Comparison of teaching methods to learn a tilt and balance wheelchair skill

Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial

OBJECTIVES

To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group.

METHODS

We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30-45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores.

RESULTS

Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021).

CONCLUSIONS

Individualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.

Effectiveness of Group Wheelchair Skills Training for People With Spinal Cord Injury: A Randomized Controlled Trial

OBJECTIVE

To assess the effectiveness of group wheelchair skills training to elicit improvements in wheelchair skills.

DESIGN

Randomized double-blinded controlled trial.

SETTING

Four Spinal Cord Injury Model Systems Centers.

PARTICIPANTS

Manual wheelchair users with spinal cord injury (N=114).

INTERVENTION

Six 90-minute group Wheelchair Skills Training Program (WSTP) classes or two 1-hour active control sessions with 6 to 10 people per group.

MAIN OUTCOME MEASURES

Baseline (t1) and 1-month follow-up (t2) Wheelchair Skills Test Questionnaire (WST-Q) (Version 4.2) for capacity and performance and Goal Attainment Scale (GAS) score.

RESULTS

Follow-up was completed by 79 participants (WSTP: n=36, active control: n=43). No differences were found between missing and complete cases. Many users were highly skilled at baseline with a WST-Q capacity interquartile range of 77% to 97%. There were no differences between groups at baseline in WST-Q measures or demographics. Compared with the active control group, the WSTP group improved in WST-Q capacity advanced score (P=.02) but not in WST-Q capacity or WST-Q performance total scores (P=.068 and P=.873, respectively). The average GAS score (0% at t1) for the WSTP group at t2 was 65.6%±34.8%. Higher GAS scores and WST-Q capacity scores were found for those who attended more classes and had lower baseline skills.

CONCLUSIONS

Group training can improve advanced wheelchair skills capacity and facilitate achievement of individually set goals. Lower skill levels at baseline and increased attendance were correlated with greater improvement.

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.

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.

The Effect of Rolling Resistance on Stationary Wheelchair Wheelies

OBJECTIVE

To test the hypotheses that increased rolling resistance (RR) reduces rear-wheel displacement and perceived difficulty during the takeoff and balance phases of stationary wheelchair wheelies.

DESIGN

We carried out within-subject comparisons of 20 participants as they each performed, in random order, two 30-sec stationary wheelies in three RR settings (tile, 5-cm-thick foam, and 12.5-cm-high blocks in front of and behind the rear wheels). The main outcome measures were rear-wheel displacement (in centimeters for the takeoff phase and centimeters per second for the balance phase) from a spring-loaded potentiometer and Likert scales of perceived difficulty.

RESULTS

For rear-wheel displacement, all six of the pairwise comparisons (three terrains x two phases (takeoff and balance)) showed a significant statistical difference (P < 0.002). In each of the six pairwise comparisons, displacement was less for the higher of the two RR conditions. For perceived difficulty, during the balance phase, participants perceived tile to be significantly more difficult than either foam (P = 0.0067) or blocks (P = 0.0002). The other pairwise comparisons were not statistically significant.

CONCLUSION

In conditions of increased RR, rear-wheel displacement and perceived difficulty are reduced during stationary wheelchair wheelies. These findings have implications for teaching wheelchair users to perform wheelies, a foundation of many advanced wheelchair skills.

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.

Influence of task complexity on mechanical efficiency and propulsion technique during learning of hand rim wheelchair propulsion

OBJECTIVE

To investigate the consequence of task complexity on gross mechanical efficiency and propulsion technique during the learning process of hand rim wheelchair propulsion.

METHODS

Three groups of unimpaired subjects (N=10 each) received a 3-week wheelchair practice period (3 week(-1), nine practice trials) with different levels of complexity, i.e. propelling a stationary wheelchair ergometer, wheelchair propulsion on a motor-driven treadmill or at a circular wheelchair track. During practice trials 1 and 9, gross mechanical efficiency and propulsion technique variables (work per cycle, cycle frequency, push and cycle time, effective force) were measured.

RESULTS

Using multi-level regression analysis, no differences in the development over time in mechanical efficiency and propulsion technique could be discerned between the three conditions of task complexity. Only the percentage push time during the cycle decreased significantly more in the group that practiced on the ergometer compared to the treadmill-practice group. For all three groups a change over time was shown for cycle frequency, push time and cycle time.

DISCUSSION

Under the current experimental conditions, task complexity does not have an influence on gross mechanical efficiency and propulsion technique during the learning process of wheelchair propulsion. The 3-week practice period had a favorable practice effect on timing regardless of the task complexity.

Learning to perform wheelchair wheelies: comparison of 2 training strategies11No 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 exposed

OBJECTIVE

To test the hypotheses that, during wheelie training, adding the proactive balance strategy (PBS) to the conventional reactive balance strategy (RBS) increases the success rate, decreases training time, and lessens postural sway during the wheelie.

DESIGN

Randomized controlled trial.

SETTING

Kinesiologic laboratory in a rehabilitation center.

PARTICIPANTS

Twenty-two participants (12 wheelchair users, 10 able-bodied) randomly assigned to the RBS group or to the PBS+RBS group; the groups were balanced according to gender, age, and diagnostic category.

INTERVENTION

Participants were trained to perform stationary wheelies in 2 highly structured settings.

MAIN OUTCOME MEASURES

Success rate in achieving wheelie competence, training time, and postural sway on a force platform.

RESULTS

Success rate was 100% for both groups. The RBS group required a mean +/- standard deviation of 43+/-31 minutes of training time and the PBS+RBS group required 45+/-28 minutes (P=.54). There was no significant difference between training groups with respect to postural sway measures (P=.50). Age correlated with both training time (r=.70, P=.001) and postural sway (r=.52, P=.03). Qualitatively, we identified 3 take-off patterns and confirmed the use of the 2 balance patterns.

CONCLUSIONS

The addition of the PBS to RBS training did not improve wheelie success rate, training time, or postural sway. Although older wheelchair users require more training time, many such users can learn this useful skill if given the opportunity.

Wheelchair skills training program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation center.

PARTICIPANTS

Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects' mean age +/- standard deviation (SD) was 59+/-18.3 years.

INTERVENTION

Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5+/-1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay.

MAIN OUTCOME MEASURES

Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined.

RESULTS

There were no adverse incidents. The control group's mean percentage score +/- SD increased from 60.1%+/-14.4% to 64.9%+/-13.3%, an 8% improvement of the posttest relative to the pretest (P=.01). The WSTP group's mean score increased from 64.9%+/-9.4% to 80.9%+/-5.6%, a 25% improvement of the posttest relative to the pretest (P<.000). The WSTP group showed significantly greater improvements than the control group (P<.000). Among the specific skills, significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills (P<.001).

CONCLUSIONS

The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.