Handcycling Classification: A First Step Towards an Evidence-based System

Paralympic classification plays a crucial role in ensuring fair competition for athletes with varying impairments across a wide range of sports. It provides a framework for grouping athletes into classes based on the impact of their impairments on performance, thereby allowing athletes with similar activity limitations to compete against each other. However, the classification process is not without its challenges. Subjectivity, lack of scientific evidence highlighting the impact of impairment, and lack of standardized assessment tools, for example, present ongoing issues that need to be addressed to advocate for the integrity of Paralympic sport. Handcycling faces unique classification challenges due to the diverse range of impairments among athletes and the complex interaction between impairments, performance and human-handbike interface. The existing classification system categorizes athletes into classes based on the extent of their impairments. However, there is a growing recognition of the need for a more evidence-based approach. Research projects, such as this thesis, aim to address some of the handcycling classification needs by exploring key determinants of handcycling performance and proposing refinements to the classification system. The goal is to ensure that handcycling classification better reflects athletes' functional abilities and promotes fair and equitable competition. This research project began with a critical examination of the existing handcycling classification system, revealing significant differences in average time-trial velocities between adjacent classes. This initial exploration highlighted the necessity for an evidence-based approach to classification. Subsequent chapters delved into specific aspects of handcycling performance and their implications for classification. For instance, Chapter 3 focused on the relationship between sprint power and road time-trial performance, demonstrating the predictive value of sprint tests across different impairment types and bike categories. Chapter 4 investigated the role of trunk function was investigated in recumbent handcycling performance. Results showed that the impact of trunk flexion strength on performance is not entirely aligned with the current classification system. This challenged existing assumptions and prompted further exploration into other potential performance determinants. One such determinant, upper-limb strength, was explored in Chapter 5. Strong associations were found between push and pull force and sprint power output. This emphasized the importance of incorporating objective upper-limb strength assessments into the handcycling classification process. In Chapters 6 and 7 potential determinants of performance were investigated that are intrinsically linked to the human-handbike interface and the different handbike configurations. Chapter 6 investigated the impact of performing closed kinetic chains with the lower limbs on upper-limb strength by pushing against footrests of the handbike. The insights revealed performance advantages for athletes with lower-limb function compared with athletes without lower-limb function while they are competing in the same class. In Chapter 7 hand function impairment simulations were explored. The aim of this chapter was to understand whether there were performance disparities present among athletes with different levels of hand function. Results revealed hand function impairment impacts performance, highlighting the need for further research in this area and respective equipment nuances. Finally, an expert panel was brought together in the study of Chapter 8. The aim of this study was to assess the implications of the findings, described in the current thesis, for handcycling classification. Additionally, the study sought to achieve consensus on some issues while also identifying unresolved controversies in others related to handcycling classification. In Chapter 9 the main findings of the thesis are summarized and it is discussed what they collectively contribute to evidence-based handcycling classification. Ongoing research and collaboration will be essential to refine the classification process and ensure fairness, equity, and inclusivity for athletes in handcycling competition.