Wheelchair Skills Test Scores Research Articles

Wheelchair Skills Test in simulated versus community settings: a mixed-methods crossover study of experienced motorized mobility scooter users

Purpose The Wheelchair Skills Test (WST) is commonly conducted in a simulated setting. Although the WST can be done in the community setting, its usefulness in this setting has not been systematically evaluated. The purpose of this study was to compare the WST in the simulated versus community settings, and to explore participants’ perceptions of performing in each environment. Methods For this mixed-methods study, we studied 20 motorized mobility scooter users who had used their devices for ≥ 3 months. Each participant completed the WST Version 4.3 twice in random order – once in a simulated setting and once in their community within a two-week period. Semi-structured interviews were conducted after completion of the WST in both environments. A self-report version of the WST (WST-Q) was also completed that measured perceived capacity, frequency of skill performance, and confidence. Results The mean (SD) total WST score in the simulated setting was 88.9% (8.6) and 92.7% (7.8) in the community setting. The two WST scores were moderately correlated (r = 0.306, p = 0.190). Community-setting WST scores were moderately correlated with WST-Q confidence scores. Simulated-setting scores were moderately correlated with WST-Q frequency scores. Although most participants preferred performing the WST in their communities due to convenience and familiarity, they perceived the simulated setting to be reflective of their community settings. Conclusion Despite challenges, community-based testing may provide a better reflection of everyday performance for scooter users than testing in a simulated environment.

Evaluation of the Nino® Two-Wheeled Power Mobility Device: A Pilot Study.

Novel technologies such as the Nino® two-wheeled powered mobility device are promoted as offering an intuitive improved experience compared to conventional wheelchair mobility use. The Nino® has a smaller footprint than a power wheelchair, a zero-degree turning radius, tiller-based steering, and relies on the user leaning forwards and back to move and brake. This study aimed to evaluate manual wheelchair users' ability to use the Nino® to complete a variety of wheelchair skills, and also investigated task demand, user confidence, and user perceptions. Twelve participants with a mean of 22 years of experience using a wheelchair completed the study; most had spinal cord injuries and one had multiple sclerosis. Our findings indicate that Wheelchair Skills Test scores were significantly higher for individuals in their manual wheelchair than in the Nino®. Results from the Wheelchair Use Confidence Scale showed that confidence scores increased significantly after completing Nino® training, and that participants were significantly more confident using their manual chair than the Nino®. Cognitive workload, as measured by the NASA-Task Load Index, was significantly higher in the Nino® than in participants' manual wheelchairs. Findings from qualitative interviews suggest that the Nino® is unlikely to be suitable as a functional replacement of an individual's manual wheelchair. Most participants felt unsafe during braking. Other perceptions included that the Nino may be a good alternative for use as a recreational outdoor mobility device, a powered mobility option to help prevent upper extremity overuse injuries, have a positive impact on social interactions, but that a high degree of focus was required during use. In addition to needing to address safety, usability, and functional concerns, the data suggests a clinical focus on training individuals to use these new devices may be necessary for effective community use.

Usability and efficacy of a virtual reality simulator for power wheelchair training

Power wheelchair (PW) skills training is generally seen as insufficient by both clinicians and PW users. A virtual reality (VR) simulator may be helpful in improving PW driving skills, when used in addition to regular training. In previous work, challenging PW driving activities have been identified through interviews with expert clinicians and PW users and were then integrated in the McGill Immersive Wheelchair simulator (miWe). Our objective was to evaluate the effectiveness of VR simulator training on real PW driving skills. The miWe simulator included six PW driving activities (bathroom, shopping center, supermarket, elevator, street crossing and adapted transport vehicle). A computer with a joystick was installed in the participant's home. Participants (new PW users) were randomly allocated to the simulator or control group. Participants in the control group were asked to practice on a racing videogame (also using a joystick). Participants in both groups were asked to practice for at least 20 minutes every two days, over a two-week period. We compared real wheelchair driving skills as measured by the wheelchair skills test (WST), before and after the intervention. A total of 43 participants completed the study. All practiced on the simulator or computer game at least twice as much as what was minimally required. Results indicate that the WST scores in the experimental group increased by 7% on average, compared to 2% in the control group. Feedback regarding ease of use and potential usefulness of the PW simulator was very positive. Our preliminary results show that miWe simulator training may lead to improved wheelchair skills as compared to training with a racing videogame. A PW simulator may be helpful to new users if it promotes the practice of activities in specific environmental contexts to complement the basic skills training received in the clinic.

Effectiveness of the wheelchair skills training program: A systematic review and meta-analysis

The Wheelchair Skills Program (www.wheelchairskillsprogram.ca) is a set of assessment and training protocols–the Wheelchair Skills Test (WST), the questionnaire version of the WST (WST-Q) and the Wheelchair Skills Training Program (WSTP). Evidence has been accumulating about the important role that wheelchair skills training has in the wheelchair-provision process recommended by the World Health Organization. The objective of this study was to conduct a systematic review synthesizing the evidence for the effectiveness of the WSTP. We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to October 10, 2017. We selected studies that were randomized controlled trials (RCTs) assessing the effectiveness of the WSTP. Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane's Risk of Bias Tool. Meta-analyses (including sub-group analyses) were conducted for the WST and WST-Q total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen RCTs (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; P < 0.0001) compared to no treatment, standard care or educational controls, a relative increase of 21.2%. Subgroup analyses showed that training was more effective for new wheelchair users. Retention of training effects was suggested by the absence of significant declines between tests post-training and at follow-up. The WSTP was found to have positive effects on some other outcomes. No serious adverse events were reported. There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes.

Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review

Objective: To comprehensively assess the effectiveness and safety of wheelchair skills training program in improving wheelchair skills capacity. Data sources: PubMed, OVID, EBSCO, ScienceDirect, Web of Science, CINAHL, Cochrane Library, Google Scholar, and China Knowledge Resource Integrated Database were searched up to March 2017. Methods: Controlled clinical trials that compared a wheelchair skills training program with a control group that received other interventions and used the wheelchair skills test scores to evaluate wheelchair skills capacity were included. Two authors independently screened articles, extracted data, and assessed the methodological quality using the Cochrane risk-of-bias tool in randomized controlled trial (RCT) and methodological index for non-randomized studies. The data results of wheelchair skills test scores were extracted. Results: Data from 455 individuals in 10 RCTs and from 140 participants in seven non-randomized studies were included for meta-analysis using Stata version 12.0 (Stata Corporation, College Station, TX, USA). In the short term (immediately to one week) post-intervention, relative to a control group, manual wheelchair skills training could increase the total wheelchair skills test scores by 13.26% in RCTs (95% confidence interval (CI), 6.19%–20.34%; P < 0.001) and by 23.44% in non-randomized studies (95% CI, 13.98%–32.90%; P < 0.001). Few adverse events occurred during training; however, compared with a control group, evidence was insufficient to support the effectiveness of powered wheelchair skills training and the long-term (3–12 months) advantage of manual wheelchair skills training (P = 0.755). Conclusion: The limited evidence suggests that wheelchair skills training program is beneficial in the short term, but its long-term effects remain unclear.

Getting a Manual Wheelchair Over a Threshold Using the Momentum Method: A Descriptive Study of Common Errors

ObjectivesTo (1) document the success of learners' attempts to overcome a threshold in a manual wheelchair while using the momentum method; (2) describe the frequency and nature of any errors observed; and (3) compare the characteristics of participants who were or were not successful on their first attempts. DesignCross-sectional, observational study following Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SettingIndoor obstacle course in a rehabilitation center. ParticipantsAble-bodied students (N=214) learning the threshold skill. InterventionParticipants attempted to get over the Wheelchair Skills Test (WST) threshold (2cm high, 1.5m wide, and 10cm in the line of progression) in a manual wheelchair. Main Outcome MeasuresFrom each participant's video recording of the first attempt, we assigned a WST score for the skill and described any errors noted. ResultsThe WST scores for the first attempts were “pass” for 16 (7.5%), “pass with difficulty” for 100 (46.7%), and “fail” for 98 (45.8%). Eventually, requiring up to 6 attempts, 203 participants (94.9%) were successful (pass or pass with difficulty). Twenty-six different error types were identified. With the use of logistic regression analysis, the odds ratio of failing on the first attempt for women versus men was 2.71 (95% confidence interval, 1.23–6.00) (P=.0138). ConclusionsOnly about half of able-bodied people learning the threshold skill using the momentum method are successful on their first attempts, although almost all are successful with further practice and feedback. During the first attempts, there are a wide variety of errors, primarily in the popping phase of the skill. Those who are successful on their first attempts are more likely to be men. These findings have implications for the assessment and training of the threshold skill.

Measurement properties of the Wheelchair Skills Test for scooters among experienced users

Purpose: To investigate the score distribution, reliability, and validity of the objective Wheelchair Skills Test (WST) for scooter users.Method: A study using a test–retest design was conducted with 20 people who had mobility limitations that prevented them from ambulating more than one city block without a mobility aid, and who had owned a scooter for ≥3 months. Objective scooter skills, confidence, and physical accessibility were measured at both time points, while anxiety, depression, visual attention and task switching, functional independence, and visual acuity were measured only at baseline.Results: The mean total WST scores at Time 1 and Time 2 were 86.3% and 87.5%. The WST ICC was 0.889. The WST had a SEM of 2.50 and a Cronbach’s alpha of 0.74. The total WST scores were significantly correlated with total subjective WST-Q scores (r = 0.547, p = 0.013), scooter confidence (r = 0.466, p = 0.038), and were affected by gender (p = 0.005).Conclusion: The WST for scooters has good test–retest reliability and generally varies as anticipated with other measures. Although further study is needed, the WST for scooters appears to have promise for use in research and clinical practice.Implications for RehabilitationIt is important to understand the measurement properties of the tools we use in rehabilitation so the results can be interpreted correctly.As scooter use increases, better measurement of skills is required.

Effectiveness of power wheelchair simulator training, delivered at home, on wheelchair driving skills

Use of a power wheelchair (PW) can improve quality of life and participation in individuals with mobility impairments. PW skills training is generally seen as insufficient by both clinicians and PW users. A virtual reality (VR) simulator may be helpful in improving PW driving skills, when used in addition to regular training. In previous work, challenging PW driving activities have been identified through interviews with expert clinicians and PW users and were then integrated in the McGill immersive wheelchair simulator (miWe). Our objective was to evaluate the effectiveness of VR simulator training, delivered through a home program on real PW driving skills. The miWe simulator included six PW driving activities (adapted bathroom, shopping center, supermarket, elevator, street crossing and adapted transport vehicle). A computer with a joystick was installed in the participant's home. Participants (new PW users) were randomly allocated to the experimental or control group. Those in the experimental group were asked to practice all six-simulator activities for at least 20 minutes every two days, over a two-week period. Participants in the control group were asked to practice on a racing videogame, for an equivalent amount of time as the experimental group. We compared wheelchair-driving skills as measured by the wheelchair skills test (WST), before and after the intervention. Preliminary analyses were made on the 35 participants who completed the study. All practiced on the simulator or computer game at least twice as much as what was minimally required. Results indicate that the WST scores in the experimental group increased by 6% on average, compared to 3% in the control group. Feedback regarding ease of use and potential usefulness of the PW simulator was very positive. Our preliminary results show that miWe simulator training may slightly improve wheelchair skills as compared to training with a racing videogame. A PW simulator may be helpful to new users if it promotes the practice of activities in specific environmental contexts to complement the basic skills training received in the clinic.

Powered wheelchair skills training for persons with stroke: a randomized controlled trial.

The aims of this study were to test the hypothesis that people with stroke who receive formal powered wheelchair skills training improve their wheelchair skills to a significantly greater extent than participants in a control group who do not and to explore the influence of spatial neglect. Seventeen participants with stroke (including nine with spatial neglect) were randomly allocated to intervention (n = 9) or control (n = 8) groups. Those in the intervention group received up to five 30-min training sessions based on the Wheelchair Skills Training Program 4.1. The powered Wheelchair Skills Test version 4.1 was administered at baseline (T1) and after training (T2). A rank order analysis of covariance on the T2 Wheelchair Skills Test score, having adjusted for the T1 score, showed a significant effect caused by group (P = 0.0001). A secondary analysis showed no significant effect caused by spatial neglect (P = 0.923). People with stroke who receive formal powered wheelchair skills training improve their powered wheelchair skills to a significantly greater extent (30%) than participants who do not (0%). The extent of change was not affected by the presence of spatial neglect. These findings have significance for the wheelchair provision process and the rehabilitation of people with stroke.

Manual Wheelchair Skills: Objective Testing Versus Subjective Questionnaire

Rushton PW, Kirby RL, Miller WC. Manual wheelchair skills: objective testing versus subjective questionnaire. ObjectivesTo test the hypothesis that the total scores of the Wheelchair Skills Test (WST) version 4.1, an observer-rated scale of wheelchair performance, and the Wheelchair Skills Test Questionnaire (WST-Q) version 4.1, a self-report of wheelchair skills, are highly correlated. We also anticipate that the WST-Q scores will be slightly higher, indicating an overestimation of capacity to perform wheelchair skills as compared with actual capacity. DesignA cross-sectional, within-subjects comparison design. SettingThree Canadian cities. ParticipantsConvenience sample of community-dwelling, experienced manual wheelchair users (N=89) ranging in age from 21 to 94 years. InterventionNot applicable. Main Outcome MeasuresParticipants completed the subjective WST-Q version 4.1 followed by the objective WST version 4.1 in 1 testing session. ResultsThe mean ± SD total percentage scores for WST and WST-Q were 79.5%±14.4% and 83.0%±12.1% for capacity and 99.4%±1.5% and 98.9%±2.5% for safety, respectively. The correlations between the WST and WST-Q scores were ρ=.89 (P=.000) for capacity and ρ=.12 (P=.251) for safety. WST-Q total score mean differences were an average of 3.5%±6.5% higher than WST scores for capacity (P=.000) and .52%±2.8% lower for safety (P=.343). For the 32 individual skills, the percentage agreement between the WST and WST-Q scores ranged from 82% to 100% for capacity and from 90% to 100% for safety. ConclusionWST and WST-Q version 4.1 capacity scores are highly correlated although the WST-Q scores are slightly higher. Decisions on which of these assessments to use can safely be based on the circumstances and objectives of the evaluation.

Efficacy and Retention of the French-Canadian Version of the Wheelchair Skills Training Program for Manual Wheelchair Users: A Randomized Controlled Trial

Routhier F, Kirby RL, Demers L, Depa M, Thompson K. Efficacy and retention of the French-Canadian version of the Wheelchair Skills Training Program for manual wheelchair users: a randomized controlled trial. ObjectivesTo test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months. DesignMulticenter, single-blind, randomized controlled trial. SettingThree rehabilitation centers in Montréal, Quebec, Canada. ParticipantsManual wheelchair users (N=39), a sample of convenience. InterventionParticipants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min). Main Outcome MeasuresThe French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2). ResultsAt t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by ≤0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P≥.017 at a Bonferroni-adjusted α level of .005). ConclusionWSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months.

Manual Wheelchair Skills Capacity and Safety of Residents of a Long-Term-Care Facility

Smith C, Kirby RL. Manual wheelchair skills capacity and safety of residents of a long-term-care facility. Objectives To evaluate the manual wheelchair skills capacity and safety of residents of a long-term-care (LTC) facility. Our secondary objectives were to describe the wheelchairs that the participants used and to document the participants' perceptions of their assessment experiences. Design A cross-sectional, descriptive, mixed-methods study. Setting One hundred and seventy-five bed LTC veterans' facility. Participants Manual wheelchair users (N=13), a sample of convenience consisting of 10 men and 3 women, with a mean ± SD age of 86.8±6.4 years. Interventions None. Main Outcome Measures Wheelchair Skills Test (WST), version 4.1, the Wheelchair Specification Form, and qualitative observations. Results The mean ± SD total WST scores for capacity and safety were 35.3%±15.4% and 92.5%±6.1%. The mean ± SD number of sessions required was 3.0±1.1 and the mean ± SD total time required was 54.8±20.2 minutes. The analysis of the individual skills and participants provided valuable insights. Only 1 (8%) of the 13 wheelchairs was considered to have proper components and set-up for self-propulsion. Participants generally reported enjoying the wheelchair-skills experience. Conclusions The residents of a LTC veterans' facility whom we studied had significant difficulties when attempting a set of manual wheelchair skills, but they were generally safe. Many of their wheelchairs were less than ideal for self-propulsion. However, these participants enjoyed being challenged to perform wheelchair skills. If these findings are representative, they may have implications for the wheelchair-provision process in the LTC setting.

Influence of long-term wheelchair rugby training on the functional abilities in persons with tetraplegia over a two-year post-spinal cord injury

The aim of this study was to assess the influence of long-term wheelchair rugby training on the functional abilities of persons with tetraplegia over a 2-year period post-spinal cord injury. A prospective non-randomized controlled trial. Forty people with incomplete tetraplegia were examined. Participants were divided into 2 groups: a wheelchair rugby training group (n = 20) and a control group (n = 20). The Wheelchair Skills Test was used to assess functional changes in patients. In order to assess the strength of the 10 key muscles in the upper limb, the American Spinal Injury Association (ASIA) motor score was used. All participants were assessed at the beginning of the study (at the start of wheelchair rugby training) and reassessed after 2 years. Between pre- and post-measurements patients from the wheelchair rugby group attended wheelchair rugby training once a week. The baseline values of the Wheelchair Skills Test in the wheelchair rugby group was 71.3, and this increased significantly by 24%. In the control group, the mean Wheelchair Skills Test value was 63.2, and this improved by 4%. A significant correlation between Wheelchair Skills Test score and ASIA motor score was found in both groups. Participation in regular wheelchair rugby training may preserve and augment functional abilities in individuals with incomplete tetraplegia.

Manual Wheelchair-Handling Skills by Caregivers Using New and Conventional Rear Anti-Tip Devices: A Randomized Controlled Trial

Kirby RL, Walker R, Smith C, Best K, MacLeod DA, Thompson K. Manual wheelchair-handling skills by caregivers using new and conventional rear anti-tip devices: a randomized controlled trial. Objective To test the hypothesis that, in comparison with caregivers handling manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new design (Arc-RADs) perform relevant wheelchair skills better and as safely. Design Randomized controlled trial. Setting Rehabilitation center. Participants Caregivers (n=16) and the wheelchair users (n=16) for whom they cared. Intervention Participants were trained in wheelchair-handling skills for an average of 54 minutes each. Main Outcome Measures Total percentage score on a set of 20 rear anti-tip device- and caregiver-relevant skills from the Wheelchair Skills Test, version 3.2, administered a minimum of 3 days after training. Results For the C-RAD and Arc-RAD groups, the mean ± SD Wheelchair Skills Test scores were 40%±0% and 98.8%±3.5%, respectively ( P<.001). Skills that required the wheelchair to be tipped back extensively (eg, for ascending a 15cm curb) accounted for the differences between the groups. There were no adverse effects in either group. Conclusions The Arc-RAD design allows significantly better caregiver wheelchair-handling skills than the conventional design, without compromising safety.

Comparison Between A Tilt-in-Space Wheelchair and a Manual Wheelchair Equipped With a New Rear Anti-Tip Device From the Perspective of the Caregiver

Kirby RL, MacDonald B, Smith C, MacLeod DA, Webber A. Comparison between a tilt-in-space wheelchair and a manual wheelchair equipped with a new rear anti-tip device from the perspective of the caregiver. Objective To test the hypothesis that, in comparison with a commercially available tilt-in-space wheelchair, a lightweight manual wheelchair equipped with a new, rear anti-tip device (Arc-RAD) provides caregivers with improved wheelchair-handling performance, less exertion, and greater satisfaction. Design Within-participant comparisons. Setting Rehabilitation center. Participants Able-bodied participants (n=19) simulating caregivers and simulating wheelchair users (n=7). Intervention Caregiver participants were trained (50–75min) in wheelchair-handling skills. Main Outcome Measures Each participant was tested in both wheelchairs, in random order. To evaluate wheelchair-handling skills, we used the total percentage score on the Wheelchair Skills Test (WST), version 3.2. For exertion, we used a visual analog scale (in percent). For satisfaction, we used the Quebec Users' Evaluation of Satisfaction with assistive Technology (QUEST; range of values, 8–40), version 2. Results Mean percentage WST scores ± SD for the Arc-RAD and tilt-in-space wheelchairs were 95.9%±4.2%, and 91.9%±4.8%, respectively ( P=.008). The mean perceived exertions during Arc-RAD and tilt-in-space wheelchair use were 26.1%±20.4% and 46.6%±23.2% ( P=.003). The mean total QUEST satisfaction scores for the Arc-RAD and tilt-in-space wheelchairs were 35.1±3.8 and 28.4±4.7 ( P=.002). Conclusions In comparison with the larger and heavier tilt-in-space wheelchair, a lightweight manual wheelchair equipped with a new rear anti-tip design allows 4.4% better wheelchair-handling performance, 44% less exertion, and 23.6% greater wheelchair satisfaction.

The manual wheelchair-handling skills of caregivers and the effect of training

Kirby RL, Mifflen NJ, Thibault DL, Smith C, Best KL, Thompson KJ, MacLeod DA. The manual wheelchair-handling skills of caregivers and the effect of training. Objective To test the hypothesis that the Wheelchair Skills Training Program (WSTP) is effective in improving the wheelchair-handling skills of untrained caregivers. Design Within-participant comparisons. Setting Rehabilitation center and community. Participants Twenty-four caregivers of manual wheelchair users. Interventions Caregiver participants underwent the WSTP, version 2.4, adapted for caregivers. Training was individualized on the basis of an integrated testing-and-training protocol that took place on a single occasion (total, ≈50min). Main outcome measures Total percentage scores on the objective Wheelchair Skills Test (WST), version 2.4, for the pretraining (N=24), posttraining (N=24), and retention (n=9) evaluations. For the skill-transfer evaluation (n=10), we used the questionnaire version (WST-Q), administered by telephone to participants after return to their communities. Results There were no serious adverse incidents. The mean pretraining total WST score ± standard deviation was 77.8%±12.0%. Posttraining, this increased to 94.7%±7.1% ( P<.001), a 22% relative increase. At retention testing, a median latency of 7 days later, the mean value, 94.2%±7.1%, did not decrease significantly from the posttraining level ( P=.38). At skill-transfer testing, a median latency of 179 days posttraining, the mean value, 92.5%±8.7%, did not decrease significantly from the posttraining level ( P=.73). The greatest improvements were at the advanced skill level. Conclusions The WSTP is a safe, practical, and effective method of improving the wheelchair-handling skills of untrained caregivers. Skill improvements are generally well retained and transfer well to the community. Such training could play an important role in the rehabilitation process.

Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students

Coolen AL, Kirby RL, Landry J, MacPhee AH, Dupuis D, Smith C, Best KL, MacKenzie DE, MacLeod DA. Wheelchair Skills Training Program for clinicians: a randomized controlled trial with occupational therapy students. Arch Phys Med Rehabil 2004;85:1160–7. Objective To test the hypothesis that a brief formalized period of wheelchair skills training, added to the standard curriculum, results in significantly greater overall improvements in wheelchair skills than a standard undergraduate occupational therapy (OT) curriculum alone. Setting Rehabilitation center. Design Randomized controlled trial. Participants Eighty-two students in a university undergraduate OT program. Interventions All students received the standard university curriculum. The 22 second-year students, randomly allocated to the Wheelchair Skills Training Program (WSTP) group, were also trained (on a single occasion each, in groups of 1–3 at a time) on the 50 skills that make up the WSTP. The mean ± standard deviation (SD) training time was 121.2±33.5 minutes per group. Main outcome measure Total percentage score on the Wheelchair Skills Test (WST), Version 2.4. Results From before to after intervention, second-year students in the WSTP group increased their mean percentage WST scores ± SD from 64.8%±9.0% to 81.0%±5.2%, a 25% improvement ( P<.001). Over a comparable period, the 18 students in the second-year control group increased from 66.0%±8.0% to 72.4%±7.1%, a 9.7% improvement ( P=.015). The WSTP group improved to a significantly greater extent ( P=.005). For a subset of 8 students in the WSTP group who were retested 9 to 12 months later, the mean WST score was 79.7%±4.1%, not significantly less than their WST 2 scores ( P=.29). The mean WST score for the 42 students in the fourth-year control group was 73.9%±4.1%, significantly lower than the mean postintervention WST score of the second-year students in the WSTP group ( P<.0001) and not different from the second-year control group ( P=.58). Conclusions The WSTP is an effective way to improve the wheelchair-skills performance of OT students. This has implications for the education of all rehabilitation clinicians.

The wheelchair skills test (version 2.4): measurement properties

Kirby RL, Dupuis DJ, MacPhee AH, Coolen AL, Smith C, Best KL, Newton AM, Mountain AD, MacLeod DA, Bonaparte JP. The Wheelchair Skills Test (version 2.4): measurement properties. Arch Phys Med Rehabil 2004;85:794–804. Objective To evaluate the measurement properties of the Wheelchair Skills Test (WST), version 2.4. Design Cohort study. Setting Rehabilitation center. Participants A total of 298 subjects (169 wheelchair users, 129 able-bodied subjects) ranging in age from 17 to 88 years. Intervention We videotaped subjects as they attempted the 50 skills of the WST 2.4. Main outcome measures The test-retest, intrarater, and interrater reliabilities were determined on a subset of 20 wheelchair users. We assessed construct validity by evaluating whether the WST detected expected changes and concurrent validity by seeing how well total WST scores correlated with criterion measures. Results The mean time ± standard deviation taken to administer the WST was 27.0±9.3 minutes. There were no serious adverse incidents, and the test was well tolerated. For the test-retest, intrarater and interrater reliabilities, the intraclass correlation coefficients for the total scores were .904, .959, and .968. For individual skills, the percentage concordance ranged from 73% to 100%. Regarding construct validity, there was a slightly negative Pearson correlation between total WST score and age (–.434). Gender was identified as a significant factor on multiple regression analysis ( P<.001). Wheelchair users with more than 21 days of experience scored higher than those with less experience (65.0% vs 59.6%; P=.01). Participants with stroke and related disorders had a mean score (55.0%±13.9%) that was significantly lower than those in other diagnostic categories ( P<.05). Participants using conventional wheelchairs had lower scores than those in lightweight ones (66.4% vs 75.1%; P<.001). Regarding concurrent validity, Spearman rank correlations between total WST scores and the global assessments of the wheelchair users’ therapists and admission and discharge FIM instrument scores were .394, .38, and .31. Conclusions The WST 2.4 is practical and safe, and its measurement properties are very good to excellent. Further study is needed to determine its usefulness in various clinical settings.

Wheelchair skills training program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation

MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair Skills Training Program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil 2004;85:41–50. Objective To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program. Design Randomized controlled trial. Setting Rehabilitation center. Participants Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects’ mean age ± standard deviation (SD) was 59±18.3 years. Intervention Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5±1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay. Main outcome measures Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined. Results There were no adverse incidents. The control group’s mean percentage score ± SD increased from 60.1%±14.4% to 64.9%±13.3%, an 8% improvement of the posttest relative to the pretest ( P=.01). The WSTP group’s mean score increased from 64.9%±9.4% to 80.9%±5.6%, a 25% improvement of the posttest relative to the pretest ( P<.000). The WSTP group showed significantly greater improvements than the control group ( P<.000). Among the specific skills, significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills ( P<.001). Conclusions The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.

Poster 148: The wheelchair skills test, version 2.4: measurement properties.

Objective: To evaluate the measurement properties of the Wheelchair Skills Test (WST), Version 2.4. Design: Prospective, cohort. Setting: Rehabilitation center. Participants: 298 in all, 169 wheelchair users, and 129 able-bodied subjects, ranging in age from 17 to 88 years. Interventions: Each participant attempted the 50 skills of the WST 2.4. Main Outcome Measures: Reliability was determined on a subset of 20 wheelchair users. We assessed construct validity by evaluating whether the WST detected expected changes and concurrent validity by seeing how well total WST scores correlated with criterion measures. Results: The mean time ± SD taken to administer the WST was 27.0±9.3 minutes. There were no serious adverse incidents. For the test-retest and intra- and interrater reliabilities, the intraclass correlation coefficients for the total scores were .904, .959, and .968. For individual skills, the percentage concordance ranged from 73% to 100%. Regarding construct validity, there was a slight negative correlation between total WST score and age ( r=−.434, P<.001). Gender was identified as a significant factor on multiple regression analysis ( P<.001). Wheelchair users with >21 days of experience scored higher than those with less experience (65.0% vs 59.6%, P=.01). Participants with stroke and related disorders had a mean score (55.0%±13.9%) that was significantly lower than those in other diagnostic categories ( P<.05). Participants using conventional wheelchairs had lower scores than those in lightweight ones (66.4% vs 75.1%, P<.001). Regarding concurrent validity, correlations between total WST scores and the global assessments of the wheelchair users’ therapists and admission and discharge FIM scores were .394, .38, and .31. Conclusions: The WST 2.4 is practical and safe and has very good to excellent measurement properties. Further study will be needed to determine its usefulness in a variety of clinical settings.