The Impact of a Peer-facilitated, Virtual Handcycling Sport Program for Aging Adults with Spinal Cord Injury or Disease: A Mixed Methods Case Series

Research Objectives: To investigate the impact of a peer-facilitated, virtual handcycling sport intervention on physical, psychological, and social health of adults living with spinal cord injury or disease (SCI/D) aged 50 years or older.

Design: Concurrent, mixed methods case series.

Setting: Home-based setting in Ontario, Canada.

Participants: Eligible participants were manual wheelchair users living with chronic SCI/D who were aged 50 years or older and received medical clearance to participate. Three volunteers were enrolled; two participants completed the intervention and one participant was withdrawn before study completion due to fractures unrelated to the sport program.

Interventions: Participants completed a maximum of 45 minutes of moderate to vigorous intensity group-based virtual handcycling on Zwift and Microsoft Teams twice weekly for 12 weeks. The program was co-led by a physiotherapist and a peer who was living with SCI/D, aged over 50 years, and experienced with competitive handcycling.

Main Outcome Measures: Participants completed clinical outcome measures assessing physical, psychological, and social health at baseline, immediately post-intervention, and at 12-week follow-up: Spinal Cord Independence Measure (SCIM), 6-Minute Push Test (6MPT), Moorong Self-Efficacy Scale (MSES), Exercise Self-Efficacy Scale (ESES), Positive Affect and Well-Being Scale short form (PAWB), and Multidimensional Scale of Perceived Social Support (MSPSS). Meaningful change was evaluated using the two-standard deviation band method and minimal detectable change. Adverse events were monitored throughout the program using an online survey. Participants completed an individual semi-structured interview following program completion, informed by the Modified Health through Sport Conceptual Model. Interview data was analyzed using thematic analysis.

Results: One participant experienced meaningful improvement in 6MPT distance immediately post-intervention and meaningful increase in the Mobility Sub-Scale score of the SCIM at 12-week follow-up, which was congruent with perceived physical health improvements reported during the interview. Immediately post-intervention, the second participant experienced meaningful increase in ESES score, which aligned with the perception of psychological health benefits, and meaningful improvement in MSPSS score, which did not align with qualitative perspectives indicating no change. At 12-week follow-up, meaningful reductions in ESES score and Mobility Sub-Scale score of the SCIM were observed for the second participant, which was corroborated by reports of skin breakdown limiting sport participation. No changes were observed in MSES or PAWB scores for either participant, which was incongruent with perceived psychological health improvements.

Conclusions: Virtual handcycling provided some temporary physical, psychological, and social benefits for aging participants with SCI/D. Findings warrant further exploration of this area through larger research studies.

Author(s) Disclosures: No conflicts of interest to disclose.