Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise

Marleen Elisabeth Sol,Fit-For-The-Future!-Consortium ,Laura De Groot,Janke Frederike De Groot,Olaf Verschuren

doi:10.1186/s12887-017-0809-9

Abstract

BackgroundWheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents.MethodsMixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the ‘COnsensus-based Standards for the selection of health Measurement Instruments’ (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing.ResultsPhase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons.ConclusionsThe newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice.

Highlights

Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity
Three outcome measures focused on a specific aspect of wheelchair mobility; wheelchair propulsion (WPT, slalom test) [47, 48] or wheelchair driving (WC-WAIMS) [33]
All fifteen outcome measures contained items related to wheelchair mobility, ranging from 1/11 WMS items [45] to 10/10 WMS [40, 41] items per total number of items

Summary

Introduction

Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. The objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents. Several studies have reported on the importance of wheelchair mobility skills (WMS) to overcome mobility problems and improve participation [4, 5]. At the same time though, the importance of WMS training in children was recently confirmed in a qualitative study exploring factors associated with levels of physical activity [11]. This can be illustrated by a quote from one of the parents: “Wheelchair training, that is very important I think, .she can do much more now....a lot of places are not adjusted for wheelchairs ....and you can just go....your life becomes a lot more fun” [11]

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