Cycling of people with a lower limb amputation in Thailand

The barriers perceived by Chilean athletes with disability at different social ecological levels

People with disabilities face various barriers that hinder or prevent access to physical activity, impacting their quality of health and life. This study aimed to examine the barriers to physical activity experienced by Chilean athletes with disability. The sample consisted of 35 Chilean athletes with disability. The participants answered the Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) to assess perceptions of social ecological subdivided into four levels. Sex, the type of sport practice, the region where live, the type of disability, and the physical disability were considered. The organizational level was the main barrier according to the ecological level, with the lack of adaptation of outdoor spaces and the lack of information or inclusive advertising in the sports center being the main barriers identified. An effect of the type of disability on the social ecological barriers was observed, with differences between the non-wheelchair user and wheelchair user groups. The organizational and community context were the main perceived barriers. Thus, it is considered relevant to generate actions for specific interventions in order to promote the practice of physical activity and reduce the main barriers identified in the different contexts within the community.

Overcoming barriers to cycling for knee disarticulation and transfemoral prosthesis users: A pilot study in The Netherlands

BACKGROUND

Cycling has a number of benefits, especially for individuals with a knee disarticulation or transfemoral prosthesis. However, the barriers they face in cycling are not well understood.

OBJECTIVES

To explore the barriers in cycling experienced by users with a knee disarticulation or transfemoral prosthesis, and to gather solutions to overcome these barriers.

METHODOLOGY

A qualitative research approach was used. In-depth, semi-structured, self-developed interviews were conducted with experienced prosthetic users (N=8) and an adapted version was used for certified prosthetists/orthotists (CPOs) (N=3). The interview included physical, psychological, prosthetic, and bicycle-related items.

FINDINGS

Based on the findings from the interviews, the following barriers and corresponding recommendations were identified:Physical barriers: Exertion, skin damage in the groin area and discomfort in the back and hip.Recommendation: Use of an electric bicycle and use of a crank shortener or saddle adjustment to overcome asymmetry in cycling.Psychological barriers: Fear of falling or fear of balance disturbances.Recommendation: Task- and context-specific training, or graded exposure to cycling during prosthetic training, along with potentially using a more advanced bike with improved balance.Prosthetic barriers: Problems with switching the knee prosthesis mode for cycling; challenges with prosthetic suspension; and discomfort caused by the socket brim design.Recommendation: Manufacturers should integrate automatic detection of cycling in microprocessor prosthetic knee joints; use of a total elastic suspension belt (TES-belt); and lowering the ventral edge of the socket.Bicycle-related barriers: Slipping of the prosthetic foot off the pedal.Recommendation: Use of anti-slip pedals or a block heel under the shoe.

CONCLUSION

By addressing the challenges and barriers, we aim to promote greater engagement in cycling, which offers significant physical and psychological benefits for persons with knee disarticulation or transfemoral amputation. Eventually, this can enhance their quality of life and foster greater independence.

Cycling in people with a lower limb amputation

Background

To evaluate cycling participation and identify barriers and facilitators related to cycling participation in people with a lower limb amputation (LLA) in the Netherlands.

Methods

A questionnaire was sent to adults with a LLA between March and August 2019 to obtain information regarding prosthesis, individual’s characteristics, amputation, cycling barriers and facilitators, and prosthetic satisfaction. The questionnaires were distributed via 8 orthopedic workshops, post and were given directly. To find cycling predictors, variables associated with cycling (p < 0.1) were entered into a logistic regression analysis. Non-significant variables were removed manually.

Results

Participants (n = 207, 71% males) had a mean age of 62.0 ± 13.0 years. The most frequent level of amputation was transtibial (42%), and trauma was the most frequent cause of amputation (43%). After the LLA, 141 participants (68%) cycled for recreation (80%), physical fitness (74%), and transport (50%). In the past six months, cyclists cycled for recreation (79%) and transport (66%). Most cycled less than once a day. Recreational cyclists cycled alone (75%) for a median duration of 45 min or 14 km per ride. Cyclists with a transportation purpose usually cycled to go shopping (80%) or to visit friends (68%), with a median duration of 20 min or five kilometers per ride. Cyclists reported more facilitators (median (IQR) = 5 (3, 7) than non-cyclists 0 (0, 3). The majority of cyclists reported a positive attitude toward cycling (89%) and cycled because of health benefits (81%). A dynamic foot (odds ratio: 5.2, 95% CI 2.0, 13.3) and a higher number of facilitators (odds ratio: 1.3, 95% CI 1.2, 1.5) positively predicted cycling, whereas the presence of other underlying diseases (odds ratio: 0.4, 95% CI 0.2, 0.9) negatively predicted cycling (R²: 40.2%).

Conclusion

In the Netherlands, the majority of adults cycled after a LLA, mainly for recreational purposes. A dynamic foot, a higher number of facilitators, and no other underlying diseases increases the likelihood of cycling after a LLA. The results suggest that personal motivation and a higher mobility level could be the key to increasing cycling participation. Future research should determine the association between motivation, mobility levels, and cycling with a LLA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00302-3.