Wheelchair Skill Performance Research Articles

Effects of wheelchair skills training during peer-led Active Rehabilitation Camps for people with spinal cord injury in Poland: a cohort study.

Prospective cohort study. To evaluate the effects of wheelchair skills training (WSTR) for participants with spinal cord injury (SCI) during peer-led Active Rehabilitation Camps (ARC) in Poland. We hypothesized that participation in ARC will improve wheelchair skill performance and self-efficacy in individuals with SCI. We also aimed to determine demographic and injury-related factors associated with greater improvements in wheelchair skill performance and self-efficacy. Thirteen consecutive ARCs in Poland. Participants (n = 122) with traumatic or nontraumatic SCI older than 16 years were evaluated at the beginning (T1) and completion (T2) of ARC and at 3-month follow-up (T3) through the Queensland Evaluation of Wheelchair Skills (QEWS) and the Wheelchair Skills Test Questionnaire (WST-Q). At T2, 43% of participants reached the threshold for substantial clinically meaningful change in QEWS, 73% in WST-Q capacity, and 67% in confidence, with approximately half of those reporting such gains at T3. At a group level, participants achieved small effect-size improvements (QEWS) at T2; large effects in wheelchair skills capacity at T2 and T3; large effects in wheelchair skill confidence at T2, and low effects at T3. Prior attendance to ARC was the only independent variable that explained 10% of variance in wheelchair capacity gains. Peer-led WSTR during ARCs is highly effective at improving wheelchair skills in individuals with SCI. These improvements are largely retained after three months. Persons with SCI should have a chance to participate in more than one camp to maintain and further improve their wheelchair skills.

Outcomes in occupational therapy students’ preparation for wheelchair skills training provision

ABSTRACT While wheelchair skills training has demonstrated highly effective outcomes for wheelchair users, prevalence of receiving comprehensive skills training is low. Studies demonstrate a wheelchair skills “bootcamp” significantly improves occupational therapy students’ capacity to demonstrate wheelchair skill performance; however, how bootcamps impact students’ self-efficacy to deliver skills training in future clinical practice is unclear. This study explored a large dataset collected from nine successive student cohorts attending a structured wheelchair skills bootcamp at a single site. Bootcamps were 4–4.5 hours in duration and content was based on the Wheelchair Skills Program. Mean improvement in skill capacity was 34.8% (95% CI 33.5; 36.1) and wheelchair self-efficacy improved by 28.7% (95% CI 27.3; 30.1). Post-bootcamp self-efficacy scores for Assessment (80.9%), Training (78.5%), Spotting (87.4%), and Documentation (70.4%) all improved by 30–40%. Mandatory bootcamps had lower baseline scores but similar post-bootcamp and change scores as voluntary ones. Cohorts during the COVID-19 pandemic had significantly lower baseline scores for wheelchair skill capacity and confidence as well as self-efficacy with assessment, but significantly larger improvements post-bootcamp. An experiential bootcamp is effective across a wide range of occupational therapy student cohorts in preparing them to deliver wheelchair skills training in future clinical practice.

Wheelchair Skills, Capacity and Performance of Manual Wheelchair Users with Spinal Cord Injury in a Selected Rehabilitation Centre of Bangladesh

Introduction: There is growing recognition that Occupational Therapist has a significant role along with other professional in wheelchair skills training. In rehabilitation center, wheelchair skills are provided as a part of community re-integration process of people with spinal cord injury. However, individual capacity, confidence, performance in wheelchair skills should be prioritized in collaborative treatment plan to ensure occupational functioning of people with spinal cord injury in the community. Objectives: The objectives are to find out the level of wheelchair skills capacity, confidence, and performance of persons with SCI and determine correlation among capacity, confidence and performance. Methodology: This cross-sectional descriptive study was carried out in the community among purposively selected ninety manual wheelchair users using the WST-Q version 4.3. Non-parametric test was used to determine correlation among wheelchair skills capacity, confidence and performance. Result: The median (inter-quartile range) values for WST-Q capacity, WST-Q confidence, and WST-Q performance were 74.26% (57.02%-78.78%), 75.75% (66.66%-80.01%), and 72.00% (54.54%-76.47%). The total WST-Q capacity scores correlated significantly with the total WST-Q confidence scores (r=.955; p<.000) and total WST-Q performance scores (r=.888; p<.000). Success rates were <70% for12 of the 34 individual skills on the WST-Q. Conclusion: Wheelchair skills training enhance confidence and participation among people with spinal cord injury. Occupational therapist should focus on improving participation in occupational functioning at community level.

The associations of functional independence and quality of life with sitting balance and wheelchair skills among wheelchair users with spinal cord injury

Context/Objective To examine the associations of functional independence and quality of life (QOL) with sitting balance and wheelchair skills among individuals living with Spinal Cord Injury (SCI) who use a wheelchair full time. Methods Secondary data analysis of a total of 59 wheelchair users living with SCI. Eighteen individuals were included in all analyses involving sitting balance. Demographics information and characteristics of SCI were collected through a survey. Participants reported their wheelchair skills performance, confidence, and capacity; functional independence; and QOL using the Wheelchair Skills Test Questionnaire (WST-Q) 5.0, Spinal Cord Independence Measure (SCIM III), and World Health Organization QOL (WHOQOL-BREF), respectively. Sitting balance was assessed remotely using the Function in Sitting Test (FIST). Correlations between variables were analyzed using the Spearman rank correlation test. Results All the measures of SCIM III (total, selfcare, and mobility) correlated with the FIST (ρ = 0.52–0.66, p < 0.01 and p < 0.05). SCIM III-Mobility correlated with WST-performance, capacity, and confidence (ρ = 0.38–0.51, p < 0.01). WHOQOL-physical health and environment significantly correlated with WST-capacity and confidence (ρ = 0.26–0.33, p < 0.05). The FIST, WST-Performance, and level of injury did not correlate with any WHOQOL domain. Conclusions Lower functional independence and mobility are associated with poor sitting balance and poor wheelchair skills. Higher QOL may be associated with higher wheelchair skills. Future research is warranted to examine these relationships longitudinally to establish causality.

Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study.

IntroductionThe manual wheelchair skills training programme is used to structure teaching manual wheelchair use for people following injury or disability. This pilot study aimed to explore the outcomes of introducing a group wheelchair skills training programme on skill performance, confidence and frequency of wheelchair use for people with lower limb amputation in a rehabilitation setting from the perspective of participants and group facilitators.MethodThis pilot study used a two‐phase mixed methods nested design. Eleven people with lower limb amputations received a minimum of two 45‐min wheelchair skills sessions, using the Wheelchair Skills Training Program, delivered in a mix of group and one‐to‐one sessions. In phase one, wheelchair skill performance, confidence and frequency were measured using the Wheelchair Skills Test Questionnaire‐Version 5.0, goal achievement was measured through the Functional Independence Measure and Goal Attainment Scale. These measures were repeated in phase two. Nested within phase two was qualitative data collection. Interviews were conducted with eight participants and a focus group held with three programme facilitators, to gather their perceptions of the training process. Descriptive statistics were used to analyse and report quantitative data and thematic analysis was used to combine qualitative data from the two participant groups.ResultsPost intervention, the mean Wheelchair Skills Test Questionnaire score increased in performance (42.3 ± 13.4), confidence (33.9 ± 20.7) and frequency (33.9 ± 27.3). Goal Attainment was achieved or exceeded by 91% of all participants. Four themes were developed from qualitative data including, “motivators driving learning,” “delivery methods, structure and profile of the Wheelchair Skills Training Program,” “managing risk and safety” and “confidence in wheelchair use.”ConclusionsThe pilot study found that The Wheelchair Skills Training Program can improve wheelchair performance, confidence and frequency to support enhanced safety, independence and quality of life for people with lower limb amputations.

A study on the effects of modified wheelchair skills program (WSP) for hemiplegic clients

ABSTRACT The purpose of this study was to evaluate the modified WSP for improving wheelchair skills capacity, perceived satisfaction and performance in daily activities for hemiplegia patients in Korea. The modified WSP was tailored to better fit the environment and the treatment needs of hemiplegic patients in Korea. The resulting training procedure was augmented to help hemiplegic patients understand the basic mechanics of the wheelchair. To assess the efficacy of the modified WSP, 24 hemiplegic patients were selected as subjects and WST, COPM, K-MBI, and subjective opinion surveys were utilized. The results of the training showed significant improvement of WST, COPM, K-MBI scores in the experimental group and especially, the WST and COPM score showed statistically insignificant improvement compared to the control group. A modified WSP may prove effective for hemiplegic patients who exhibit low volition or are experiencing wheelchair use for the first time.

Influence of Peer-led Wheelchair Training on Wheelchair Skills and Participation in Older Adults: Clinical Outcomes of a Randomized Controlled Feasibility Trial

ObjectiveTo estimate treatment effect size of a peer-led Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU) program on objective wheelchair skills (primary); and on perceived wheelchair skills capacity and performance, wheelchair use self-efficacy, satisfaction with participation, life-space mobility, and participation frequency (secondary); and to evaluate retention 6 months later (secondary). DesignRandomized controlled trial. SettingRehabilitation centers and communities. ParticipantsCommunity-living older adults (N=40). InterventionWheelSeeU comprised six 90-minute peer-led sessions of customized training (in pairs) according to participants’ goals. A support-trainer provided spotting. The control group comprised six 90-minute professional-led didactic information sessions (in pairs). Main Outcome MeasuresThe Wheelchair Skills Test (WST), Wheelchair Skills Test Questionnaire (WST-Q), Wheelchair Use Confidence Scale for Manual Wheelchair Users-Short Form (WheelCon-M-SF), Wheelchair Outcomes Measure (WhOM), Life-Space Mobility (LSA), and Late Life Function and Disability Index (LLFDI) were collected at baseline (T1), postintervention (T2), and 6 months postintervention (T3). ResultsOf 121 screened, 39 individuals did not meet the inclusion criteria and 41 declined to participate. Forty participants (64.5 years of age; 60% men) were randomized, 38 completed the intervention, and 35 completed T3 assessments. There were no adverse effects. WheelSeeU did not have a statistically significant greater effect on objective WST (primary) or WST-Q capacity, WheelCon, LSA, and LLFDI at T2 compared to the control group. Effect sizes were statistically significant and large for WST-Q performance (Cohen’s d=0.72) and the WhOM (Cohen’s d=0.82) at T2, and effects were retained at T3. ConclusionCompared to an active control group, WheelSeeU did not have a greater effect on wheelchair skills capacity. However, WheelSeeU should not be prematurely dismissed as an approach to potentially improve wheelchair skills performance and satisfaction with participation in meaningful activities. Sex and depression are important when designing interventions for older adults.

Relationship between wheelchair skills scores and peak aerobic exercise capacity of manual wheelchair users with spinal cord injury: a cross-sectional study

Purpose: Although both wheelchair skills and fitness are important and probably inter-related, the extent and nature of the relationship between them are not well understood. The objective of this study was to test the hypothesis that there are significant relationships between wheelchair skills scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Materials and methods: We studied 26 participants, recording Wheelchair Skills Test Questionnaire scores and peak power output from graded aerobic wheelchair exercise testing on a motorized treadmill.Results: The median Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores were 83.3%, 81.5%, and 76.7% and the median peak power output was 58.2 W. On regression analysis, there were significant relationships between the total Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores and peak power output (R2 0.270–0.709, odds ratios 1.043–1.150, p < 0.05).Conclusions: Significant relationships exist between the wheelchair skills capacity, confidence, and performance scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. These findings suggest that both wheelchair skills training and exercise training may be useful during the rehabilitation of people with spinal cord injury.Implications for rehabilitationModerate positive relationships exist between wheelchair skills capacity and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Moderate positive relationships exist between wheelchair skills confidence and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Although further research is needed, these findings suggest that clinicians should address both wheelchair skills training and exercise training during the rehabilitation of people with spinal cord injury and not assume that either alone is sufficient.

Wheelchair Skills Capacity and Performance of Manual Wheelchair Users With Spinal Cord Injury

ObjectivesTo describe the wheelchair skills capacity and performance of experienced manual wheelchair users with spinal cord injury (SCI) and to assess measurement properties of the Wheelchair Skills Test (WST) and Wheelchair Skills Test Questionnaire (WST-Q). DesignCross-sectional descriptive study involving within-subject comparisons. SettingFour Spinal Cord Injury Model Systems centers. ParticipantsManual wheelchair users with SCI (N=117). InterventionsNot applicable. Main Outcome MeasuresWST and WST-Q version 4.2 as well as measures for Confidence, Basic Mobility, Independence, Ability to Participate, Satisfaction, and Pain Interference. ResultsThe median (interquartile range) values for WST capacity, WST-Q capacity, and WST-Q performance were 81.0% (69.0%–90.0%), 88.0% (77.0%–97.0%), and 76.0% (66.3%–84.0%). The total WST capacity scores correlated significantly with the total WST-Q capacity scores (r=.76; P<.01) and WST-Q performance scores (r=.55; P<.01). The total WST-Q capacity and WST-Q performance scores were correlated significantly (r=.63; P<.001). Success rates were <75% for 10 of the 32 (31%) individual skills on the WST and 6 of the 32 (19%) individual skills on the WST-Q. Regression models for the total WST and WST-Q measures identified statistically significant predictors including age, sex, body mass index, and/or level of injury. The WST and WST-Q measures correlated significantly with the Confidence, Basic Mobility, Independence, or Pain Interference measures. ConclusionsMany people with SCI are unable to or do not perform some of the wheelchair skills that would allow them to participate more fully. More wheelchair skills training may enhance participation and quality of life of adults with SCI. The WST and WST-Q exhibit good content, construct, and concurrent validity.

Low-intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels.

To investigate the effects of low-intensity wheelchair training on wheelchair-specific fitness, wheelchair skill performance and physical activity levels in inactive people with long-term spinal cord injury. Randomized controlled trial. Inactive manual wheelchair users with spinal cord injury for at least 10 years (n = 29), allocated to exercise (n = 14) or no exercise. The 16-week training consisted of wheelchair treadmill-propulsion at 30-40% heart rate reserve or equi-valent in terms of rate of perceived exertion, twice a week, for 30 min per session. Wheelchair-specific fitness was determined as the highest 5-s power output over 15-m overground wheelchair sprinting (P5-15m), isometric push-force, submaximal fitness and peak aerobic work capacity. Skill was determined as performance time, ability and strain scores over a wheelchair circuit. Activity was determined using a questionnaire and an odometer. Significant training effects appeared only in P5-15m (exercise vs control: mean +2.0 W vs -0.7 W, p = 0.017, ru=0.65). The low-intensity wheelchair training appeared insufficient for substantial effects in the sample of inactive people with long-term spinal cord injury, presumably in part owing to a too-low exercise frequency. Effective yet feasible and sustainable training, as well as other physical activity programmes remain to be developed for inactive people with long-term spinal cord injury.

Pilot Study of a Peer-Led Wheelchair Training Program to Improve Self-Efficacy Using a Manual Wheelchair: A Randomized Controlled Trial

ObjectivesTo evaluate the effect of a peer-led wheelchair training program on self-efficacy of manual wheelchair (MWC) use and to explore influences of the intervention on MWC skills, life-space mobility, and satisfaction with participation. DesignPilot randomized controlled trial. SettingRehabilitation center and community. ParticipantsCommunity-living MWC users (N=28; mean MWC experience, 13y; mean age, 49y; 6 [21%] women). InterventionsThe experimental group (n=16) received six 1.5-hour sessions of a peer-led self-efficacy–enhanced wheelchair training program (WheelSee). On the basis of individualized goals, peer trainers administered WheelSee to pairs of MWC users. The control group (n=12) received no intervention. Main Outcome MeasuresThe primary outcome—wheelchair use self-efficacy—was assessed using the Wheelchair Use Confidence Scale (WheelCon) version 3.0. Secondary outcomes included wheelchair skills capacity and performance (Wheelchair Skills Test Questionnaire version 4.1), life-space mobility (Life Space Assessment), and satisfaction with participation (Wheelchair Outcome Measure). ResultsControlling for baseline scores, an analysis of covariance revealed that WheelSee had a large statistically significant effect on MWC use self-efficacy in community-living adult MWC users (Cohen d=1.4; P=.002) than in a control group. WheelSee also had a large statistically significant effect on MWC skills capacity (Cohen d=1.3; P=.003) and performance (Cohen d=1.0; P=.02). There were no statistically significant differences in life-space mobility or satisfaction with participation scores between the groups. ConclusionsA peer-led MWC training program improves wheelchair use self-efficacy in adult MWC users and had a positive influence on other wheelchair-related outcomes. WheelSee may offer a promising intervention strategy to accommodate the training needs of community-living MWC users.

Development, reliability and validity of the queensland evaluation of wheelchair skills (QEWS).

Psychometric studyObjectives:To develop and test a valid and reliable assessment of wheelchair skills for individuals with spinal cord injuries (SCI); the Queensland Evaluation of Wheelchair Skills (QEWS). Hospital, Australia. Phase 1: Four Delphi panel rounds with clinical experts were used to develop the QEWS. Phase 2: Intra-rater and inter-rater reliability of the QEWS items were examined in 100 people with SCI. Phase 3a: Concurrent validity was investigated by examining the association between QEWS total scores and physiotherapists' global ratings of wheelchair skill performance. Phase 3b: Construct validity was tested in 20 people with recent SCI by examining change in QEWS total scores between when they first mobilised in a wheelchair and scores obtained 10 weeks later. Phase 1: The QEWS was developed. Phase 2: The intra-class correlation coefficients reflecting the intra-rater reliability and the inter-rater reliability for the QEWS total score were 1.00 and 0.98, with scores being within one point of each other 96 and 91% of the time, respectively. Phase 3a: The QEWS total scores were comparable with the global rating of wheelchair skill performance (r2=0.93). Phase 3b: The QEWS scores changed by a median (interquartile range (IQR)) of 4 (1 to 6) points over the 10-week period following first wheelchair mobilisation. The QEWS is a valid and reliable tool for measuring wheelchair skills in individuals with SCI. The QEWS is efficient and practical to administer and does not require specialised equipment.

Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial.

This is an open randomized controlled trial. The objective of this study was to investigate the effects of a 16-week hybrid cycle versus handcycle exercise program on fitness and physical activity in inactive people with long-term spinal cord injury (SCI). The study was conducted in two rehabilitation centers with a specialized SCI unit. Twenty individuals (SCI⩾8 years) were randomly assigned to a hybrid cycle (voluntary arm exercise combined with functional electrical stimulation (FES)-induced leg exercise) or a handcycle group. During 16 weeks, both groups trained twice a week for 30 min at 65-75% heart rate reserve. Outcome measures obtained before, during and after the program were fitness (peak power output, peak oxygen consumption), submaximal VO2 and heart rate (HR), resting HR, wheelchair skill performance time score) and physical activity (distance travelled in wheelchair and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) score). Changes were examined using a two-factor mixed-measures analysis of variance. For all fitness parameters, except for submaximal VO2, no interaction effects were found. The hybrid cycle group showed a decrease in VO2 over time in contrast to the handcycle group (P=0.045). An overall reduction in HRrest (5±2 b.p.m.; P=0.03) and overall increase in PASIPD score (6.5±2.1; P=0.002) were found after 16 weeks of training. No overall training effects were found for the other fitness and activity outcome measures. In the current study, hybrid cycling and handcycling showed similar effects on fitness and physical activity, indicating that there seem to be no additional benefits of the FES-induced leg exercise over handcycle training alone.

Wheelchair skills performance between discharge and one year after inpatient rehabilitation in hand-rim wheelchair users with spinal cord injury

To study possible changes in wheelchair skills in participants with spinal cord injury between discharge and 1 year after rehabilitation, and to determine whether changes in wheelchair skills performance are related to lesion and personal characteristics, self-efficacy, and wheelchair satisfaction. Prospective cohort study. Eight rehabilitation centres with spinal cord injury units in the Netherlands. A total of 111 participants performed the Wheelchair Circuit twice: at discharge (t1) and 1 year after discharge (t2). Personal/lesion characteristics, self-efficacy, and wheelchair satisfaction were measured. Normalized ability score and performance time score were analysed with a linear multilevel regression analysis for possible associations with wheelchair skills. No statistically significant changes were found in the ability and performance time scores of the Wheelchair Circuit over the first year after discharge. Younger persons, those with paraplegia, and those with a better self-efficacy score showed higher ability scores and faster performance time scores on both test occasions. Wheelchair skills performance, measured with the Wheelchair Circuit, did not change during the first year after discharge from inpatient rehabilitation. Wheelchair skills performance was associated with age, lesion level and self-efficacy perceptions.

Design of a randomized-controlled trial on low-intensity aerobic wheelchair exercise for inactive persons with chronic spinal cord injury

Purpose: To investigate effects and working mechanisms of low-intensity aerobic wheelchair exercise on fitness, (upper-body) health and active lifestyle in inactive persons with chronic spinal cord injury (SCI). Methods: A multicenter randomized-controlled trial (RCT) in 40 inactive manual wheelchair users (aged 28–65y) with chronic paraplegia or tetraplegia (time since injury >10y). Subjects will be randomly assigned to an intervention or a control group. The intervention will consist of 16 weeks (2 times per week, 30 min per session) of low-intensity aerobic handrim wheelchair exercise (30–40% HRR) on a treadmill. Repeated measurements will be performed before starting the intervention or entrance of the control group, and after week 8, 16 and 42 following the start. The primary outcome will be wheelchair-specific physical fitness. Secondary outcomes will be upper-body pain and discomfort, shoulder load, propulsion technique, wheelchair skill performance and physical activity levels. Conclusions: Results of this first RCT on low-intensity aerobic wheelchair exercise for inactive persons with chronic SCI can improve SCI-specific exercise guidelines and provide an evidence-base for an aftercare program aimed at preserving fitness, health and active lifestyle of persons aging with SCI.Implications for RehabilitationLow-intensity wheelchair aerobic exercise may be effective for improving fitness, (upper-body) health and active lifestyle of inactive persons with chronic SCI, without the high dropout rates that plague exercise programs for this population.Results of this study can 1) improve SCI-specific aerobic exercise guidelines and 2) provide an evidence-base for a long-term aftercare rehabilitation program for persons aging with SCI.As this study is embedded in Dutch rehabilitation practice, chances of knowledge transfer and implementation are high, and strengthen the Dutch SCI rehabilitation network.

Wheelchair Skill Performance of Manual Wheelchair Users With Spinal Cord Injury

Many individuals with a spinal cord injury (SCI) rely on their wheelchairs to complete daily mobility tasks. Unfortunately, the natural environment creates many mobility challenges for wheelchair users. A study by Meyers et al found that wheelchair users reported curbs, uneven terrain, and travel surface as barriers to their mobility.1 To negotiate these mobility tasks, wheelchair users require certain wheelchair skills. A study by Kilkens et al found wheelchair skills performance to be moderately associated with participation.2 Therefore, the inability to perform certain skills can limit a wheelchair user’s functional independence and participation in daily activities. The purpose of this study was to examine wheelchair skill performance of manual wheelchair users with SCI among 6 Model SCI Systems (MSCIS).

Manual Wheelchair Skills Capacity Versus Performance

Inkpen P, Parker K, Kirby RL. Manual wheelchair skills capacity versus performance. ObjectivesTo test the hypotheses that self-reported manual wheelchair skills capacity and performance are highly correlated and that capacity significantly exceeds performance. DesignCross-sectional. SettingRehabilitation center. ParticipantsManual wheelchair users (N=26) with a variety of diagnoses and an average of 10.8 years of wheelchair experience. InterventionsNone. Main Outcome MeasureWe administered the questionnaire version of the Wheelchair Skills Test version 4.1 (WST-Q), recording the participants' capacity and performance scores on each of 32 skills. ResultsThe mean total WST-Q capacity and performance scores ± SD were 72.5%±19.2% and 58.1%±21.2%. The Spearman rho correlation coefficient between total WST-Q capacity and performance scores was .853 (P=.000). The mean difference ± SD in total WST-Q scores (capacity minus performance) was 14.4%±9.5% with a median of 10.9% (P=.000 on a Wilcoxon signed-rank test). There were 9 (28%) of the 32 skills for which the participants' mean capacity success rates were ≥20% higher than the mean performance success rates. Of the reasons for not performing individual skills, 66% of the instances were because the participant lacked the capacity. A variety of other reasons were given by participants for not performing skills of which they were capable (eg, the situation was not encountered, it could be avoided, or assistance was usually available). ConclusionsManual wheelchair skills capacity and performance are highly correlated but capacity exceeds performance, more so for some skills than others. Although further study is needed, these findings have implications for the assessment and training of wheelchair skills.

Comparison between performance with a pushrim-activated power-assisted wheelchair and a manual wheelchair on the Wheelchair Skills Test

Purpose. To test the hypothesis that people using a pushrim-activated power-assisted wheelchair (PAPAW) can accomplish a wider range of wheelchair skills than when using a manual wheelchair (MWC).Methods. We studied 30 able-bodied participants, using within-participant comparisons. Participants used a manual wheelchair equipped with both PAPAW and regular MWC rear wheels, and rear anti-tip devices (Arc-RADs) that permitted wheelie-like function. We trained participants to perform the wheelchair skills of the Wheelchair Skills Training Program (WSTP, Version 2.4). From the Wheelchair Skills Test (WST, Version 2.4), we calculated pass-fail success rates for the 50 individual skills and a total percentage WST score.Results. The mean (±SD) total WST scores were 89.3 (±7.0)% for the PAPAW and 88.8 (±8.4)% for the MWC, with a mean difference of 0.6 (±5.6)% (p = 0.59). Qualitative observations suggested that skills requiring a higher force on the pushrim (e.g., incline ascent) were performed more easily with the PAPAW, whereas skills requiring greater control of the wheelchair (e.g., wheelie-dependent skills) were performed more easily with the MWC.Conclusion. Overall wheelchair skill performance with the PAPAW is not superior to that when using the MWC. The PAPAW may be helpful for specific skills that require more wheel torque, but the additional torque appears to be disadvantageous when performing skills that require greater control.

Subject- and Injury-Related Factors Influencing the Course of Manual Wheelchair Skill Performance During Initial Inpatient Rehabilitation of Persons With Spinal Cord Injury

Kilkens OJ, Dallmeijer AJ, Angenot E, Twisk JW, Post MW, van der Woude LH. Subject- and injury-related factors influencing the course of manual wheelchair skill performance during initial inpatient rehabilitation of persons with spinal cord injury. Objectives To study changes in wheelchair skills in subjects with spinal cord injury (SCI) during rehabilitation; to determine whether changes in wheelchair skill performance are related to the subject, lesion characteristics, secondary complications, and upper extremity pain; and to investigate if wheelchair skill performance at discharge can be predicted from these features. Design Longitudinal. Subjects performed the Wheelchair Circuit 3 times during rehabilitation: at admission (t1), 3 months later (t2), and at discharge (t3). Setting Eight rehabilitation centers in the Netherlands. Participants One hundred twenty-one subjects with SCI. Interventions Not applicable. Main Outcome Measures The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. Results All the scores of the Wheelchair Circuit improved significantly between t1 and t2, and between t2 and t3. The scores were related to age and lesion level, whereas changes in scores were related to age, sex, lesion level, and secondary complications. The variables age, body mass index, sex, lesion level, motor completeness, and secondary complications contributed significantly to the prediction of the scores at t3. Conclusions Wheelchair skill performance improved during rehabilitation. Personal and lesion characteristics are most important for improving wheelchair skill performance and predicting wheelchair skill performance.

The Longitudinal Relation Between Physical Capacity and Wheelchair Skill Performance During Inpatient Rehabilitation of People With Spinal Cord Injury

Kilkens OJ, Dallmeijer AJ, Nene AV, Post MW, van der Woude LH. The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury. Objective To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury (SCI) during rehabilitation. Design Observational prospective cohort study. Measurements were taken 3 times during subjects’ rehabilitation. Setting Eight rehabilitation centers in the Netherlands. Participants Ninety-seven subjects with SCI. Interventions Not applicable. Main Outcome Measures Parameters of physical capacity were upper-extremity muscle strength (manual muscle test [MMT] sum score), peak oxygen uptake, and peak power output (POpeak). The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. Results POpeak was related to all 3 scores of the Wheelchair Circuit, and the MMT sum score was related to the ability score and the performance time score. The results indicate that (1) subjects with higher values of POpeak and/or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and (2) when a subject increased his/her POpeak and/or MMT sum score, this was associated with better wheelchair skill scores. Conclusions There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI. To optimize wheelchair skill performance, attention should be directed toward manual wheelchair exercise training and strength training of the upper body.