Wheeled Mobility Table 15 Wheelchair Skills

Author Year
Country
Research Design
Score
Total Sample Size

Methods

Outcome

Wang et al. 2015
USA
RCT
PEDro=5
N=21

Population: Experimental Group (n=9): Mean age: 33.2 yr; Gender: males=6, females=3; Level of Injury: T1-L1=9. Controls (n=9): Mean age: 34.5 yr; Gender: males=6, females=3; Level of Injury: T2-12=9.
Intervention: Patients were randomly allocated to an experimental group with immediate video feedback during wheelchair training or a control group with conventional training. Three skills were taught: ramp wheelie and curb. The experimental group observed a video of a model performing the target skill and then attempted to perform the skill whilst being filmed. Patients then reviewed the model video and their own performance to identify differences in performance. All training sessions were conducted 2/wk until the patient had mastered the target skill they had been working on. A skill competency test was administered after 3-4 wks of training followed by a retention test 1 wk after passing the competency test. A transfer test (doing the skill in a different environment) was completed 1d after passing the retention test.
Outcome Measures: Time spent completing wheelchair skills during training and testing, Number of occurrences requiring spotter assistance, Success rates during testing.
  1. There were no significant differences between groups concerning training time required to complete each skill and in the number of spotter assistance for all three tasks, however, the experimental group required significantly less spotter assistance during the curb skill training (p<0.05).
  2. No significant differences were found between groups regarding completion time of the curb skill and the ramp skill during all three tests but the experimental group completed the wheelie skill significantly quicker than the control group during the competency test (p<0.05). There were no significant differences in completion time for the wheelie skill during the retention and transfer tests.
  3. The experimental group required more spotter assistance for the curb skill and yielded a significantly lower success rate than the controls (both p<0.05) during the transfer test.

Routhier et al. 2012
Canada
RCT
PEDro=7
N=39

Population: Wheelchair Skills Training Program (WSTP) group: Mean age: 48.9 yr, Gender: males=13, females=6; Mean height: 164.5 cm; Mean weight: 83.7 kg. Control group: Mean age: 43.1 yr, Gender: males=13, females=6; Mean height: 163.5 cm; Mean weight: 70.2 kg.
Intervention: Participants were randomly put into either the control group or WSTP group. Both groups were given standard care but the WSTP group was also given a mean of 5.9 training sessions with standard care.
Outcome measures: Wheelchair Skills testing.
  1. Total P(WSTP versus control at t2): p=0.030.
  2. P(t2 versust3): WSTP p=0.990, Control p=0.641.
  3. WSTP training shows improvement in wheelchair skill right after the training particularly in community skills level but the Statistical significance was not reached between groups at 3 mo follow-up.

Ozturk & Dokuztug 2011
Turkey
RCT
PEDro=5
N=24

Population: Training Group (n=14): Mean age: 38.8 yr; Gender: males=5, females=9. Control Group (n=10): Mean age: 28.7 yr; Gender: males=6, females=4. Injury etiology: SCI=13, Other=11.
Intervention: Participants, who were manual wheelchair users (rear-wheel drive), were randomly assigned to either the training or control (no training) group. The training group received the Wheelchair Skills Program (45 min, 3x/wk for 4 wk). Supervised by a physiotherapist, sessions targeted basic skills and progressed to more advanced wheelchair skills. Session content was developed after a trainer observed the individual in their living environment.
Outcome Measures: Wheelchair Skills Test (WST).
  1. The mean time between baseline and follow-up was 35.5±6.4 days in the training group and 30.8±3.6 days in the control group (p=0.013).
  2. Within-group analysis showed a significant increase in WST performance scores for both the training (p=0.002) and control groups (p=0.01); however, statistically significant improvements for WST Safety scores were only found in the training group (p=0.001).
  3. Comparing between groups, when controlling for baseline WST values, the performance and safety scores remained significantly higher in the training group (p=0.001 and p<0.001, respectively).

Taylor et al. 2015
USA
Observational
N=1376

Population: Mean age: 38 yr; Gender: males=1115, females=261; Injury etiology: motor vehicle accident=688, fall or falling object=344, violence=151, sports=151, other=55; Level of Injury: tetraplegia C1-4=393, tetraplegia C5-8=270, paraplegia=499, other=214; Level of severity: AIS A-C=1140, AIS D=214.
Intervention: Patients enrolled in the SCIRehab Project completed questionnaires from time of injury through to discharge along with a follow-up telephone interview at 1 yr post-injury. Data collected for the study focused on responses regarding training interventions/activities, adapted equipment, and equipment evaluation.
Outcome Measures: Types of wheelchair training and skills learned, Types of fitting assessment, Adaptive equipment used, Wheelchair satisfaction.
  1. Propulsion was practiced most frequently for both manual and power wheelchair users during training.
  2. Gloves during physical therapy and occupational therapy were the most common type of adaptive equipment among manual wheelchair users. Adaptive joysticks and dorsal wrist splints were most common among power wheelchair users.

Morgan et al. 2015
USA
Qualitative
N=27

Population: Health care Professionals: Mean years of experience: 7.8 yr. Experienced Manual Wheelchair users: Mean age: 39.5 yr; Gender: males=13; females=1; Mean duration of wheelchair use: 14.3 yr; Level of injury: cervical=11, thoracic=3.
Intervention: Focus groups were formed to discuss how the current manual wheelchair skill teaching could be improved. Both current manual wheelchair users and Health care professionals were included in these groups. The international Classification of Functioning Disability and Health (ICF) codes were used to identify themes.
Outcome measures: Health care professionals: This group was asked when skills teaching was completed, its duration and by who and what skills are taught. They were then asked to discuss about what they thought should be taught as well as where, when and who are best to provide the teaching. Experienced Wheelchair users: This group was asked to discuss manual wheelchair skills and if they personally received any when they were a new user and what they were taught where that took place. Then they were asked to discuss what they thought should be taught in those skills lessons and where and when would be best to get the most from the teaching. Finally, they were asked to individually rank the 10 most important things a new wheelchair user should know when starting out.
Eighteen ICF chapters (out of 30) and 44 categories (out of 363) were identified that were related to wheelchair skills training.

Health Care Professionals:

  1. The importance for the manual wheelchair users to be able to communicate on how to help them use and maintain their wheelchair. Education about their chair itself and all its features and adjustments.
  2. Focused on decreasing pain and the problems caused by pressure sores. Thought that the education in the safety of the chair and of pressure relief is important since they will be sitting for majority of the time.
  3. Pushing technique for shoulder injury prevention.
  4. Practicing environmental changes and adapting their movements in the chair

Wheelchair Users:

  1. Lessons were different for each wheelchair user. Others had a therapist demonstrate what they wanted them to do and then spot them as they tried until they felt comfortable to do it alone. Many learned transfers e.g., car, shower, toilet. Some said specific life skills were learned once at home.
  2. Psychological factors were thought to be something that would improve wheelchair skills lessons, the lack motivation was said to be debilitating towards learning the physical movement of the wheelchair. The idea of waiting to start these lessons till after a bit of time has passed to it give you time to work on the psychological shock that has just occurred before getting into the physical lessons.
  3. Wished they learned more about hand protection and how not to hurt their hands from the push rims and tires. Pushing through doorways and outside hand protection were a concern for new wheelchair users.
  4. Important emphasis on transfers from all aspects of a home or car (shower, toilet, bed).
  5. Wanting more training to be in their own environments and not just a hospital setting do to it being no realistic to their lifestyles.
  6. Top 5 ranked skills to learn were 1) General transfers (bed, shower/bathtub, car) 2) Maintenance/ cleaning/adjustments 3)Propulsion techniques 4)Small bumps/curbs 5)Positioning/sitting posture.

Fliess-Douer et al. 2013
Belgium
Pre-Post
N=111

Population: Mean age: 38.2 yr; Gender: males=80, females=31; Level of injury: paraplegia=76, tetraplegia=34; Level of severity: complete=76, incomplete=33.
Intervention: Patients completed the Wheelchair Circuit which consists of eight tasks including a figure-8, a 15 m sprint, mounting a platform and doorstep, performance on two different degrees of slopes (3% and 6%) on a treadmill, 3 min propulsion with varying speeds on a treadmill, and wheelchair transfer across eight rehabilitation centres. A questionnaire on participation was then completed and analysed in relation to the patient’s physical and mobility performance on the wheelchair circuit tasks. Assessments were conducted at discharge from inpatient rehabilitation and at 1 yr follow-up.
Outcome Measures: Self-efficacy scale (SES), General Competency Scale (ALCOS-16), Quebec user evaluation of satisfaction with assistive technology questionnaire (Dquest), Wheelchair Circuit test; wheelchair ability score on all tasks, performance time on figure-8 and 15m sprint.
  1. Performance time was significantly correlated with age, lesion level and SES score as older patients were significantly slower than younger patients (p<0.001), patients with paraplegia were on average 13.1 sec faster than tetraplegia patients (p<0.001) and 10 points higher on SES resulted in 1.5 sec faster performance time (p=0.03).
  2. Higher wheelchair ability scores were significantly correlated with younger age (p<0.001), higher SES scores (p=0.02), and patients with paraplegia compared to tetraplegia (p<0.0001).
  3. Dquest satisfaction scores were not significantly correlated with performance time or wheelchair ability score (p=0.62 and p=0.60 respectively).
  4. There was no significant interaction between wheelchair ability and performance time with ALCOS-16 score (p=1.0 and p=0.55 respectively) from discharge to 1 yr follow-up.

Hosseini et al. 2012
USA
Post Test
N=214

Population: Mean age: 38.8 yr; Gender: males=170, females=44; Level of injury: paraplegia=154, tetraplegia=60; Mean time since injury: 11.7 yr.
Intervention:
Participants completed the Wheelchair Skills Test.
Outcome Measure:
Wheelchair Skills Test (WST).
  1. Compared to participants with tetraplegia, those with paraplegia had significantly better WST scores regarding folds and unfolds wheelchair (p<0.001), descends 15-cm curb (p<0.05), holds 30-sec wheelie (p=0.043), turns 180º in wheelie (p=0.012), ground to WC transfer (p=0.01), ascends at least three stairs (p<0.05), and descends at least three stairs (p=0.045).

Van Velzen et al. 2012
Netherlands
Pre-Post
N=103

Population: Working Group (n=46): Mean age: 37.4 yr; Gender: males=36, females=10; Level of Injury: paraplegia=29, tetraplegia=11; Level of severity: AIS A=19, AIS B=6, AIS C=8, AIS D=6.
Non-Working Group (n=57): Mean age: 37.7 yr; Gender: males=43, females=14; Level of Injury: paraplegia=32, tetraplegia=22; Level of severity: AIS A=29, AIS B=10, AIS C=12, AIS D=3
Intervention: SCI patients who participated in the Dutch Research Project received questionnaires from the start of rehabilitation to 5yr after discharge with emphasis on employment situation before and after occurrence of SCI.
Outcome Measures: Utrecht Activities List (UAL) – Paid work subscale, Wheelchair ability score on all tasks, Performance time on figure-8 and 15 m sprint, Physical capacity parameters.
  1. Patients with a 10 Watt higher peak aerobic power output were 1.38 times more likely to return to work (p=0.028 (Odds ratio 1.38)) but peak oxygen uptake was not associated with return to work (p=0.084).
  2. Higher wheelchair ability score (p=0.022 (Odds ratio 1.63)), lower performance time (p=0.019 (Odds ratio 0.88)) and lower physical strain (p=0.038 (Odds ratio 1.38)) were all significantly associated with returning to work.

De Groot et al. 2010
Netherlands
Cohort
N=142

Population: Mean age: 40.8 yr; Gender: male=97, females=37; Level of injury: paraplegia=77, tetraplegia=47; Level of severity: complete=94, incomplete=40.
Intervention: Patients completed the Wheelchair Circuit which consists of eight tasks including a figure-8, a 15 m sprint, mounting a platform and doorstep, performance on two different degrees of slopes (3% and 6%) on a treadmill, 3 min propulsion with varying speeds on a treadmill, and wheelchair transfer across eight rehabilitation centres. Three statistical models were created to predict wheelchair circuit outcomes at discharge (on five clinical measures, on all eight research tasks and on performance time). Independent variables included baseline Wheelchair Circuit Scores and demographic and SCI diagnostic variables. Data was collected at the start of active inpatient rehabilitation and at discharge.
Outcome Measures: Wheelchair ability score on five non-treadmill tasks and all eight tasks of the Wheelchair Circuit test, performance time on figure-8 and 15 m sprint.
  1. Baseline wheelchair ability scores on the five non-treadmill tasks, ability scores on all eight tasks and performance time were significantly related to discharge scores (all p<0.001).
  2. Age at start of rehabilitation was significantly predictive of ability scores on the five non-treadmill tasks (Enter p=0.002, Backward p=0.001), on all eight ability tasks (Enter p=0.007, Backward p=0.005), and performance time (both p<0.001).
  3. Lesion level was significantly predictive only for performance time (Enter p=0.033, Backward p=0.035).
  4. Body mass index and completeness of SCI did not make significant contributions to the explained variance to any of the models.

Kilkens et al. 2005b
Netherlands
Observational
N=81

Population: Mean age: 39.3 yr; Gender: males=56, females=25; Level of injury: paraplegia=56, tetraplegia=25; Level of severity: complete=51, incomplete=30.
Intervention: Patients completed the Wheelchair Circuit which consists of eight tasks including a figure-8, a 15 m sprint, mounting a platform and doorstep, performance on two different degrees of slopes (3% and 6%) on a treadmill, 3min propulsion with varying speeds on a treadmill, and wheelchair transfer. A questionnaire on participation was then completed.
Outcome Measures: 68-Item Sickness Impact Profile – Mobility Range and Social Behavior (SIPSOC), Wheelchair Circuit; wheelchair ability score on all tasks, performance time on figure-8 and 15 m sprint, physical strain heart-rate reserve after slope tasks.
  1. SIPSOC scores were moderately but significantly correlated with lesion level (p<0.05), age, wheelchair ability, performance time and physical strain (all p<0.01).
  2. After controlling for demographics and lesion level, performance time was found to be more predictive of participation (p<0.01) than wheelchair ability or physical strain. Including scores from wheelchair circuit increased variance explained from 1% to 34% (r2).

Kilkens et al. 2005c
Netherlands
Observational
N=121

Population: Mean age: 39.8 yr; Gender: males=90, females=31; Level of injury: paraplegia=63, tetraplegia=57; Level of severity: complete=83, incomplete=38.
Intervention: Rehabilitation patients completed a wheelchair circuit consisting of eight tasks including a figure-8, a 15 m sprint, mounting a platform and doorstep, performance on two different degrees of slopes (3% and 6%) on a treadmill, 3 min propulsion with varying speeds on a treadmill, and wheelchair transfer at three time points; at the start of rehabilitation (T1), after 3 mo (T2), and at discharge (T3).
Outcome Measures: Wheelchair ability score on all tasks, Performance time on figure-8 and 15 m sprint, Physical strain heart-rate reserve after slope tasks.
  1. Wheelchair circuit outcomes (ability score performance time and physical strain improved significantly over time across all three time points. There were no significant differences between sites.
  2. Younger age was significantly associated with a higher ability score (p=0.004) and faster performance time (p<0.01).
  3. Lesion level was significantly associated with a higher ability score, faster performance time, and less physical strain (all p<0.001) as demonstrated by patients with paraplegia.
  4. Ability score at T3 was predicted by ability score at T1, age, and body mass index (BMI) (explained 60% of the variance).
  5. Performance time at T3 was predicted by performance at T1 and age (explained 61% of the variance).
  6. Physical strain at T3 was predicted by physical strain at T1 and BMI (explained 45% of the variance).
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