Beyond rehabilitation: a qualitative exploration of sport participation context and FES-cycling user experience in spinal cord injury

BACKGROUND: While functional electrical stimulation (FES)-cycling benefits for spinal cord injury (SCI) are documented, user acceptance and sustained engagement remain underexplored. Understanding how sport participation history and values shape FES-cycling experiences is essential for predicting technology adoption beyond rehabilitation. OBJECTIVE: To explore FES-cycling user experiences within the context of participants' sport participation history, examining how sport-related values, post-injury adaptations, and existing barriers influence device acceptance and attitudes towards sustained use. METHODS: Fifteen male individuals with SCI (mean age 43.9 ± 14.0 years; mean time since injury 11.2 ± 11.9 years) participated in the study, with 11 presenting complete and four incomplete SCI. They all completed a short FES-cycling training and semi-structured interviews exploring: sport experiences pre/post-injury, disability impact on participation, barriers and facilitators to sport access, FES-cycling user experience and future use perspectives. An inductive thematic analysis identified patterns across data, adopting a data-driven approach through line-by-line coding to identify emergent themes, subsequently organized within a higher-order thematic framework. RESULTS: Five themes emerged: (1) meanings attached to sport (competition, cooperation, escape, resilience, self-improvement); (2) post-injury sport changes (physical/psychological adaptations, renewed appreciation); (3) sport access (barriers: cost, infrastructure, time; facilitators: organizations, policies); (4) FES-cycling experience (physical/emotional benefits, frustrations); and (5) future perspectives (opportunities, limitations). CONCLUSIONS: Sport-related values directly shaped how participants evaluated FES-cycling capabilities and practical viability. FES-cycling acceptance depends on whether the device aligns with users' sport-related values and addresses their existing barriers to participation. Realistic implementation, supported by dialogue with participants about limitations and challenges, can help bridge the gap between rehabilitation and sustained engagement in physical activity.