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. 2023 Jan;46(1):146-153.
doi: 10.1080/10790268.2021.1975082. Epub 2021 Nov 2.

Supine arm cycling during the post-flap recovery period for persons with spinal cord injuries: The multi-purpose arm cycle ergometer (M-PACE) safety and pilot testing

Christine M Olney  1 , John E Ferguson  1   2 , Greg Voss  1 , Eric Nickel  1 , Stuart Fairhurst  1 , Alexandra S Bornstein  1 , Sara Kemmer  1 , Crystal Stien  1 , Kristin Scheel  1 , Charlotte Brenteson  1 , Ann Goding  1 , Mary Murphy Kruse  1 , Byron Eddy  1 , Gary Goldish  1   2 , Andrew H Hansen  1   2   3   4
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Supine arm cycling during the post-flap recovery period for persons with spinal cord injuries: The multi-purpose arm cycle ergometer (M-PACE) safety and pilot testing

Christine M Olney et al. J Spinal Cord Med. 2023 Jan.

Abstract

Objective: To describe how using a supine arm cycle ergometer can safely reduce deconditioning experienced by patients with spinal cord injury or disorder (SCI/D) during their four to six weeks of complete bed rest after surgery to close a stage 4 pressure injury.

Design: This pilot project used a newly designed arm cycle ergometer (known as the M-PACE) that extends over the bed, allowing a patient to lie completely supine while exercising.

Setting: The M-PACE was designed and built at the Minneapolis Veterans Affairs Health Care System (MVAHCS) and pilot tested at the MVAHCS SCI/D Center.

Participants: Patients with SCI/D, recovering from flap surgery and deemed appropriate to use the arm cycle ergometer were enrolled in the pilot study (n = 47).

Outcome measures: A pre-post six-minute arm test (6MAT), a proxy for conditioning, was conducted on a subset (n = 15) of participants before and after the supine cycling exercise training program. Participants' rating of perceived exertion (RPE) scores were collected at cessation of each 6MAT. Participants gave feedback on their perception of using the M-PACE.

Results/conclusions: The 6MAT RPE was significantly reduced after training with the M-PACE while on bed rest (P = 0.003). Also, significantly more rotations were performed after completing the training program (P = 0.02). Further, study participants who accessed the M-PACE found using it helped offset the tedium of laying supine during flap surgery recovery. The differences in the 6MAT pre- to post measures indicate the M-PACE should be further studied for offsetting the normal deconditioning that occurs with extended bedrest.

Keywords: Bedrest; Deconditioning; Ergometry; Exercise; Flap surgery; Pressure injuries; Rehabilitation.

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Figures

Figure 1
Figure 1
Final design of the supine arm cycle ergometer. The default safety feature moves the overhead mechanism away from the patient.
Figure 2
Figure 2
Usage of the M-PACE varied across the participants, depending on their type of flap surgery, prescribed time on bedrest, or other mitigating circumstances. This figure depicts the number of weeks the M-PACE was used by 40 of the 47 participants (39 participants with SCI/D, one non-SCI/D participant).
Figure 3
Figure 3
Pre and post reported perceived exertion (RPE) scores at the end of the 6MAT of participants who used the M-PACE after flap surgery (P = 0.003). A lower score suggests less exertion after the 6MAT. Of the 15 cases, 14 maintained their conditioning (RPE stayed the same or reduced). Nine of those 14 improved their conditioning as reported per RPE during the post-surgical phase.
Figure 4
Figure 4
Pre and post revolutions using the M-PACE during the 6MAT. The increase in the number of revolutions pre to post was significant (P = 0.02).
See this image and copyright information in PMC

References

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