as an average participant EDSS ≥ 6.0) 4) evaluate FES cycling as an intervention study.ResultsInitial searches found 1163 studies. 9 of which met the full inclusion criteria: 5 pre-post studies with no control group, 2 randomised controlled trials (RCTs), 1 retrospective study and 1 case study. Two studies had the same participant group and intervention but reported different outcomes. Outcome data was available for n=76 unique participants, with n=82 completing a FES cycling intervention. Of the n=4 papers with clear dropout rates, pooled dropout rate was 25.81%. Two papers reported non-significant improvements in aerobic capacity following a FES cycling intervention. Four papers reported no change in lower limb strength and two papers reported significant reductions in spasticity post training. Four studies failed to provide information regarding adverse events with the other studies reporting n=10 adverse events across 36 participants.ConclusionFindings suggest FES cycle training may reduce CVD risk alongside trends for a reduction in spasticity post training, however the low quality of the literature precludes any definitive conclusions. FES cycle training appears to be well tolerated in PwMS with mobility impairment, with no serious adverse events.

AB - BackgroundPeople with Multiple Sclerosis (PwMS) are at an increased risk of diseases associated with low levels of physical activity (PA). Deconditioning may lead to an acceleration in the development of secondary complications from MS, impairing physical function and exacerbating disease progression. Functional Electrical Stimulation (FES) Cycling may provide a suitable lower limb exercise intervention for PwMS with mobility impairment. The effects of FES cycling on cardiovascular, musculoskeletal and functional outcomes for PwMS with mobility impairment are yet to be investigated to date.ObjectiveThe objective of this review was to systematically examine the outcomes of PwMS with mobility impairment following FES cycling intervention.MethodsA systematic search of four electronic databases (MEDLINE, Web of Science, CINAHL and PEDro) from their inception to 8th January 2019 was performed. Inclusion criteria was 1) include human participants with definite diagnosis of MS 2) participants had to be aged 18 years or older 3) include participants with mobility impairment (determined as an average participant EDSS ≥ 6.0) 4) evaluate FES cycling as an intervention study.ResultsInitial searches found 1163 studies. 9 of which met the full inclusion criteria: 5 pre-post studies with no control group, 2 randomised controlled trials (RCTs), 1 retrospective study and 1 case study. Two studies had the same participant group and intervention but reported different outcomes. Outcome data was available for n=76 unique participants, with n=82 completing a FES cycling intervention. Of the n=4 papers with clear dropout rates, pooled dropout rate was 25.81%. Two papers reported non-significant improvements in aerobic capacity following a FES cycling intervention. Four papers reported no change in lower limb strength and two papers reported significant reductions in spasticity post training. Four studies failed to provide information regarding adverse events with the other studies reporting n=10 adverse events across 36 participants.ConclusionFindings suggest FES cycle training may reduce CVD risk alongside trends for a reduction in spasticity post training, however the low quality of the literature precludes any definitive conclusions. FES cycle training appears to be well tolerated in PwMS with mobility impairment, with no serious adverse events.

KW - Multiple sclerosis

KW - Mobility impairment

KW - Functional electrical stimulation

KW - Functional electrical stimulation cycling

KW - High EDSS

U2 - 10.1016/j.msard.2019.101485

DO - 10.1016/j.msard.2019.101485

M3 - Article

VL - 37

JO - Multiple Sclerosis and Related Disorders

JF - Multiple Sclerosis and Related Disorders

SN - 2211-0348

M1 - 101485

ER -