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Impact of a Wheelchair Education Protocol Based on Practice Guidelines for Preservation of Upper-Limb Function: A Randomized Trial

      Abstract

      Objectives

      To determine if strict use of the Paralyzed Veterans of America's Clinical Practice Guidelines for Preservation of Upper Limb Function affects wheelchair setup, selection, propulsion biomechanics, pain, satisfaction with life, and participation of individuals with new spinal cord injuries (SCIs).

      Design

      Single blinded, randomized controlled trial.

      Setting

      Model SCI systems rehabilitation facility and community.

      Participants

      Volunteer sample of manual wheelchair users with new SCIs (N=37).

      Intervention

      The intervention group was strictly educated on the clinical practice guideline by a physical therapist and an occupational therapist in an inpatient rehabilitation facility. The standard of care group received standard therapy services.

      Main Outcome Measures

      Comparison of wheelchair setup, selection, propulsion biomechanics, pain, and Satisfaction With Life Scale and Craig Handicap Assessment and Reporting Technique scores at the time of discharge from inpatient rehabilitation and at 6 months and 1 year postdischarge.

      Results

      Participants in the intervention group pushed on tile with significantly lower push frequency (P=.02) at the discharge visit. On the ramp, the intervention group used a significantly larger push length (P=.03) across all time points. No significant differences were found between groups related to wheelchair setup, selection, pain, satisfaction with life, and participation.

      Conclusions

      The intervention group showed better skills on key wheelchair propulsion biomechanics variables related to upper-limb health. Use of a structured education program may be an effective method of educating new manual wheelchair users to prevent the development of upper-limb impairments in an inpatient setting. Additional follow-up testing is necessary to determine whether the differences seen in propulsion skills translate into decreased pain and improved quality of life in the long term.

      Keywords

      List of abbreviations:

      CPG (clinical practice guideline), DC (discharge study visit), IG (intervention group), MWC (manual wheelchair), NRS (numeric rating scale), SCG (standard of care group), SCI (spinal cord injury), WUSPI (Wheelchair Users Shoulder Pain Index)
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