Home-Based Functional Electrical Stimulation Cycling Enhances Quality of Life in Individuals with Spinal Cord Injury

Background:

With advances in medicine and increased survival rates, the focus of health care after spinal cord injury (SCI) has evolved from extending life to increasing independence and quality of life (QOL). Because enhancing QOL is an ultimate goal of the rehabilitation process, research involving the improvement of QOL is of great importance.

Objective:

The purpose of this study was to determine the effects of a home-based functional electrical stimulation lower extremity cycling (FES-LEC) program on the QOL of persons with SCI.

Design:

Eleven veterans with posttraumatic C4-T11 AIS A-C SCI participated in 8 weeks of 3 times weekly home-based FES-LEC. QOL was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Tests were completed by all participants prior to and after the 8-week FES-LEC program.

Results:

There were significant increases in the physical and environmental domain QOL scores. There were nominal nonsignificant increases in the psychological and social domain QOL scores.

Conclusions:

The results of this study provide evidence that home-based FES-LEC 3 times per week for 8 weeks has the potential to result in QOL improvements.Key words: cycling, electrical stimulation quality of life, spinal cord injuryWith medical advances over the past century, there has been a dramatic increase in life-span of those with spinal cord injury (SCI).¹ This has changed the focus of health care after SCI from extending life to increasing independence and quality of life (QOL).² Chappell and Wirz³ state that enhancing QOL is the ultimate goal of rehabilitation, and the overall processes of optimizing physical function and independence comprise 2 of the many components of enhancing the QOL of persons with SCI. The US Surgeon General reports that physical activity is an important factor in promoting QOL. Persons with SCI have been shown to have decreased QOL after injury,^4–6 thus research measuring the effects of physical activity on the QOL of persons with SCI is necessary.The World Health Organization (WHO) defines QOL as the individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. This concept takes into account the effect of physical health, psychological state, level of independence, social relationships, personal beliefs, and relationship to pertinent environmental features.⁷ One intervention that has been associated with the enhancement of QOL is physical activity.⁸ White and colleagues⁹ studied the effects of leisure time physical activities on community-dwelling older adults and found that physical activity and QOL were linked through selfefficacy, whereby physical activities that produce a positive experience and positive feedback are most likely to improve QOL. The study of the relationship between QOL and physical activity for persons with SCI is a more recent undertaking, thus there are relatively few studies that have targeted the psychological effects of regular physical activity in persons with SCI. Hicks et al² studied the effects of an upper body resistance training program using arm ergometry twice weekly for 9 months on the QOL of 34 individuals with SCI. Results showed positive QOL factors; the exercise group reported significantly less stress, fewer depression symptoms, and greater satisfaction with their physical functioning. The results also showed a nonsignificant increase in satisfaction in the selfperceived physical appearance of the exercise group relative to the control group. Fitzwater,¹⁰ a general medical practitioner and FES researcher, provided a personal view as a self-exerciser reporting the perception of improved body image and a preference for functional electrical stimulation lower extremity cycling (FES-LEC) over hand and arm activities.Our group has recently reported case reports utilizing a home-based FES-LEC program. Two older male adults with motor complete tetraplegia participated in FES-LEC 3 times per week for 9 weeks and 6 months, respectively. The results in both case reports showed improvements in perceived body image and self-esteem.^11,12 However, information concerning the effects of exercise, particularly FES-LEC on QOL of those with SCI, remains limited. The purpose of this study was to determine the effects of an Internetconnected home-based FES cycling program on the QOL (physical, psychological, social, and environmental health) of persons with SCI.