3.2. richard weston

INNOVATIVE THINKINGFOR THE REAL WORLD

Exploring the potential of electric bicycles for people after stroke

Richard Weston, Naoimh McMahon, Caroline Watkins

Presentation to the Scientists for Cycling ColloquiumUniversity of Aveiro, Portugal, 18 November 2016


Pilot study outline• Stakeholder engagement event(s) were held to explore the potential use of electric

bicycles by people after stroke. Attendees included:

• Stroke survivors and their family/carers

• electric bike developers (Electric Bike Research Executive)

• third sector representatives (Preston on Wheels - Wheels for All)

• healthcare professionals

• The three research questions were:

1. What would make people after stroke want to start cycling, or to start cycling again?

2. What would their concerns/anxieties about cycling be?

3. How could these concerns/anxieties be overcome?

INNOVATIVE THINKINGFOR THE REAL WORLDINNOVATIVE THINKINGFOR THE REAL WORLD

Research approach• Three events:

– 1st @ UCLan sport arena• demonstration of adapted bikes/ebikes, followed by a focus group

– 2nd @ local stroke group meeting• demonstration of adapted bikes as part of local initiative, followed by 2

focus groups

– 3rd @ local stroke group meeting• presentation of research findings, followed by open discussion


First Event• Structured into two parts:

• in the morning participants to familiarise themselves with a range of cycles, 2, 3 and four wheel, upright, recumbent, seated, etc. and electric bikes. participants able to try cycles away from traffic on a 1.5 km cycle track and to speak to professionals about adapting cycles to suit their circumstances

• After lunch the participants participated in a focus group discussing a number of issues to help identify the potential benefits of, and barriers to, cycling and using electric bikes


Topics for discussionBenefits Barriers Equipment & Training

• Opportunities for increased physical activity where effort can be moderated

• Reduced cost of travel• Green travel• Increased independence• Fun and enjoyment• Increased

strength/cardiovascular fitness

• Health economics implications - NHS resource use

• Impact of different stroke related impairments on use e.g. muscle weakness, tone, balance difficulties, vision impairment, arm weakness etc.

• Safety: e.g. cycling alone, cycling on roads, running out of power

• Initial cost• Getting on/off• Manoeuvrability & storage

when off bike

• Types of bikes: different wheel size, recumbent, 3-4 wheels etc.

• Adaptations: handlebars, gears, electric control, pedals

• Confidence/training for increased confidence: e.g. challenging routes/terrain

• Monitoring effect – perceived exertion: Borg scale (RPE), heart rate


Findings

• The focus group findings fell into three themes:i. getting into cycling, ii. concerns and challenges, and iii. making it possible.

For each theme, further subthemes were identified.


Theme 1: Getting into Cycling

• Sub-themes:i. improved mood through being outdoors,

… I wanted to get out of the house, … being cooped up adds to feeling a little bit more down as time goes on

ii. doing something for yourself,… one weekend I thought, I know, I’ll see if I can get up the stairs … a week or two later at a case conference, I was listening to them say that I had done this awful thing and gone upstairs … I felt naughty as if I shouldn’t have done it

iii. being part of a community,… since I’ve had this trike, one of the things that sort of amazed me when I’m cycling along and proper cyclists come past they wave…you are part of that group … you’re not labelled


Theme 2: Concerns & Challenges

• Sub-themes:i. safety

… we decided that a three wheeler would have been the better bicycle for me, which makes you feel safer, cause two wheelers, you’ve had it… cars coming too close, I was told there is research … that showed that cars go closer to cyclists in Lycra … so the secret is to look as unprofessional as possible

ii. practical issuesgetting to and from the cycling location, transporting a bike, cost issues, storage and maintenance issues for those with their own bikes


Theme 3: Making it Possible

• Sub-themes:i. starting slowly,

… if you practice during group sessions and you’re okay, you think, maybe I could buy my own bike now that I’m used to it, so it’s a good way of testing if you could do it

ii. getting properly set up,… the mechanisms required to change things such as the seat height, gears and brakes along with clipping the helmet buckle

iii. having a helping hand,… I couldn’t do without my friend to help me, to lift in and out and that sort of thing so I am dependent on my friend


In Summary• high level of interest in taking up, or resuming, cycling• getting out-and-about was a major motivator as well as the

social aspects of cycling – promoting mental wellbeing as well as physical health

• primary concerns related to (road) safety and physical limitations after stroke, together with the cost of adaptions

• most participants expressed a desire to carry on and go further, but stroke related fatigue and reduced motor power limited physical activity. The use of power assisted, or pedelecs, were seen as a possible solution to this


Next steps

• understanding the limitations of the intervention – who would/would not benefit?

• understanding the technical requirements of adaptions, monitoring use, etc.

• recruiting suitable participants – have suitable facilities, motivation, etc.

• attracting funding for a small pilot study to provide bikes and monitor use and changes in physical health and mental wellbeing


ANY QUESTIONS?

3.2. richard weston

Education