• Developed to assist clinicians in assessing the effect of different postural supports (e.g. back support and seat cushions) by an experienced group of physiotherapists using a literature review and input from individuals with SCI and researchers.
  • The 4FTPSMW is a functional test suited for the clinical setting (e.g. the timed forward wheeling task is based on a distance of 23 meters (plus length of the wheelbase) – the average length of a crosswalk in a 4 lane intersection).
  • The 4FTPSMW is only relevant to individuals who use a manual wheelchair (i.e. not suited to individuals who use a power wheelchair).

The test includes four functional tasks:

  1. Timed Forward Wheeling (23m)
  2. Ramp Ascent (forward wheeling)
  3. Forward Vertical Reach Distance
  4. One-Stroke Push

Timed Forward Wheeling

Start the subject from a stationary position (anterior edges of front castors positioned directly behind start line). Instruct the subject to start wheeling on “go” and stop when they have passed a line marked 23 metres away from the start line. Measure the duration of time it takes the subject to wheel 23 m, starting from the first movement of the casters and stopping when the rear wheels completely cross the line.

Forward Vertical Reach

Equipment: 1 meter measuring stick with felt pen attached to one end and a carpenter’s level secured in the middle

Position the subject’s wheelchair parallel to a marking board and instruct the to hold a measuring stick with both hands (palms facing down), and keep their forearms parallel to their thighs. Position the tip of the felt pen within 1 inch of the marking board. Instruct the subject to raise the measuring stick upward, but to keep the stick level and to avoid excessive backward arching. Mark the marking board at the highest point reached. Record the distance from the floor to the point reached.

Ramp Ascent (Forward Wheeling)

Equipment: Ramp (10.3m in length, 1:13 grade)

The subject begins wheeling 4.5 m from the base of the ramp and is instructed to wheel up the entire ramp until they reach the top flat surface. If the subject is unable to complete the ramp without stopping, a maximum rest period of 30 seconds is allowed. As many rest periods as necessary can be taken, so long as independent forward propulsion is resumed before the 30 second rest time is over. Time the duration it takes the subject (including rest time) to get from the base of the ramp to the top of the ramp to the nearest second.

One-Stroke Push

Position the subject’s wheelchair with all 4 wheels on a carpeted surface. Instruct the subject to propel the wheelchair forward by pushing once with maximal effort. Measure the distance from the most posterior point of the rear wheels as a starting point to the most posterior point of the rear wheels when the wheelchair has rolled to a complete stop.

ICF Domain

Activity ▶ Mobility

Administration

Approximately 30 minutes to complete 4 Tasks

(5-minute rest breaks are provided between tasks to limit fatigue).

Number of Items

N/A

Equipment

  • 23 m corridor
  • 1 m measuring stick
  • Ramp (10.3 m and 1:13 grade)
  • Carpeted surface (1.5 cm pile)
  • Stop watch

Scoring

  • Wheeling tasks are scored to the nearest second
  • Reaching and one-stroke push tasks are scored in centimeters.

Languages

English

Training Required

Does not require advanced training.

Availability

Can be found here.

# of studies reporting psychometric properties: 1

Interpretability

MCID: not established for SCI

SEM & MDC: calculated for the 4 tasks (from May et al. 2003; Group 1 n=10, Group 2 n=10, all male, neurological condition affecting spinal cord)

SEM MDC
Forward wheeling 0.82 seconds 2.27 seconds
Forward vertical reach 0.91 cm 2.52 cm
Ramp ascent 8.17 seconds 22.65 seconds
One-stroke push 3.84 cm 10.64 cm

Normative data is not yet established for SCI population, but:

Mean (SD) scores for trial 1 and trial 2

Timed forward wheeling: 14.6-14.7 (8.2-7.3) seconds
Ramp ascent: 39.6-34.4 (81.7-70.1) seconds
Forward vertical reach distance: 160.7-160.8 (9.1-10.1) cm
One-stroke push: 102.1-109.8 (38.4-40.6) cm

Threshold Values

Timed forward wheeling: Minimum: 6.6-6.9  seconds; Maximum: 31.0-34.3 seconds
Ramp ascent: Minimum: 3.2 seconds; Maximum: 219.9-255.1 seconds
Forward vertical reach distance: Minimum: 145.6-147.4 cm; Maximum: 172.3-173.6 cm
One-stroke push: Minimum: 45.7-47.7 cm; Maximum: 175.5-188.7

(May et al. 2003: Group 1 n = 10, Group 2 n = 10; all male; neurological condition affecting spinal cord)

High Intra-rater Reliability

High Test-retest Reliability for all 4 tasks (performed twice on same day):

ICC = 0.99, P<.001

High Inter-rater Reliability calculated for all tasks except 1-stroke push:

ICC = 0.99, P<.001

(May et al. 2003: Group 1 n=10, Group 2 n=10; all male; neurological condition affecting spinal cord)

Validity

No values were reported for the validity of the 4FTPSMW for the SCI population.

Responsiveness

No values were reported for the responsiveness of the 4FTPSMW for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the 4FTPSMW for the SCI population.

Reviewers

Dr. William Miller, Matthew Querée

Date Last Updated

22 August 2016

May LA, Butt C, Minor L, Kolbinson K, Tulloch K. Measurement reliability of functional tasks for person who self-propel a manual wheelchair. Arch Phys Med Rehabil 2003;84:578-583.
http://www.ncbi.nlm.nih.gov/pubmed/12690598

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