The wheelchair skills test, version 2.4: Validity of an algorithm-based questionnaire version

The Attentional Demands of Wheelchair Operation

To determine how motor control patterns in wheelchair propulsion mediate attentional demands. Fourteen participants completed two single- and dual-task trials of Serial-7 Subtraction and four, 30-second motor tasks: Static Sitting, Short Leans, Maximal Leans, and Stationary Propulsion. Differences in cognitive and motor function were determined through paired samples t-tests and percent changes (dual-task costs [DTCs]) were calculated. Within-subjects, repeated-measures ANOVAs determined differences in DTCs across motor tasks. Cognitive function was maintained from the single- to dual-task trials across tasks (DTC ≤ 13%; p = 0.12-0.74). Motor function was uniquely maintained during Maximal Leans (DTC ≤ 0.5%; p = 0.12-0.93), which yielded significantly lower dual-task cognitive function than the others (p < 0.01). Seated balance may be the primary contributor to the attentional demands of wheelchair propulsion.

Wheelchair users' satisfaction after provision using the WHO 8-step guidelines: A pilot study

BACKGROUND

Wheelchairs are vital for the successful rehabilitation and inclusion of people with mobility disabilities; 10% of the population with disabilities needs a wheelchair, but only 15% have access to an adequate one. Not user-configured wheelchairs may lead to postural deformities and pressure ulcers, thus negatively impact user satisfaction, wheelchair skills, and quality of life.

OBJECTIVE

To assess the impact of the 8-step "Guidelines on the provision of manual wheelchairs in less-resourced settings" from the World Health Organization (WHO) on user satisfaction, wheelchair skills, and quality of life of Mexican manual wheelchair users.

METHODS

12 wheelchair users with spinal cord injury that received rehabilitation were recruited. Volunteers were provided a wheelchair and cushion following the WHO 8-step guidelines. Assessment of QUEST, WHOQOL-Bref, and WST-Q was performed at the beginning of the study and 12 months later.

RESULTS

Significant improvement was observed in terms of satisfaction (QUEST; P = 0.009) after receiving the wheelchair and the foam cushion (QUEST; P = 0.004). WHOQol-Bref did not denote significant differences. For the dimensions assessed by the WST-Q scores, a significant 10.9% improvement was observed in both, capacity (P = 0.022) and performance (P = 0.009).

CONCLUSIONS

The application of the WHO 8-step guidelines for wheelchair provision may contribute to increase user satisfaction regarding the wheelchair and cushion devices as well as the prescription process as determined by the QUEST. According to the WST-Q, functional capacity and mobility may also be improved by following the 8-step guidelines.

A semi-structured interview to capture manual wheelchair use for mobility activities among individuals with spinal cord injury in real-life situations: development and content validity of the Wheelchair Mobility Activity Log (WC-MAL)

STUDY DESIGN

Mixed-method approach.

OBJECTIVES

To develop and assess the content validity of a semi-structured interview that captures the lived experience of using a manual wheelchair among individuals with SCI in the real world, the Wheelchair Mobility Activity Log (WC-MAL).

SETTING

SCIR-Group (UDESC)/Brazil.

METHODS

Developing the WC-MAL comprised five steps: (1) defining the construct-based on the International Classification of Functioning, Disability and Health (ICF); (2) identifying relevant activities from other assessment instruments and interviews with the end-users (14 Individuals with SCI and 13 rehabilitation professionals); (3) Selecting the items - activities were linked to ICF codes and grouped into sets; (4) developing the scoring scales based on interviews with the end-users; and, (5) evaluating content validity in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The content validity ratio (CVR) for each item and scale and the overall instrument content validity index (CVI) were calculated.

RESULTS

From an initial draft of 295 activities identified, a set of 222 activities was linked to the ICF domain of "Mobility (d4)" and further refined to generate the 23 items in the WC-MAL. Three scales were developed to assess Frequency (how often), Performance (how well), and Assistance (assistance needed) levels. The items and scales showed a CVR superior to the critical value established (≥0.64). The general CVI value was 0.96.

CONCLUSION

The WC-MAL is a promising clinical instrument with adequate content validity to assess the spontaneous use of the manual wheelchair in the real world among individuals with SCI.

A Remote-Learning Course can improve the subjective wheelchair-skills performance and confidence of wheelchair service providers: an observational cohort study

PURPOSE

To test the hypothesis that a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence of wheelchair service providers, and to determine the participants' views on the Course.

METHODS

This was an observational cohort study, with pre-post comparisons. To meet the objectives of the six-week Course, the curriculum included self-study and weekly one-hour remote meetings. Participants submitted their Wheelchair Skills Test Questionnaire (WST-Q) (Version 5.3.1) "performance" and "confidence" scores before and after the Course. Participants also completed a Course Evaluation Form after the Course.

RESULTS

The 121 participants were almost all from the rehabilitation professions, with a median of 6 years of experience. The mean (SD) WST-Q performance scores rose from 53.4% (17.8) pre-Course to 69.2% (13.8) post-Course, a 29.6% relative improvement (p < 0.0001). The mean (SD) WST-Q confidence scores rose from 53.5% (17.9) to 69.5% (14.3), a 29.9% relative improvement (p < 0.0001). Correlations between performance and confidence were highly significant (p < 0.0001). The Course Evaluation indicated that most participants found the Course useful, relevant, understandable, enjoyable, "just right" in duration, and most stated that they would recommend the Course to others.

CONCLUSIONS

Although there is room for improvement, a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence scores of wheelchair service providers by almost 30%, and participants were generally positive about the Course.

Association between individual wheelchair skills and fitness in community-dwelling manual wheelchair users with spinal cord injuries

PURPOSE

Wheelchair skills are a key component to promotion of community participation among persons with spinal cord injury (SCI). The objective of this secondary analysis was to examine the association between individual wheelchair skills from the Wheelchair Skills Test Questionnaire (WST-Q) and fitness among community-dwelling adults with SCI.

MATERIALS AND METHODS

Twenty-six adults were recruited to complete the WST-Q and a standard graded aerobic wheelchair exercise test on a motorized treadmill for assessing peak power output (POpeak).

RESULTS

Spearman Rho rank-order correlation (ρ) analyses indicated statistically significant correlations between POpeak and six basic (ρ = 0.41-0.57), eight intermediate (ρ = 0.44-0.59), and nine advanced (ρ = 0.42-0.80) WST-Q skill scores. After controlling for sex and injury level (Partial Spearman Rho rank order) significant correlations persisted for four advanced skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position; ρ = 0.46-0.59) and one additional skill (i.e., ascends high curb ρ = 0.51).

CONCLUSIONS

More advanced wheelchair skills are significantly associated with fitness in persons with SCI. The directionality of the skills-fitness relationship, specifically whether wheelchair skills facilitate greater fitness or fitness is a prerequisite for certain wheelchair skills needs to be determined in future, larger studies. However, results from this study provide a comprehensive list of wheelchair skills that are associated with fitness that can be directly applied to guide further research and practice promoting community participation among persons with SCI.Implications for RehabilitationSignificant positive associations exist between advanced wheelchair skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position and ascends high curb) and fitness in manual wheelchair users with spinal cord injury (SCI).This study provides a list of skills associated with fitness to guide clinical practice and areas for further rehabilitation research assessing the directionality of the relationship between fitness and wheelchair skills.

Measurement Properties of Clinical Instruments for Assessing Manual Wheelchair Mobility in Individuals with Spinal Cord Injury: A Systematic Review

OBJECTIVE

To evaluate the measurement properties of clinical instruments used to assess manual wheelchair mobility in individuals with spinal cord injury (SCI).

DATA SOURCES

This systematic review was conducted according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was conducted up to December 2021 on MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Biblioteca Regional de Medicina, and Cumulative Index to Nursing and Allied Health databases without time restriction.

STUDY SELECTION

Peer-reviewed original research articles that examined any clinical wheelchair mobility and/or skill assessment instrument among adults with SCI and reported data on at least one measurement property or described the development procedure were evaluated independently by two reviewers.

DATA EXTRACTION

Data were independently extracted according to Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. Measurement property results from each study were independently rated by two reviewers as sufficient, insufficient, indeterminate, or inconsistent. The evidence for each measurement property was rated as high, moderate, low, or very low (Grading of Recommendations, Assessment, Development, and Evaluation). Recommendations for highly-rated instruments were performed.

DATA SYNTHESIS

Twenty-nine studies with 21 instruments were identified. The methodological quality of studies ranged from insufficient to sufficient, and the quality of evidence ranged from very low to high. Six instruments reported content validity. Reliability and construct validity were the most studied measurement properties. Structural validity and invariance for cross-cultural measurement were not reported. The highly rated instruments were the Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire.

CONCLUSIONS

Although numerous instruments for assessing wheelchair mobility and/or skills among individuals with SCI were identified, not many measurement properties have been sufficiently established. The Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire show the current best potential to be recommended for clinical and research use. Further studies are needed to strengthen or change these recommendations.

Estimation of Steering and Throttle Angles of a Motorized Mobility Scooter with Inertial Measurement Units for Continuous Quantification of Driving Operation

With the growing demand from elderly persons for alternative mobility solutions, motorized mobility scooters (MMSs) have been gaining importance as an essential assistive technology to aid independent living in local communities. The increased use of MMSs, however, has raised safety issues during driving and magnified the necessity to evaluate and improve user driving skills. This study is intended to develop a novel quantitative monitoring method for MMS driving operation using inertial measurement units (IMUs). The proposed method used coordinate transformations around the rotational axes of the steering wheel and the throttle lever to estimate the steering and throttle operating angles based on gravitational accelerations measured by IMUs. Consequently, these operating angles can be monitored simply using an IMU attached to the throttle lever. Validation experiments with a test MMS in the stationary state confirmed the consistency of the proposed coordinate transformation with the MMS's geometrical structure. The driving test also demonstrated that the operating angles were estimated correctly on various terrains and that the effects of terrain inclination were compensated using an additional IMU attached to the scooter body. This method will be applicable to the quantitative monitoring of driving behavior and act as a complementary tool for the existing skills' evaluation methods.

Cross-cultural adaptation and reliability of the Brazilian version of the wheelchair skills test-questionnaire 4.3 for manual wheelchair users

The Wheelchair Skills Test-Questionnaire form for Manual Wheelchairs Operated by Wheelchair Users (WSTQ-M-WCU 4.3) assesses wheelchair skills that may influence users' occupational performance in their daily activities. The purpose of this study was to cross-culturally adapt the WSTQ-M-WCU 4.3 to Brazilian Portuguese and to examine the inter-rater and test-retest reliabilities. This is a methodological study of cross-cultural adaptation and psychometric properties of reliability. The agreement achieved in the cross-cultural adaptation concerning idiomatic, cultural, conceptual and semantic aspects was 100%, 99.2%, 100% and 96.18%, respectively. We analyzed the test-retest and inter-rater reliabilities in a convenience sample of 46 manual wheelchair users using Cronbach's Alpha and Bland-Altman plots. The Brazilian version has excellent internal consistency (α > 0.9) and strong inter-rater reliability (p < .05). This instrument can guide practitioners in training wheelchair skills, thus contributing to the planning of interventions and for evidence-based practice in Assistive Technology.

SWADAPT1: assessment of an electric wheelchair-driving robotic module in standardized circuits: a prospective, controlled repeated measure design pilot study

Objectives

The objective of this study is to highlight the effect of a robotic driver assistance module of powered wheelchair (PWC), using infrared sensors and accessorizing a commercial wheelchair) on the reduction of the number of collisions in standardized circuit in a population with neurological disorders by comparing driving performance with and without assistance.

Methods

This is a prospective, single-center, controlled, repeated measure design, single-blind pilot study including patients with neurological disabilities who are usual drivers of electric wheelchairs. The main criterion for evaluating the device is the number of collisions with and without the assistance of a prototype anti-collision system on three circuits of increasing complexity. Travel times, cognitive load, driving performance, and user satisfaction are also analyzed.

Results

23 Patients, 11 women and 12 men with a mean age of 48 years old completed the study. There was a statistically significant reduction in the number of collisions on the most complex circuit: 61% experienced collisions without assistance versus 39% with assistance (p = 0.038).

Conclusion

This study concludes that the PWC driving assistance module is efficient in terms of safety without reducing the speed of movement in a population of people with disabilities who are habitual wheelchair drivers. The prospects are therefore to conduct tests on a target population with driving failure or difficulty who could benefit from this device so as to allow them to travel independently and safely.

Exploratory investigation of the outcomes of wheelchair provision through two service models in Indonesia

The World Health Organization (WHO) estimates that only 17-37% of the approximately 77 million people who need a wheelchair have access to one. Many organizations are trying to address this need through varying service delivery approaches. For instance, some adhere to WHO's recommended 8-steps service approach while others provide wheelchairs with little to no service. There is limited and sometimes conflicting evidence of the impact of the WHO's recommendations on the outcomes of wheelchair provision. To help build this evidence, we \explored outcomes of two groups of users who received their wheelchairs through two service models over time. The 8-Steps group (n = 118) received a wheelchair selected from a range of models from service providers trained using the WHO process, and the standard of care (SOC) group (n = 24) received hospital-style wheelchairs and without clinical service. Interviews were conducted at baseline and at follow-up 3 to 6 months after provision, to collect data about wheelchair usage, satisfaction, skills, maintenance and repairs, and life satisfaction. Across-group statistical comparisons were not appropriate due to significant differences between groups. In general, participants used their wheelchairs every day but reported very low mobility levels (<500 meters for the 8-steps group, and <100 meters for the SOC group.) The 8-steps group used their wheelchair for either between 1-3 hours per day, or more than 8 hours per day. The SOC used it between 1 and 3 hours per day. Overall, wheelchair usage and wheelchair skills decreased over the 3- to 6-month data collection timeline. Wheelchair breakdowns were common in both groups emphasizing the need for maintenance, occurring more frequently in the 8-Steps (28.8%) compared to the SOC group (8%), and emphasizing the need for maintenance services. No significant differences were found when comparing device satisfaction across wheelchairs types. Our results emphasize the need for routine maintenance to address frequent wheelchair breakdowns. Our results also demonstrate a large disparity in several outcome variables across groups which motivates future studies where across-group comparisons are possible.

Goal attainment in mobility after acute rehabilitation of mobility-restricting paralysis syndromes with regard to the ambulatory therapeutic level of participation NeuroMoves : A German national multicenter observational cohort study

Background

A central goal of rehabilitation in patients with paralysis syndromes after stroke or spinal cord injury (SCI) is to restore independent mobility as a pedestrian or wheelchair user. However, after acute rehabilitation, the mobility frequently deteriorates in the ambulatory setting, despite the delivery of rehabilitative interventions such as physical therapy or the prescription of assistive devices. The aim of the NeuroMoves study is to identify factors that are associated with changes of mobility in the ambulatory setting after acute inpatient rehabilitation, with a particular focus on participation according to the ICF (International Classification of Functioning, Disability and Health).

Methods

The NeuroMoves study is intended as a national multicenter observational cohort study with 9 clinical sites in Germany. A total of 500 patients with mobility-restricting paralysis syndromes (i.e. stroke or SCI) are to be recruited during acute inpatient rehabilitation prior to discharge to the ambulatory setting. Patients will have 8 months of follow-up in the ambulatory setting. Three study visits at the clinical sites (baseline, midterm, and final) are planned at 4-months intervals. The baseline visit is scheduled at the end of the acute inpatient rehabilitation. During the visits, demographical data, neurological, functional, quality of life, and implementation measures will be assessed.

At baseline, each study participant receives an activity tracker (sensor for recording ambulatory mobility) along with a tablet computer for home use over the 8 months study duration. While mounted, the activity tracker records mobility data from which the daily distance covered by walking or wheelchair use can be calculated. Customized applications on the tablet computer remind the study participants to answer structured questionnaires about their health condition and treatment goals for physical therapy. Using the study participants’ tablet, therapists will be asked to answer structured questionnaires concerning treatment goals and therapeutic measures they have applied. The primary analysis concerns the association between mobility (daily distance covered) and the degree of participation-oriented rehab interventions. Further exploratory analyses are planned.

Discussion

The findings could inform healthcare decision-making regarding ambulatory care in Germany focusing on mobility-promoting interventions for patients with mobility-restricting paralysis syndromes.

Study registration

German Clinical Trials Register, DRKS-ID: DRKS00020487 (18.02.2020).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02167-y.

Concurrent Validity and Reliability of the Transfer Assessment Instrument Questionnaire as a Self-Assessment Measure

Objectives

To evaluate the psychometric properties of the Transfer Assessment Instrument Questionnaire (TAI-Q), a self-assessment measure to evaluate transfer quality compared with clinician-reported measures.

Design

Participants self-assessed transfers from their wheelchair to a mat table using the TAI-Q. For session 1, participants self-assessed their transfer both before and after reviewing a video of themselves completing the transfer (session 1). Self-assessment was completed for another transfer after a 10-minute delay (session 2, intrarater reliability) and after a 1- to 2-day delay (session 3, test-retest reliability). Self-assessment was compared with a criterion standard of an experienced clinician scoring the same transfers with the Transfer Assessment Instrument (TAI) version 4.0 (concurrent validity).

Setting

2017 National Veterans Wheelchair Games.

Participants

Convenience sample of full-time wheelchair users (N=44).

Interventions

Not applicable.

Main Outcome Measures

TAI-Q and TAI.

Results

After video review of their transfer, acceptable levels of reliability were demonstrated for total TAI-Q score for intrarater (intraclass correlation [ICC], 0.627) and test-retest reliability (ICC, 0.705). Moderate to acceptable concurrent validity was demonstrated with the TAI (ICC, 0.554-0.740). Participants tended to underestimate the quality of their transfer (reported more deficient items) compared with the TAI. However, this deficit decreased and reliability improved from pre-video review to post-video review and from session 1 to session 2. The minimum detectable change indicated that a change of 1.63 to 2.21 in the TAI-Q total score is needed to detect a significant difference in transfer skills.

Conclusions

When paired with video review, the TAI-Q demonstrates moderate to acceptable levels of reliability and validity for the total score. Self-assessment was completed quickly (<5min) and could help to potentially screen for deficiencies in transfer quality and opportunities for intervention.

Correlates of self-reported Wheelchair Skills Test Questionnaire scores of new users of mobility scooters: a cross-sectional study

OBJECTIVES

To describe the subjective reported scooter-skill scores of new mobility scooter users and to identify significant correlations with other characteristics and measures.

MATERIALS AND METHODS

This was a single-centre study using a cross-sectional design. Participants (N = 22) completed the Wheelchair Skills Test-Questionnaire (WST-Q) Version 4.3 for scooter users. It measures the users' perceived capacity (what the user can do), performance (what the user actually does), and confidence (or self-efficacy). Their scooter skills were also rated objectively with the Wheelchair Skills Test (WST). They completed standardised measures of cognition, hearing, vision, life space mobility, visual attention and task switching, and confidence negotiating the social environment using their scooters.

RESULTS

Mean total WST-Q capacity scores were 83% and performance scores were 25%. WST-Q capacity scores had significant positive correlations with WST-Q performance (r = 0.321) and confidence scores (r = 0.787), WST capacity scores (r = 0.488), and confidence negotiating the social environment (WheelCon) (r = 0.463). WST-Q capacity scores were significantly negatively correlated with Trail Making B scores (r = -0.591) and age (r = -0.531).

CONCLUSIONS

The correlations between WST-Q scores and other variables are similar to those found in other studies among users of scooters and other mobility devices. The gap between capacity and performance scores highlights the needs for additional skills training in this population of novice scooter users.IMPLICATIONS FOR REHABILITATIONIn implementing scooter training for new scooter users, attention should be paid to building community-based skills for navigating both the physical and the social environment.Scooter users' age and their driving capabilities need to be taken into account when developing and delivering the training.

Relationship between wheelchair skills scores and peak aerobic exercise capacity of manual wheelchair users with spinal cord injury: a cross-sectional study

Purpose: Although both wheelchair skills and fitness are important and probably inter-related, the extent and nature of the relationship between them are not well understood. The objective of this study was to test the hypothesis that there are significant relationships between wheelchair skills scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Materials and methods: We studied 26 participants, recording Wheelchair Skills Test Questionnaire scores and peak power output from graded aerobic wheelchair exercise testing on a motorized treadmill.Results: The median Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores were 83.3%, 81.5%, and 76.7% and the median peak power output was 58.2 W. On regression analysis, there were significant relationships between the total Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores and peak power output (R² 0.270-0.709, odds ratios 1.043-1.150, p < 0.05).Conclusions: Significant relationships exist between the wheelchair skills capacity, confidence, and performance scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. These findings suggest that both wheelchair skills training and exercise training may be useful during the rehabilitation of people with spinal cord injury.Implications for rehabilitationModerate positive relationships exist between wheelchair skills capacity and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Moderate positive relationships exist between wheelchair skills confidence and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Although further research is needed, these findings suggest that clinicians should address both wheelchair skills training and exercise training during the rehabilitation of people with spinal cord injury and not assume that either alone is sufficient.

Wheelchair skills training for occupational therapy students: comparison of university-course versus "boot-camp" approaches

Objective: To test the hypothesis that occupational therapy students who receive wheelchair skills training education using a distributed-practice university-course approach versus a condensed-practice boot-camp approach results in greater improvements post-intervention in relevant outcomes. Design: A quasi-experimental, nonequivalent control group design. Setting: A university occupational therapy program. Participants: Occupational therapy students (experimental group) and recent occupational therapy graduates (control group) (N = 58). Interventions: A 15-week, 45-hour wheelchair provision course in which a total of 24 hours were dedicated to wheelchair skills testing and training education (experimental group) versus an 8-hour wheelchair skills training boot-camp (control group). Main outcome measures: Assessments were conducted pre- and post-intervention using the Wheelchair Skills Test Questionnaire (WST-Q), Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon) and Self-Efficacy on Assessing, Training and Spotting wheelchair skills (SEATS). Results: Compared to baseline, the WST-Q, WheelCon and SEATS scores improved significantly for both groups (p < .001). There were no significant differences in change scores (post-intervention - baseline values) between the groups for WST-Q, WheelCon or SEATS scores, however, the experimental group demonstrated a trend (p < .051) of higher scores for all outcome measures. Conclusions: Occupational therapy students who received wheelchair skills training using either a distributed-practice university-course or condensed-practice boot-camp approach demonstrated significant post-training improvements in their WST-Q, WheelCon and SEATS scores, but no significant differences were found between groups. Implications for Rehabilitation Both a distributed-practice university-course approach and a condensed-practice bootcamp approach for training wheelchair skills to occupational therapy students results in large post-intervention improvements in wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills. The pre-education (optional course) wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills scores found in this cohort of occupational therapy students confirms the need to include this wheelchair content in mandatory occupational therapy curricula.

Effectiveness of the Wheelchair Skills Training Program: a systematic review and meta-analysis

OBJECTIVE

To conduct a systematic review synthesizing the evidence for the effectiveness of the Wheelchair Skills Training Program (WSTP).

DATA SOURCES

We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to 10 October 2017.

STUDY SELECTION

Randomized controlled trials (RCTs) assessing the effectiveness of the WSTP.

DATA EXTRACTION

Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane's Risk of Bias Tool.

DATA SYNTHESIS

Meta-analyses (including sub-group analyses) were conducted for the Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen articles (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; p < .0001) compared to no treatment, standard care or educational controls, a relative increase over baseline of 21.2%. Subgroup analyses showed that training was more effective for new wheelchair users. Retention of training effects was suggested by the absence of significant declines between tests post-training and at follow-up. The WSTP was found to have positive effects on some other outcomes. No serious adverse events were reported.

CONCLUSIONS

There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes. Implications for rehabilitation A systematic review and meta-analysis of 13 randomized controlled trials on a total of 581 participants, using the Wheelchair Skills Training Program (WSTP) as the intervention, found that the WSTP increased Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores by 21.2% relative to baseline. Subgroup analyses showed that training was more effective for new wheelchair users. The WSTP was found to have positive effects on some other outcomes and no serious adverse events were reported. The WSTP warrants cautious implementation in clinical and educational settings.

Pain, fatigue, function and participation among long-term manual wheelchair users partnered with a mobility service dog

PURPOSE

To assess the effects of a mobility service dog (MSD) on pain, fatigue, wheelchair-related functional tasks, participation and satisfaction among manual wheelchair users over a nine-month period.

METHOD

A longitudinal study with repeated assessment times before and three, six and nine months after intervention was achieved. Intervention consisted in partnering each participant with a MSD. The setting is a well-established provincial service dog training school and participants homes. A convenience sample of 24 long-term manual wheelchair users with a spinal cord injury was involved. Outcome measures were: Wheelchair User's Shoulder Pain Index (WUSPI), Rate of Perceived Exertion (RPE), vitality scale from the SF-36, grip strength, Wheelchair Skills Test (WST), Canadian Occupational Performance Measure (COPM), Reintegration to Normal Living Index (RNLI), Life Space Assessment, Psychosocial Impact of Assistive Devices Scale (PIADS) and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0).

RESULTS

Shoulder and wrist pain as well as fatigue decreased significantly over time with the use of a MSD as evidenced by scores from WUSPI, RPE and SF-36 (feeling less worn out). Manual wheelchair propulsion skills (steep slopes, soft surfaces and thresholds) improved significantly over time as confirmed by the WST. Participation increased significantly over time as revealed by the COPM (for five occupations) and the RNLI (for five items). Satisfaction with the MSD was high over time (QUEST: nine items) and with a high positive psychosocial impact (PIADS: 10 items).

CONCLUSION

MSD represents a valuable mobility assistive technology option for manual wheelchair users. IMPLICATIONS FOR REHABILITATION   For manual wheelchair users partenered with mobility service dog  • Shoulder pain and fatigue significantly decreased and continued to decrease between the third and sixth month and the ninth month.   • Performance with propelling the wheelchair up steep slopes increased from 41 to 88% and on soft surfaces increased from 53 to 100% after 3 months, respectively.   • Occupational performance satisfaction was significantly increased for mobility in relation with the transfers, navigating in a natural environment and picking up objects.   • High satisfaction towards psychosocial competency, psychosocial adequacy and self-esteem were reported at months three, six and nine.

A randomized control trial feasibility evaluation of an mHealth intervention for wheelchair skill training among middle-aged and older adults

BACKGROUND

Providing mobility skills training to manual wheelchair (MWC) users can have a positive impact on community participation, confidence and quality of life. Often such training is restricted or not provided at all because of the expense of, and limited access to, occupational and physical therapists before and after discharge. This is particularly true among middle-aged and older adults, who often have limited access to rehabilitation services and require more time to learn motor skills. A monitored MWC skills training home program, delivered using a computer tablet (mHealth), was developed as an alternative approach to service delivery. The purpose of this study was to evaluate the feasibility of implementing this mHealth MWC skills training program among middle-aged and older adults.

METHODS

A 2 × 2 factorial design randomized controlled trial (RCT) was used to compare the mHealth intervention and control groups, with additional wheeling time as a second factor. Community-dwelling MWC users aged 55 and older, who had used their MWC for less than two years and propelled with two hands, were recruited. Feasibility outcomes related to process, resources, management and treatment criteria were collected.

RESULTS

Eighteen participants were recruited, with a retention rate of 94%. Mean (±SD) duration for the first and second in-person training sessions were 90.1 ± 20.5 and 62.1 ± 5.5 min, respectively. In the treatment group, 78% achieved the minimum amount of home training (i.e., 300 min) over four weeks and 56% achieved the preferred training threshold (i.e., 600 min). Trainers reported only seven minor protocol deviations. No tablets were lost or damaged and there was one incident of tablet malfunction. No injuries or adverse incidents were reported during data collection or training activities. Participants indicated 98% agreement on the post-treatment benefit questionnaire.

DISCUSSION

Overall, the study protocol enabled implementation of the intervention in a safe, efficient and acceptable manner. Participant recruitment proved to be challenging, particularly gaining access to individuals who might benefit. Resource issue demands were acceptable for administration of the intervention; data collection was more time-consuming than anticipated but could be reduced with minor revisions. Participant retention and home program treatment adherence was high; both participant and trainer burden was acceptable. Treatment group participants reported a positive experience and clinical benefits from training program. The findings suggest a full-scale RCT evaluating the clinical impact of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) intervention is warranted, provided the recruitment issues are addressed through collaborative partnerships and active recruitment strategies.

Test-retest reliability and construct validity of the Aspects of Wheelchair Mobility Test as a measure of the mobility of wheelchair users

Background

The Aspects of Wheelchair Mobility Test (AWMT) was developed for use in a repeated measures format to provide comparative effectiveness data on mobility facilitated by different wheelchair types. It has been used in preliminary studies to compare the mobility of wheelchairs designed for low-resource areas and is intended to be simple and flexible enough so as to be used in low-technology settings. However, to reliably compare the impact of different types of wheelchairs on the mobility of users, a measure must first be a reliable and valid measure of mobility.

Methods

This study investigated the test–retest reliability and concurrent validity for the AWMT 2.0 as a measure of mobility. For reliability testing, participants in a low-resource setting completed the tests twice in their own wheelchairs at least one week apart. For concurrent validity, participants also completed the Wheelchair Skills Test Questionnaire (WST-Q), a related but not identical validated assessment tool.

Results

Concurrent validity was indicated by a significant positive correlation with an r value of 0.7 between the WST-Q capacity score and the AWMT 2.0 score. Test–retest reliability was confirmed by an intraclass correlation coefficient greater than 0.7 between the two trials.

Conclusion

Results support the preliminary reliability and validity of the AWMT 2.0, supporting its effectiveness in comparing the mobility provided by different wheelchair types. This information can be used to enable effective use of limited funds for wheelchair selection at individual and organisational scales.

Measurement properties of the Wheelchair Skills Test for scooters among experienced users

PURPOSE

To investigate the score distribution, reliability, and validity of the objective Wheelchair Skills Test (WST) for scooter users.

METHOD

A study using a test-retest design was conducted with 20 people who had mobility limitations that prevented them from ambulating more than one city block without a mobility aid, and who had owned a scooter for ≥3 months. Objective scooter skills, confidence, and physical accessibility were measured at both time points, while anxiety, depression, visual attention and task switching, functional independence, and visual acuity were measured only at baseline.

RESULTS

The mean total WST scores at Time 1 and Time 2 were 86.3% and 87.5%. The WST ICC was 0.889. The WST had a SEM of 2.50 and a Cronbach's alpha of 0.74. The total WST scores were significantly correlated with total subjective WST-Q scores (r = 0.547, p = 0.013), scooter confidence (r = 0.466, p = 0.038), and were affected by gender (p = 0.005).

CONCLUSION

The WST for scooters has good test-retest reliability and generally varies as anticipated with other measures. Although further study is needed, the WST for scooters appears to have promise for use in research and clinical practice. Implications for Rehabilitation It is important to understand the measurement properties of the tools we use in rehabilitation so the results can be interpreted correctly. As scooter use increases, better measurement of skills is required.

Wheelchair Skills Capacity and Performance of Manual Wheelchair Users With Spinal Cord Injury

OBJECTIVES

To describe the wheelchair skills capacity and performance of experienced manual wheelchair users with spinal cord injury (SCI) and to assess measurement properties of the Wheelchair Skills Test (WST) and Wheelchair Skills Test Questionnaire (WST-Q).

DESIGN

Cross-sectional descriptive study involving within-subject comparisons.

SETTING

Four Spinal Cord Injury Model Systems centers.

PARTICIPANTS

Manual wheelchair users with SCI (N=117).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

WST and WST-Q version 4.2 as well as measures for Confidence, Basic Mobility, Independence, Ability to Participate, Satisfaction, and Pain Interference.

RESULTS

The median (interquartile range) values for WST capacity, WST-Q capacity, and WST-Q performance were 81.0% (69.0%-90.0%), 88.0% (77.0%-97.0%), and 76.0% (66.3%-84.0%). The total WST capacity scores correlated significantly with the total WST-Q capacity scores (r=.76; P<.01) and WST-Q performance scores (r=.55; P<.01). The total WST-Q capacity and WST-Q performance scores were correlated significantly (r=.63; P<.001). Success rates were <75% for 10 of the 32 (31%) individual skills on the WST and 6 of the 32 (19%) individual skills on the WST-Q. Regression models for the total WST and WST-Q measures identified statistically significant predictors including age, sex, body mass index, and/or level of injury. The WST and WST-Q measures correlated significantly with the Confidence, Basic Mobility, Independence, or Pain Interference measures.

CONCLUSIONS

Many people with SCI are unable to or do not perform some of the wheelchair skills that would allow them to participate more fully. More wheelchair skills training may enhance participation and quality of life of adults with SCI. The WST and WST-Q exhibit good content, construct, and concurrent validity.

Wheeled mobility skills of wheelchair basketball players: a randomized controlled study

PURPOSE

The aim of this study was to assess the influence of wheelchair basketball sport on the functional abilities of wheelchair users.

METHOD

This is a randomized controlled study. Wheelchair basketball players (n = 111) and non-player (n = 85) were included in this study. We administered the questionnaire version of the wheelchair skills test questionnaire (WST_Q), recording the participants' capacity and performance scores on each of 32 skills.

RESULTS

Player group have the baseline values of WST_Q higher than control group. The mean total percentage score of player group was significantly greater than control group (p < 0.05). The get over 15 cm level (respectively, rations of capacity and performance of groups: player/control: 50.5-20% and 54.1-24.7%) and the ascends 10° incline (player/control 96.4-48.2% and 98.2-54.1%).

CONCLUSIONS

Participation in regular wheelchair basketball sport may preserve and augment functional abilities in with wheelchair user Implications for rehabilitation The skills-sports relationship is reciprocal. With increased wheelchair skills, people may be more inclined to engage in sports; subsequently, with greater sports, wheelchair skills could improve. Wheelchair mobility skills during clinical rehabilitation should reflect the daily activities and needs of each wheelchair user. WST-Q provides advantages in terms of requiring less time and material in using of clinical.

The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia

Background

For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization’s service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls.

Methods

This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only.

Results

167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list (p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a “wheelie”. The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist (p = 0.019).

Conclusions

Wheelchair provision according to World Health Organization’s 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages.

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial

OBJECTIVES

To test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation centers and communities.

PARTICIPANTS

Powered wheelchair users (N=116).

INTERVENTION

Five 30-minute WSTP training sessions.

MAIN OUTCOME MEASURES

Assessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA).

RESULTS

There was no significant t2-t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3.

CONCLUSIONS

Powered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

Measurement properties of the Wheelchair Skills Test-Questionnaire for powered wheelchair users

PURPOSE

To evaluate the test-retest reliability, concurrent validity and responsiveness of the Wheelchair Skills Test - Questionnaire (WST-Q) Version 4.1 for powered wheelchair users.

METHODS

A volunteer sample of 72 community-dwelling, experienced powered wheelchair users, ranging in age from 50 to 77 years, participated in this study. Participants completed measures at baseline and 1 month later.

RESULTS

Mean ± standard deviation total percentage WST-Q scores at baseline and 1 month were 83.7% ± 10.9 and 86.3% ± 10.0 respectively. Cronbach's alpha was 0.90 and the 1 month test-retest intraclass correlation coefficient (ICC1,1) was 0.78 (confidence interval: 0.68-0.86). There were no floor or ceiling effects. Percentages of agreement between baseline and 1 month for individual skills ranged from 72.2% to 100%. The correlations between the WST-Q and the objective Wheelchair Skills Test (WST), WheelCon and Life Space Assessment were r = 0.65, r = 0.47 and r = 0.47 respectively. The standard error of measurement (SEM) and smallest real difference (SRD) were 5.0 and 6.2 respectively.

CONCLUSION

The WST-Q 4.1 has high internal consistency, strong test-retest reliability and strong support for concurrent validity and responsiveness.

IMPLICATIONS FOR REHABILITATION

There is evidence of reliability, validity and responsiveness of the Wheelchair Skills Test - Questionnaire (WST-Q) among experienced older adult powered wheelchair users. The WST-Q can be used to measure powered wheelchair skills, guide intervention and measure change over time.

Habilidades motoras de cadeirantes influenciadas pelo controle de tronco

O objetivo deste estudo foi analisar a efetividade de um protocolo de treinamento de estabilização segmentar lombar (ESL) no controle de tronco e nas habilidades em cadeira de rodas (CR) em indivíduos paraplégicos. A amostra foi composta por 5 homens (31,2±12,9 anos) com lesão medular abaixo de T6. O deslocamento total (DT) e as amplitudes ântero-posterior (AP) e médio-lateral (ML) do centro de pressão (CP) foram analisados por meio de uma plataforma de força, em duas posições de teste (mãos no joelho e braços cruzados) e as habilidades na cadeira de rodas foram analisadas pelo Wheelchair Skills Test (WST), pré e pós protocolo de treinamento de ESL. A análise estatística foi realizada no software SPSS (15.0), utilizando o teste ANOVA para α ≤ 0,05. Na comparação pré e pós-treino, houve redução significativa do deslocamento total do CP na posição sentada com mãos nos joelhos (P<0,01) e braços cruzados (P<0,01). Não se observou mudança nas habilidades com CR do WST entre as avaliações pré e pós treinamento em nenhum dos níveis estudados. O protocolo de treinamento de ESL proposto foi efetivo para a melhora do controle de tronco, mas não modificou as habilidades no manejo de cadeira de rodas em indivíduos paraplégicos.

Manual wheelchair skills: objective testing versus subjective questionnaire

OBJECTIVES

To test the hypothesis that the total scores of the Wheelchair Skills Test (WST) version 4.1, an observer-rated scale of wheelchair performance, and the Wheelchair Skills Test Questionnaire (WST-Q) version 4.1, a self-report of wheelchair skills, are highly correlated. We also anticipate that the WST-Q scores will be slightly higher, indicating an overestimation of capacity to perform wheelchair skills as compared with actual capacity.

DESIGN

A cross-sectional, within-subjects comparison design.

SETTING

Three Canadian cities.

PARTICIPANTS

Convenience sample of community-dwelling, experienced manual wheelchair users (N=89) ranging in age from 21 to 94 years.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Participants completed the subjective WST-Q version 4.1 followed by the objective WST version 4.1 in 1 testing session.

RESULTS

The mean ± SD total percentage scores for WST and WST-Q were 79.5%±14.4% and 83.0%±12.1% for capacity and 99.4%±1.5% and 98.9%±2.5% for safety, respectively. The correlations between the WST and WST-Q scores were ρ=.89 (P=.000) for capacity and ρ=.12 (P=.251) for safety. WST-Q total score mean differences were an average of 3.5%±6.5% higher than WST scores for capacity (P=.000) and .52%±2.8% lower for safety (P=.343). For the 32 individual skills, the percentage agreement between the WST and WST-Q scores ranged from 82% to 100% for capacity and from 90% to 100% for safety.

CONCLUSION

WST and WST-Q version 4.1 capacity scores are highly correlated although the WST-Q scores are slightly higher. Decisions on which of these assessments to use can safely be based on the circumstances and objectives of the evaluation.

Association between mobility, participation, and wheelchair-related factors in long-term care residents who use wheelchairs as their primary means of mobility

OBJECTIVES

To explore how wheelchair-related factors, mobility, and participation are associated in a sample of long-term care residents who use wheelchairs as their primary means of mobility.

DESIGN

Cross-sectional survey.

SETTING

Eleven residential care facilities in the lower mainland of British Columbia, Canada.

PARTICIPANTS

One hundred forty-six self-responding residents and 118 proxy respondents: mean age 84 (range 60-103). Most were female (69%), and a small proportion (9%) drove a power wheelchair.

MEASUREMENTS

The Nursing Home Life Space Diameter Assessment was used to measure resident mobility, and the Late Life Function and Disability Instrument: Disability Component was used to measure participation frequency in daily activities.

RESULTS

Path analysis indicated that wheelchair-related factors were associated with participation frequency directly and indirectly through their relationship with mobility. The final model explained 46% of the variance in resident mobility and 53% of the variance in resident participation frequency. Wheelchair skills, which include the ability to transfer in and out of and propel a wheelchair, were important predictors of life-space mobility and frequency of participation, and life space mobility was a significant predictor of frequency of participation. Depression was associated with poorer wheelchair skills and mobility and less-frequent participation. Counterintuitively, perceived environmental barriers were positively associated with frequency of participation.

CONCLUSION

The findings suggest that, by addressing wheelchair-related factors, resident's mobility and participation may be improved, but the efficacy of this approach needs to be confirmed experimentally.

Efficacy and retention of the French-Canadian version of the wheelchair skills training program for manual wheelchair users: a randomized controlled trial

OBJECTIVES

To test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months.

DESIGN

Multicenter, single-blind, randomized controlled trial.

SETTING

Three rehabilitation centers in Montréal, Quebec, Canada.

PARTICIPANTS

Manual wheelchair users (N=39), a sample of convenience.

INTERVENTION

Participants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min).

MAIN OUTCOME MEASURES

The French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2).

RESULTS

At t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by ≤0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P≥.017 at a Bonferroni-adjusted α level of .005).

CONCLUSION

WSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months.

Predictors of mobility among wheelchair using residents in long-term care

OBJECTIVE

To identify predictors of mobility among long-term care residents who use wheelchairs as their main means of mobility. Based on the Matching Person to Technology Model, we hypothesized that wheelchair-related, personal, and environmental factors would be independent predictors of mobility.

DESIGN

Cross-sectional study.

SETTING

Eleven long-term residential care facilities in the lower mainland of British Columbia, Canada.

PARTICIPANTS

Residents (N=268): self-responding residents (n=149) and residents who required proxy respondents (n=119).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Mobility was measured using the Nursing Home Life-Space Diameter. Standardized measures of personal, wheelchair-related, and environmental factors were administered and sociodemographic data were collected as independent variables.

RESULTS

Independent mobility decreased as the distance from the resident's room increased: 63% of participants were independently mobile on their units, 40% were independently mobile off their units within the facilities, and 20% were independently mobile outdoors. For the total sample, the significant predictors of mobility, in descending order of importance, were: wheelchair skills (including the capacity to engage brakes and maneuver), functional independence in activities of daily living, having 4 or more visits per week from friends or family, and use of a power wheelchair. This regression model accounted for 48% of variance in mobility scores.

CONCLUSIONS

Limited independent mobility is a common problem among facility residents. Residents may benefit from interventions such as wheelchair skills training or provision of powered mobility, but the effectiveness of these interventions needs to be evaluated.

Semi-autonomous competency assessment of powered mobility device users

This paper describes a stand-alone sensor package and algorithms for aiding the assessment by an occupational therapist whether a person has the capacity to safely and effectively operate a powered mobility device such as a walking aid or a wheelchair. The sensor package employed consists of a laser range finder, an RGB camera and an inertial measurement unit that can be attached to any mobility device with minimal modifications. Algorithms for capturing the data received by the sensor package and for generating the map of the environment as well as the trajectory of the mobility device have been developed. Such information presents occupational therapists with the capability to provide a quantitative assessment of whether patients are ready to be safely deployed with mobile aids for their daily activities. Preliminary evaluation of the sensor package and associated algorithms based on experiments, conducted at the premises of the Prince of Wales Hospital in Sydney, are presented.

Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study

OBJECTIVES

(1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment.

DESIGN

This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records.

SETTING

Three Veterans' Administration hospitals.

PARTICIPANTS

Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment.

RESULTS

Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls.

CONCLUSIONS

This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment.

Reliability and validity of the telephone administration of the wheelchair outcome measure (WhOM) for middle-aged and older users of power mobility devices

OBJECTIVE

To examine the measurement properties of the tele-phone administration of the Wheelchair Outcome Measure (WhOM).

SUBJECTS

Power mobility device users aged 50-89 years.

METHODS

Two independent cohorts were recruited: (i) a prospective cohort (n = 40) to estimate test-retest reliability and to determine the applicability of the telephone format, and (ii) a cross-sectional cohort to examine construct validity with 3 groups: (a) people waiting for a first power mobility device (n = 44); (b) initial users (n = 35; 1-6 months); and (c) long-term users (n = 39; 12-18 months).

RESULTS

The tool demonstrated good test-retest reliability (intraclass correlation coefficient 0.77-1.00), took 10.9 min (standard deviation = 5.2) to administer and was practical to use over the telephone. Validity testing showed moderate correlations with the Quebec User Evaluation of Satisfaction with Technology (rS = 0.36-0.45) and the Psychosocial Impact of Assistive Devices Scale (rS = 0.31-0.43). WhOM scores could discriminate non-users from users (wait-list vs initial users; wait-list vs long-term users, p < 0.001) and power wheelchair from scooter users (total WhOM scores, p < 0.05).

CONCLUSION

The WhOM is a stable, valid and applicable measure for telephone administration with older power mobility device users. It is moderately linked to satisfaction with the device and to the psychosocial impact of the device, and therefore complements rather than replaces those measures.

Issues for the selection of wheelchair-specific activity and participation outcome measures: a review

OBJECTIVES

To use the World Health Organization's International Classification of Functioning, Disability and Health as a framework to identify and to evaluate wheelchair-specific outcome instruments that are useful for measuring activity and participation.

DATA SOURCES

CINHAL, PsychInfo, EMBASE, Google Scholar, Dissertation Abstracts Medline databases, and conference proceedings.

STUDY SELECTION

Activity and participation measures that were specifically intended for adults who use wheelchairs and that were published in English in a peer-reviewed journal were included in this review. Based on electronic database searches using a variety of search terms, articles were identified by title, and appropriate abstracts were retrieved. Articles were obtained for all relevant abstracts. For peer-reviewed measures included in the review, we obtained any instruction manuals and related publications, frequently published in conference proceedings and theses or available electronically, on the development and testing of the measure.

DATA EXTRACTION

Tools included in the review were evaluated based on their conceptual coverage, reliability, validity, responsiveness, usefulness, and wheelchair contribution, which indicated how well the tool isolated the effect of the wheelchair on activity and participation outcomes.

DATA SYNTHESIS

A number of conceptual, psychometric, and applicability issues were identified with the 11 wheelchair-specific measures included in the review. A majority of the measures were mobility focused. No single tool received excellent ratings in all areas of the review. Some of the most frequent issues identified included a failure to account for differences attributable to different wheelchairs and wheelchair seating, limited psychometric testing, and high administrative and respondent burden.

CONCLUSIONS

Good reliability evidence was reported for most of the measures, but validity information was only available for 6 of the 11 measures, and responsiveness information for 3. This review suggests that these measures could be improved with further psychometric testing and with some modification to ensure that the contribution of the wheelchair to activity and participation outcomes is clearly identified.

Wheelchair Skills Training for Community-Based Manual Wheelchair Users: A Randomized Controlled Trial

OBJECTIVE

To test the hypotheses that wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation center and community.

PARTICIPANTS

Twenty community-based manual wheelchair users (15 men, 5 women; age range, 21-77 y), half with musculoskeletal and half with neurologic disorders.

INTERVENTION

Participants were randomly allocated to the Wheelchair Skills Training Program (WSTP) or control groups. In 1-hour individualized sessions, the WSTP group participants received a mean +/- standard deviation of 4.5+/-0.7 hours of training. Caregivers participated whenever possible. In addition to training at the rehabilitation center, the trainer traveled to administer training in the community.

MAIN OUTCOME MEASURES

Using the Wheelchair Skills Test (WST, version 3.1), an objective test of 57 skills, we calculated total and subtotal percentage scores (percentage number of skills passed of those possible) and individual skill success rates.

RESULTS

The WSTP group's improvement in total WST score was significantly greater than the control group's (P<.005). The mean total WST score for the WSTP group increased from a pretraining value of 63.3%+/-6.0% to 78.5%+/-8.3% posttraining, a relative improvement of 24.0% (P=.002). The control group increased from a baseline value of 70.8%+/-14.0% to 74.2%+/-11.8% at follow-up, a relative improvement of 4.8% (P=.03). The WSTP group had clinically significant pre- and posttraining improvements (> or = 20%) in the success rates of 25 of the 57 individual WST skills, compared with only 5 skills for the control group. There were no adverse incidents, and the WSTP participants' comments were all positive.

CONCLUSIONS

Wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. These findings have implications for the standard of rehabilitation care.

The manual wheelchair-handling skills of caregivers and the effect of training

OBJECTIVE

To test the hypothesis that the Wheelchair Skills Training Program (WSTP) is effective in improving the wheelchair-handling skills of untrained caregivers.

DESIGN

Within-participant comparisons.

SETTING

Rehabilitation center and community.

PARTICIPANTS

Twenty-four caregivers of manual wheelchair users.

INTERVENTIONS

Caregiver participants underwent the WSTP, version 2.4, adapted for caregivers. Training was individualized on the basis of an integrated testing-and-training protocol that took place on a single occasion (total, approximately 50 min).

MAIN OUTCOME MEASURES

Total percentage scores on the objective Wheelchair Skills Test (WST), version 2.4, for the pretraining (N=24), posttraining (N=24), and retention (n=9) evaluations. For the skill-transfer evaluation (n=10), we used the questionnaire version (WST-Q), administered by telephone to participants after return to their communities.

RESULTS

There were no serious adverse incidents. The mean pretraining total WST score +/- standard deviation was 77.8%+/-12.0%. Posttraining, this increased to 94.7%+/-7.1% (P <.001), a 22% relative increase. At retention testing, a median latency of 7 days later, the mean value, 94.2%+/-7.1%, did not decrease significantly from the posttraining level (P =.38). At skill-transfer testing, a median latency of 179 days posttraining, the mean value, 92.5%+/-8.7%, did not decrease significantly from the posttraining level (P =.73). The greatest improvements were at the advanced skill level.

CONCLUSIONS

The WSTP is a safe, practical, and effective method of improving the wheelchair-handling skills of untrained caregivers. Skill improvements are generally well retained and transfer well to the community. Such training could play an important role in the rehabilitation process.

Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students

OBJECTIVE

To test the hypothesis that a brief formalized period of wheelchair skills training, added to the standard curriculum, results in significantly greater overall improvements in wheelchair skills than a standard undergraduate occupational therapy (OT) curriculum alone.

SETTING

Rehabilitation center.

DESIGN

Randomized controlled trial.

PARTICIPANTS

Eighty-two students in a university undergraduate OT program.

INTERVENTIONS

All students received the standard university curriculum. The 22 second-year students, randomly allocated to the Wheelchair Skills Training Program (WSTP) group, were also trained (on a single occasion each, in groups of 1-3 at a time) on the 50 skills that make up the WSTP. The mean +/- standard deviation (SD) training time was 121.2+/-33.5 minutes per group.

MAIN OUTCOME MEASURE

Total percentage score on the Wheelchair Skills Test (WST), Version 2.4.

RESULTS

From before to after intervention, second-year students in the WSTP group increased their mean percentage WST scores +/- SD from 64.8%+/-9.0% to 81.0%+/-5.2%, a 25% improvement (P<.001). Over a comparable period, the 18 students in the second-year control group increased from 66.0%+/-8.0% to 72.4%+/-7.1%, a 9.7% improvement (P=.015). The WSTP group improved to a significantly greater extent (P=.005). For a subset of 8 students in the WSTP group who were retested 9 to 12 months later, the mean WST score was 79.7%+/-4.1%, not significantly less than their WST 2 scores (P=.29). The mean WST score for the 42 students in the fourth-year control group was 73.9%+/-4.1%, significantly lower than the mean postintervention WST score of the second-year students in the WSTP group (P< .0001) and not different from the second-year control group (P=.58).

CONCLUSIONS

The WSTP is an effective way to improve the wheelchair-skills performance of OT students. This has implications for the education of all rehabilitation clinicians.

The wheelchair skills test (version 2.4): measurement properties11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated

OBJECTIVE

To evaluate the measurement properties of the Wheelchair Skills Test (WST), version 2.4.

DESIGN

Cohort study.

SETTING

Rehabilitation center.

PARTICIPANTS

A total of 298 subjects (169 wheelchair users, 129 able-bodied subjects) ranging in age from 17 to 88 years.

INTERVENTION

We videotaped subjects as they attempted the 50 skills of the WST 2.4.

MAIN OUTCOME MEASURES

The test-retest, intrarater, and interrater reliabilities were determined on a subset of 20 wheelchair users. We assessed construct validity by evaluating whether the WST detected expected changes and concurrent validity by seeing how well total WST scores correlated with criterion measures.

RESULTS

The mean time +/- standard deviation taken to administer the WST was 27.0+/-9.3 minutes. There were no serious adverse incidents, and the test was well tolerated. For the test-retest, intrarater and interrater reliabilities, the intraclass correlation coefficients for the total scores were.904,.959, and.968. For individual skills, the percentage concordance ranged from 73% to 100%. Regarding construct validity, there was a slightly negative Pearson correlation between total WST score and age (-.434). Gender was identified as a significant factor on multiple regression analysis (P<.001). Wheelchair users with more than 21 days of experience scored higher than those with less experience (65.0% vs 59.6%; P=.01). Participants with stroke and related disorders had a mean score (55.0%+/-13.9%) that was significantly lower than those in other diagnostic categories (P<.05). Participants using conventional wheelchairs had lower scores than those in lightweight ones (66.4% vs 75.1%; P<.001). Regarding concurrent validity, Spearman rank correlations between total WST scores and the global assessments of the wheelchair users' therapists and admission and discharge FIM instrument scores were.394,.38, and.31.

CONCLUSIONS

The WST 2.4 is practical and safe, and its measurement properties are very good to excellent. Further study is needed to determine its usefulness in various clinical settings.