FES cycling in patients with acquired brain injury
Functional electrical stimulation cycling involves the application of a small electrical current through the skin to stimulate muscle contractions in synchrony with the pedalling motion of a lower limb ergometer. If used in addition to routine face-to-face physiotherapy, FES cycling may increase strength in the lower limbs, which may have carryover effects on the patient's ability to walk and move around.
Because preliminary studies of FES cycling were favourable, there has been much interest in it from patients, relatives and physiotherapists. However, a systematic literature review of those studies showed that the quality of those trials was low, with most failing to blind assessors - which could lead to inflated estimates of the benefit of the treatment.
The current study examined whether 4 weeks of active FES cycling in addition to usual care improve mobility and strength more than usual care alone in people with a subacute (ie, less than 6 months after) brain injury. This was a high-quality study with true randomisation, blinding of assessors, intention-to-treat analysis, concealed allocation and excellent follow-up.
Perhaps somewhat disappointingly, it was found that 4 weeks of FES cycling in addition to usual care does not improve mobility in people with a sub-acute acquired brain injury. The effect on strength was less clear, but any effect on strength is unlikely to be useful if it does not contribute to better mobility.
Although the study did not support FES cycling, the results are very valuable because the equipment required to implement FES cycling is expensive and patients need to maximise their available rehabilitation time by focusing on the most effective interventions.
> From: De Sousa et al., J Physiother 62 (2017) 203-208. All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.