OVERCOMING BARRIERS TO CYCLING FOR KNEE DISARTICULATION AND TRANSFEMORAL PROSTHESIS USERS: A PILOT STUDY IN THE NETHERLANDS
Authors: De Laat Fred , Kühne Sabine , De Vos Wouter , Geertzen Jan 
Published: December 2024

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.
Layman's Abstract
Cycling has a number of benefits, especially for people who use above the knee or through the knee prostheses. We interviewed experienced cyclists who use these types of prosthetic legs, as well as specialists who design and fit them, using a self-developed interview that covered physical, psychological, prosthetic, and bicycle-related items that could be barriers to cycling. Based on these interviews, we identified several key barriers and corresponding solutions:

Physical barriers: Exertion, skin damage in the groin area and pain in the back and hips.

Recommendation: Use an electric bicycle and use a crank shortener or adjust the saddle to help with cycling balance.

Psychological barriers: Fear of falling or losing balance while cycling.

Recommendation: Training focused on specific tasks and situations, or gradual practice of cycling during prosthetic training, possibly with a more advanced bike that offers better balance.

Prosthetic barriers: Problems with changing the knee’s cycling mode; problems with keeping the prosthesis in place; and discomfort from the edge of the socket.

Recommendation: Knee manufacturer could add automatic cycling mode detection; better suspension could be achieved by using a special belt; and lowering the socket brim for more comfort.

Bicycle barriers: The prosthetic foot slipping off the pedal.

Recommendation: Anti-slip pedals or adding a block heel under the shoe.

We hope that addressing these barriers will encourage more people who use above the knee or through the knee prostheses to cycle and enjoy the physical and psychological benefits it offers.
Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/44191/33491
How To Cite: de Laat F.A, Kühne S.W.M, de Vos W.C.A.J, Geertzen J.H.B. Overcoming barriers to cycling for knee disarticulation and transfemoral prosthesis users: A pilot study in The Netherlands. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.4. https://doi.org/10.33137/cpoj.v7i2.44191
Corresponding Author: Fred A. de Laat, MD, PhD,Affiliation: Libra Rehabilitation Medicine & Audiology, Tilburg/Eindhoven, The Netherlands.E-Mail: f.delaat@libranet.nlORCID ID: https://orcid.org/0000-0002-4348-5998