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Skills Training and Education

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Over time, there has been increasing interest and recognition in SCI-related education during rehabilitation. Patient education aims to help patients reintegrate into the community and improve quality of life through instruction on a variety of topics (Bernet et al., 2018; van Wyk et al., 2015). Educational topics that are often addressed include: learning how to self advocate, how to prevent, recognize and respond to adverse health complications, as well as coping strategies (Bernet et al., 2018). As a result, patients learn how to manage their everyday life, take responsibility for their health and assume an active role in the treatment process (van Wyk et al., 2015). Consequently, patients may feel more motivated and confident in their abilities to deal with the physical and psychological consequences of a SCI (van Wyk et al., 2015).

The efficacy of patient education in other chronic diseases, such as diabetes or arthritis, has been well documented. Multiple systematic reviews reported that patient education improves disease specific knowledge (Barlow et al., 2002; Bennett et al., 2009; Shaw et al., 2009; Coster & Norman, 2009) and reduces symptoms (Deakin et al., 2005; Gibson et al., 2009; Riemsma et al., 2009; Warsi et al., 2004). However, a lack of research investigating the effects of patient education or educational strategies in individuals with SCI exists.

The majority of skills training and education literature found focused on upper limb function in wheelchair use.  The methodological details and results from these studies are presented in Table 3.

Table 3: Education and Skills Training Interventions

Discussion

The majority of studies evaluated the effects of wheelchair education on preventing shoulder pain or increasing wheelchair skills. Rice et al. (2014) tested the efficacy of providing educational training using the PVA Clinical Practice Guidelines for Preservation of Upper Limb Function among manual wheelchair users. As a result of educational training, individuals with new SCI were able to increase their wheelchair skills to improve push frequency and length. However, no significant differences were reported in Craig Handicap Assessment and Reporting Technique (CHART) scores. Similarly, Yeo and colleagues found a significant increase in wheelchair skills with educational training (2018). However, both of these studies did not utilize outcome measures reporting on quality of life via ADL task assessment or functional independence measures (FIM). One study found that shoulder exercise education improved shoulder pain, which may translate to improvements in QOL, however this was not objectively measured (Curtis et al., 1999). In summary, providing patient education may improve wheelchair skills and reduce shoulder pain, however, it is unclear whether this directly impacts patient quality of life.

Further research in this area should focus on: (1) practical components of the educational program, (2) determining if differences in propulsion skills result in improvements in pain and/or quality of life, and (3) determining if improvements are maintained over the long-term.

Conclusion

There is level 1b evidence (from two randomized controlled trials; Yeo et al., 2018; Rice et al., 2014) that education improves wheelchair skills.

There is level 2 evidence (from one randomized controlled trial; Curtis et al., 1999) that education about shoulder exercises reduces the intensity and duration of shoulder pain post SCI.

  • Providing education to manual wheelchair uses may be effective in improving wheelchair skills and preventing shoulder pain.