Table 3 Education and Skills Training Interventions

Author Year

Research Design

Total Sample Size

Methods Outcome

Yeo et al., 2018





Population: Intervention (n=13): Mean age=35.3±4.7 yr; Gender: males=10, females=3; Time since injury: 2.9 yr; Level of injury: T1 – C7; Severity of injury: AISA A=0, B=8, C=5, D=0.

Control (n=11): Mean age=35.9±5.3 yr; Gender: males=9, females=2; Time since injury: 2.8 yr; Level of injury: T1 – C7; Severity of injury: AISA A=0, B=7, C=4, D=0.

Intervention: Participants were randomized to a training group (n=13) or a control group (n=11). The training group attended wheelchair skills training sessions, whereas the control group attended conventional exercise sessions (three d/wk for eight wk). Outcome measures were assessed at baseline, four and eight wk.

Outcome Measures: Wheelchair skills test (WST); Van Lieshout test (VLT).

1.     WST significantly improved over time compared with controls (p<0.05); WST significantly improved from baseline within the training group.

2.     No significant differences occurred in VLT between groups over time (p>0.05); VLT significantly improved from baseline in both groups (p<0.05).

Rice et al., 2014





Population: Intervention Group (IG; n=12): Mean age: 33.2±14.3 yr; Gender: males=9, females=3; Level of injury: paraplegia=12, tetraplegia=0; AIS level: A=6, B=1, C=3, D=1, Not rated=1.

Standard Care Group (SCG; n=25): Mean age: 40.8±16.4 yr; Gender: males=19, females=6; Level of injury: paraplegia=22, tetraplegia=3; Severity of Injury: AIS A=14, ASI B=3, AIS C=5, AIS D=1, N/R=2.

Intervention: All participants were independent manual wheelchair (MWC) users. The intervention group was strictly educated on the Paralyzed Veterans of America’s Clinical Practice Guidelines (CPG) for Preservation of Upper Limb Function by a physical therapist and an occupational therapist in an inpatient rehabilitation facility. The standard of care group received standard therapy services.

Outcome Measures: Comparison of wheelchair setup, selection, propulsion biomechanics, Numeric Rating Scale (NRS), Wheelchair Users

Shoulder Pain Index (WUSPI), and Satisfaction With Life Scale (SFWL), Craig Handicap Assessment and Reporting Technique (CHART) scores.

1.     In wheel chair set-up, no significant interaction, between-subject differences, or within subject differences were found between study groups (p>0.05).

2.     Although differences were not significant, the percentage of IG participants within the guideline recommendation increased by 25% while the percentage of SCG participants within the guideline recommendation decreased by 5%.

3.     No significant differences were found between groups in wheelchair selection (p>0.05); however, 100% of the IG participants had an ultralight MWC at 6mon and 1 yr compared with 68.8% (6 mon) and 77.8% (1Y) of the SCG participants.

4.     IG propelled with a significantly lower push frequency than the SCG on tile (p<0.02) and on a ramp (p<0.03) but not carpet (p=0.10).  

5.     No significant differences were found between NRS or WUSPI scores in the IG and SCG (p>0.05).

6.     A simple main effect trend (p=0.07) found that the IG had an increase in the CHART physical subsection scores between 6-mon and 1 yr and an increase in the occupational subsection scores between 6 mon and 1 yr (p=0.07).

Effect Sizes: Forest plot of standardized mean differences (SMD±95%C.I.) as calculated from pre- and post-intervention data.

Curtis et al., 1999





Population: Mean age: 35 yr; Gender: males=35, females=7; Level of injury: cervical-lumbar; Mean duration of wheelchair use: 24 yr.

Intervention: Both groups completed the Wheelchair Users Shoulder Pain Index (WUSPI) every two mo for six mo. The experimental group attended a 60 min educational session where they were instructed in five shoulder exercises.

Outcome Measures: Wheelchair User’s Shoulder Pain Index (WUSPI), Visual Analog Scale (VAS).

1.     There were no significant differences between control and experimental group in age, yr of wheelchair use or activity levels.

2.     When looking at the effect of exercise of intervention on performance corrected (PC) WUSPI, a two factor repeated measures ANOVA showed a significant effect of time only (p=0.048).


Effect Sizes: Forest plot of standardized mean differences (SMD±95%C.I.) as calculated from pre- and post-intervention data.