Original research| Volume 97, ISSUE 10, P1777-1784.e3, October 2016

Effectiveness of Group Wheelchair Skills Training for People With Spinal Cord Injury: A Randomized Controlled Trial



      To assess the effectiveness of group wheelchair skills training to elicit improvements in wheelchair skills.


      Randomized double-blinded controlled trial.


      Four Spinal Cord Injury Model Systems Centers.


      Manual wheelchair users with spinal cord injury (N=114).


      Six 90-minute group Wheelchair Skills Training Program (WSTP) classes or two 1-hour active control sessions with 6 to 10 people per group.

      Main Outcome Measures

      Baseline (t1) and 1-month follow-up (t2) Wheelchair Skills Test Questionnaire (WST-Q) (Version 4.2) for capacity and performance and Goal Attainment Scale (GAS) score.


      Follow-up was completed by 79 participants (WSTP: n=36, active control: n=43). No differences were found between missing and complete cases. Many users were highly skilled at baseline with a WST-Q capacity interquartile range of 77% to 97%. There were no differences between groups at baseline in WST-Q measures or demographics. Compared with the active control group, the WSTP group improved in WST-Q capacity advanced score (P=.02) but not in WST-Q capacity or WST-Q performance total scores (P=.068 and P=.873, respectively). The average GAS score (0% at t1) for the WSTP group at t2 was 65.6%±34.8%. Higher GAS scores and WST-Q capacity scores were found for those who attended more classes and had lower baseline skills.


      Group training can improve advanced wheelchair skills capacity and facilitate achievement of individually set goals. Lower skill levels at baseline and increased attendance were correlated with greater improvement.


      List of abbreviations:

      GAS (Goal Attainment Scale), SCI (spinal cord injury), WSP (Wheelchair Skills Program), WSTP (Wheelchair Skills Training Program), WST-Q (Wheelchair Skills Test Questionnaire)
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        • LaPlante M.P.
        • Kaye H.S.
        Demographics and trends in wheeled mobility equipment use and accessibility in the community.
        Assist Technol. 2010; 22: 3-17
        • Hosseini S.M.
        • Oyster M.L.
        • Kirby R.L.
        • Harrington A.L.
        • Boninger M.L.
        Manual wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 2237-2243
        • Lemay V.
        • Routhier F.
        • Noreau L.
        • Phang S.
        • Ginis K.M.
        Relationships between wheelchair skills, wheelchair mobility and level of injury in individuals with spinal cord injury.
        Spinal Cord. 2012; 50: 37-41
        • Bullard S.
        • Miller S.
        Comparison of teaching methods to learn a tilt and balance wheelchair skill.
        Percept Mot Skills. 2001; 93: 131-138
        • Öztürk A.
        • Ucsular F.D.
        Effectiveness of a wheelchair skills training programme for community-living users of manual wheelchairs in Turkey: a randomized controlled trial.
        Clin Rehabil. 2011; 25: 416-424
        • Kirby R.L.
        • Crawford K.A.
        • Smith C.
        • Thompson K.J.
        • Sargeant J.M.
        A wheelchair workshop for medical students improves knowledge and skills: a randomized controlled trial.
        Am J Phys Med Rehabil. 2011; 90: 197-206
        • Routhier F.
        • Kirby R.L.
        • 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.
        Arch Phys Med Rehabil. 2012; 93: 940-948
        • MacPhee A.H.
        • Kirby R.L.
        • Coolen A.L.
        • Smith C.
        • MacLeod D.A.
        • Dupuis D.J.
        Wheelchair skills training program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation.
        Arch Phys Med Rehabil. 2004; 85: 41-50
        • Best K.L.
        • Kirby R.L.
        • Smith C.
        • MacLeod D.A.
        Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial.
        Arch Phys Med Rehabil. 2005; 86: 2316-2323
        • Kirby R.L.
        • Mifflen N.J.
        • Thibault D.L.
        • et al.
        The manual wheelchair-handling skills of caregivers and the effect of training.
        Arch Phys Med Rehabil. 2004; 85: 2011-2019
        • Eastwood E.A.
        • Hagglund K.J.
        • Ragnarsson K.T.
        • Gordon W.A.
        • Marino R.J.
        Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury—1990–1997.
        Arch Phys Med Rehabil. 1999; 80: 1457-1463
        • Ottenbacher K.J.
        • Smith P.M.
        • Illig S.B.
        • Linn R.T.
        • Ostir G.V.
        • Granger C.V.
        Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation.
        JAMA. 2004; 292: 1687-1695
        • Teeter L.
        • Gassaway J.
        • Taylor S.
        • et al.
        Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project.
        J Spinal Cord Med. 2012; 35: 503-526
        • Best K.L.
        • Routhier F.
        • Miller W.C.
        A description of manual wheelchair skills training: current practices in Canadian rehabilitation centers.
        Disabil Rehabil Assist Technol. 2015; 10: 393-400
        • Zanca J.M.
        • Dijkers M.P.
        • Hsieh C.H.
        • et al.
        Group therapy utilization in inpatient spinal cord injury rehabilitation.
        Arch Phys Med Rehabil. 2013; 94: S145-S153
        • Coolen A.L.
        • Kirby R.L.
        • Landry J.
        • et al.
        Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students.
        Arch Phys Med Rehabil. 2004; 85: 1160-1167
        • Giesbrecht E.M.
        • Wilson N.
        • Schneider A.
        • Bains D.
        • Hall J.
        • Miller W.C.
        Preliminary evidence to support a “boot camp” approach to wheelchair skills training for clinicians.
        Arch Phys Med Rehabil. 2015; 96: 1158-1161
        • Best K.L.
        • Miller W.C.
        • Huston G.
        • Routhier F.
        • Eng J.J.
        Pilot study of a peer-led wheelchair training program to improve self-efficacy using a manual wheelchair: a randomized controlled trial.
        Arch Phys Med Rehabil. 2016; 97: 37-44
        • Kirby R.L.
        • Worobey L.A.
        • Cowan R.
        • et al.
        Wheelchair skills capacity and performance of manual wheelchair users with spinal cord injury.
        Arch Phys Med Rehabil. 2016; 97: 1761-1769
      1. Dalhousie University, Faculty of Medicine, Wheelchair Skills Program. Wheelchair Skills Training Program (WSTP). Available at: Accessed October 8, 2015.

        • Conover W.J.
        Practical nonparametric statistics.
        3rd ed. Wiley, New York1999