• Used to objectively evaluate manual wheelchair skills and safety.
  • There are 5 versions, including manual wheelchairs, powered wheelchairs and scooters, for both wheelchair users and caregivers (excepting scooters).
  • Existing wheelchair tests (Harvey et al. 1998) do not include the level of wheelchair skills required for daily functioning. The latest version of the WST is 4.2; prior versions include 1.0, 2.4, and 3.2.

Clinical Considerations

  • The tasks cover a wide range of difficulty while remaining functional. It is a generic tool that can be used for several populations (e.g. SCI, amputees, stroke, musculoskeletal disorders, able-bodied) and it was developed using both inpatient and community dwelling samples.
  • The Wheelchair Skills Test is developed for manual wheelchair users, therefore, it may not be appropriate for all individuals with SCI.
  • The Wheelchair Skills Test typically takes 30 minutes to administer and the WST-Q takes 10 minutes.

ICF Domain

Activity ▶ Mobility

Administration

Approx. 30 min. for WST and 10 min. for WST-Q (Questionnaire version).

Number of Items

Manual Wheelchair test: 33 tasks; Power Wheelchair test: 25 tasks.

Equipment

• Approximately 1000 square feet of space.
• A standardized wheelchair circuit or access to a variety of natural barriers (e.g. ramps, curbs, potholes, etc.) and the person’s usual wheelchair.

Scoring

  • Each skill is scored from 0-3 (Fail = 0; Pass with Difficulty or Assistance = 1; Pass = 2; Advanced Pass = 3).
  • Some skills may be marked NP (Not Possible); they can be subtracted from the denominator to avoid affecting the Total Score.
  • The tester should also record any comments that are instructive (e.g. reasons for failures, left-right asymmetry).
  • To get a percentage WST Capacity Score add up all scores, divide by number of possible skills (minus number of NP scores and number of TE scores) and multiply by 3 (and 100%).

Languages

Available in English and French.

Training Required

No formal training required. However, test familiarization and a spotter are mandatory, as well as reading the manuals (WST Manual, WST Program Manual) is recommended.

Availability

Worksheet- Manual here.

Worksheet- Power here.

The materials are continuously being updated for free so visit www.wheelchairskillsprogram.ca for the latest.

Measurement Property Summary

# of studies reporting psychometric properties: 9

Interpretability

Higher scores indicate greater wheelchair skills.

Threshold Values

55.6% of participants (28.6% of tetraplegic participants) scored over 80% (empirical cut-off for distinguishing people with advanced MWC skills, mainly skills required to control wheelies)

(Lemay et al., 2011; N = 54, 41 male; mixed injury types; 12+ months of manual WC use)

MCID: not established in SCI

SEM: 5.0 (Rushton et al. 2016: N = 72, 19% SCI; 36 males; mean(SD) age 60.7 (7.3))

MDC: 6.2  (Rushton et al. 2016: N = 72, 19% SCI; 36 males; mean(SD) age 60.7 (7.3))

Reliability

Test-retest reliability is Moderate to High for the WST (Intraclass Correlation Coefficient = 0.84-0.94, Cronbach’s Alpha = 0.65) for measured speeds.

(Pradon et al., 2012: N = 40, 30 male; mixed injury types; mean (range) 79.8 (1-360) months in rehabilitation; Kirby et al., 2002; N = 24, 3 SCI; 16 male; mixed diagnoses)

Test-retest reliability is Moderate to High for the WST (ICC = 0.91) for manual wheelchair users.

(WST v.4.1 for manual wheelchair users; Lindquist et al., 2010: N=11, 9 SCI, 9 male; no info on SCI types)

Inter-rater Reliability is Moderate to High for the WST (ICC = 0.92-0.95, Cronbach’s Alpha = 0.95) for measured speeds.

(Pradon et al., 2012: N = 40, 30 male; mixed injury types; mean (range) 79.8 (1-360) months in rehabilitation; Kirby et al., 2002; N = 24, 3 SCI; 16 male; mixed diagnoses)

Inter-rater reliability is Moderate to High for the WST (ICC = 0.855) for manual wheelchair users.

(WST v.4.1 for manual wheelchair users; Lindquist et al., 2010: N = 11, 9 SCI, 9 male; no info on SCI types)

Intra-rater Reliability is High for the WST (Intraclass Correlation Coefficient = 0.950, Cronbach’s Alpha = 0.96)

(WST v.4.1 for manual wheelchair users; Lindquist et al., 2010: N = 11, 9 SCI, 9 male; no info on SCI types; Kirby et al., 2002; N = 24, 3 SCI; 16 male; mixed diagnoses)

Internal Consistency is High for the WST (Cronbach’s Alpha = 0.90)

(Rushton et al. 2016; N = 72, 19% SCI; 36 males; mean(SD) age 60.7 (7.3))

Number of studies reporting reliability data: 6

Validity

Correlations between the WST and the Wheeled Distance per Day are Moderate (Pearson’s r = 0.36).

Correlations between the WST and age are Moderate (Pearson’s r = -0.32).

(Lemay et al., 2011; N = 54, 41 male; mixed injury types; 12+ months of manual WC use)

Correlations between the WST and Measured Speeds are Moderate (Pearson’s r = 0.57-0.75).

(Absolute values of correlations; Pradon et al., 2012: N = 40, 30 male; mixed injury types; mean (range) 79.8 (1-360) months in rehabilitation)

Correlations between the WST and the WST-Q are High (Pearson’s r = 0.65).

(Rushton et al. 2016; N = 72, 19% SCI; 36 males; mean(SD) age 60.7 (7.3))

Predictive validity

WST predicts CHART and SWLS scores.

(Hosseini et al., 2012; N=214; mixed injury types; mean(SD) 11.7(11) years post SCI)

Number of studies reporting validity data: 8

Responsiveness

Not established in SCI.

Floor/Ceiling Effect

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

Reviewers

Dr. William Miller, Matthew Querée, Sharon Jang, Gita Manhas

Date Last Updated

22 July 2020

Harvey LA, Batty J, Fahey A. Reliability of a tool for assessing mobility in wheelchair-dependent paraplegics. Spinal Cord 1998;36:427-431.
http://www.ncbi.nlm.nih.gov/pubmed/9648200

Kirby RL, Swuste J, Dupuis DJ, MacLeod DA, Monroe R. The Wheelchair Skills Test: a pilot study of a new outcome measure. Arch Phys Med Rehabil 2002;83:10-18.
http://www.ncbi.nlm.nih.gov/pubmed/11782826

Pradon D, Pinsault N, Zory R, Routhier F. Could mobility performance measures be used to evaluate wheelchair skills? J Rehabil Med, 2012; 44:276-279.
http://www.ncbi.nlm.nih.gov/pubmed/22278048

Rushton PW, Kirby RL, Routhier F, Smith C. (2016) Measurement properties of the Wheelchair Skills Test – Questionnaire for powered wheelchair users, Disability and Rehabilitation: Assistive Technology, 11:5, 400-406, DOI: 10.3109/17483107.2014.984778.  http://www.ncbi.nlm.nih.gov/pubmed/25411057

Lemay V, Routhier F, Noreau L, Phang SH, Martin Ginis KA. Relationships between wheelchair skills, wheelchair mobility and level of injury in individuals with spinal cord injury. Spinal Cord (2011), 1–5. http://www.ncbi.nlm.nih.gov/pubmed/21931330

Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual Wheelchair Skills Capacity Predicts Quality of Life and Community Integration in Persons With Spinal Cord Injury. Arch Phys Med Rehabil Vol 93, December 2012; 2237-2243. http://www.ncbi.nlm.nih.gov/pubmed/22684049

Lindquist NJ, Loudon PE, Magis TF, Rispin JE, Kirby RL, Manns PJ. Reliability of the Performance and Safety Scores of the Wheelchair Skills Test Version 4.1 for Manual Wheelchair Users. Archives of Physical Medicine and Rehabilitation. 2010;91:1752-57. http://www.ncbi.nlm.nih.gov/pubmed/21044722

Mountain AD, Kirby RL, Smith C. The Wheelchair Skills Test, Version 2.4: Validity of an Algorithm-Based Questionnaire Version. Archives of Physical Medicine and Rehabilitation. 2004;85:416-23. http://www.ncbi.nlm.nih.gov/pubmed/15031827

Kirby RL., Dupuis DJ, MacPhee AH et al. The Wheelchair Skills Test (Version 2.4): Measurement Properties. Archives of Physical Medicine and Rehabilitation. 2004;85:794-804. http://www.ncbi.nlm.nih.gov/pubmed/15129405

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