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Original research| Volume 97, ISSUE 10, P1761-1769, October 2016

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

      Abstract

      Objectives

      To 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).

      Design

      Cross-sectional descriptive study involving within-subject comparisons.

      Setting

      Four Spinal Cord Injury Model Systems centers.

      Participants

      Manual wheelchair users with SCI (N=117).

      Interventions

      Not applicable.

      Main Outcome Measures

      WST and WST-Q version 4.2 as well as measures for Confidence, Basic Mobility, Independence, Ability to Participate, Satisfaction, and Pain Interference.

      Results

      The 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.

      Conclusions

      Many 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.

      Keywords

      List of abbreviations:

      BMI (body mass index), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), WST (Wheelchair Skills Test), WST-Q (Wheelchair Skills Test Questionnaire)
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      References

        • Scherer M.J.
        • Cushman L.A.
        Measuring subjective quality of life following SCI: a validation study of the assistive technology device predisposition assessment.
        Disabil Rehabil. 2001; 23: 387-393
        • Noreau L.
        • Fougeyrollas P.
        Long-term consequences of spinal cord injury on social participation: the occurrence of handicap situations.
        Disabil Rehabil. 2000; 22: 170-180
        • Leduc B.E.
        • Lepage Y.
        Health-related quality of life after SCI.
        Disabil Rehabil. 2002; 24: 196-202
        • Krause J.
        • Carter R.E.
        • Brotherton S.
        Association of mode of locomotion and independence in locomotion with long-term outcomes after spinal cord injury.
        J Spinal Cord Med. 2009; 32: 237-248
        • van Zeltzen J.M.
        • de Groot S.
        • Post M.W.
        • Slootman J.R.
        • van Bennekom C.A.
        • van der Woude L.H.
        Return to work after spinal cord injury.
        Am J Phys Med Rehabil. 2009; 88: 47-56
        • Kilkens O.J.
        • Post M.W.
        • Dallmeijer A.J.
        • van Asbeck F.W.
        • van der Woude L.H.
        Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation.
        J Rehabil Res Dev. 2005; 42: 65-73
        • Borg J.
        • Larsson S.
        • Ostergren P.O.
        • Rahman A.S.
        • Bari N.
        • Khan A.H.
        User involvement in service delivery predicts outcomes of assistive technology use: a cross-sectional study in Bangladesh.
        BMC Health Serv Res. 2012; 12: 330
        • Donnelly C.
        • Eng J.J.
        • Hall J.
        • et al.
        Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury.
        Spinal Cord. 2004; 42: 302-307
        • Fliess-Douer O.
        • Vanlandewijck Y.C.
        • van der Woude L.H.
        Most essential wheeled mobility skills for daily life: an international survey among paralympic wheelchair athletes with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 629-635
        • Phang S.H.
        • Martin Ginis K.A.
        • Routhier F.
        • Lemay V.
        The role of self-efficacy in the wheelchair skills-physical activity relationship among manual wheelchair users with spinal cord injury.
        Disabil Rehabil. 2012; 34: 625-632
        • Kirby R.L.
        • Swuste J.
        • Dupuis D.J.
        • MacLeod D.A.
        • Monroe R.
        The Wheelchair Skills Test: a pilot study of a new outcome measure.
        Arch Phys Med Rehabil. 2002; 83: 10-18
        • Kirby R.L.
        • Dupuis D.J.
        • MacPhee A.H.
        • et al.
        The Wheelchair Skills Test (version 2.4): measurement properties.
        Arch Phys Med Rehabil. 2004; 85: 794-804
        • Lindquist N.J.
        • Loudon P.E.
        • Magis T.F.
        • Rispin J.E.
        • Kirby R.L.
        • Manns P.J.
        Reliability of the Wheelchair Skills Test (WST) version 4.1 for manual wheelchair users.
        Arch Phys Med Rehabil. 2010; 91: 1752-1757
        • Charbonneau R.
        • Kirby R.L.
        • Thompson K.
        Manual wheelchair propulsion by people with hemiplegia: within-participant comparisons of forwards vs. backwards techniques.
        Arch Phys Med Rehabil. 2013; 94: 1707-1713
        • 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 on 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
        • Ozturk 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
        • 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
        • Sawatzky B.
        • Rushton P.W.
        • Denison I.
        • McDonald R.
        Wheelchair skills training programme for children: a pilot study.
        Aust Occup Ther J. 2012; 59: 2-9
        • Tangsagulwatthana S.
        • Sawattikano N.
        • Kovindha A.
        Wheelchair skills training for individuals with spinal cord injury: a pilot study.
        Thai J Phys Ther. 2010; 32: 173-180
        • Lemay V.
        • Routhier F.
        • Noreau L.
        • Phang S.H.
        • Ginis K.A.
        Relationships between wheelchair skills, wheelchair mobility and level of injury in individuals with spinal cord injury.
        Spinal Cord. 2012; 50: 37-41
        • Hosseini S.
        • Oyster M.L.
        • Kirby R.L.
        • Harrington A.L.
        • Boninger M.L.
        Manual wheelchair skills predict quality of life and community integration in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 2237-2243
      1. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Available at: http://www.who.int/classifications/icf/en/. Accessed May 20, 2015.

      2. Kirby RL, Smith C, Parker K, MacLeod DA, McAllister M. Wheelchair Skills Test version 4.2 manual. Available at: http://www.wheelchairskillsprogram.ca/eng/testers.php. Accessed May 20, 2015.

      3. Kirby RL, Smith C, Parker K, MacLeod DA, McAllister M. Wheelchair Skills Test Questionnaire manual version 4.2. Available at: http://www.wheelchairskillsprogram.ca/eng/wstq.php. Accessed May 20, 2015.

      4. Dalhousie University. Wheelchair related publications related to wheelchair skills testing. Available at: http://www.wheelchairskillsprogram.ca/eng/publications.php. Accessed October 8, 2015.

        • Andresen E.M.
        Criteria for assessing the tools of disability outcomes research.
        Arch Phys Med Rehabil. 2000; 81: S15-S20
        • Terwee C.B.
        • Bot S.D.M.
        • de Boer M.R.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Folstein M.
        • Folstein S.
        • Fanjiang G.
        MMSE, Mini-Mental State Examination clinical guide.
        Psychological Assessment Resources, Inc., Lutz, FL2001
        • Sakakibara B.M.
        • Miller W.C.
        • Rushton P.W.
        Rasch analyses of the Wheelchair Use Confidence Scale.
        Arch Phys Med Rehabil. 2015; 96: 1036-1044
        • Heinemann A.W.
        • Dijkers M.P.
        • Ni P.
        • Tulsky D.S.
        • Jette A.
        Measurement properties of the Spinal Cord Injury-Functional Index (SCI-FI) Short Forms.
        Arch Phys Med Rehabil. 2014; 95: 1289-1297
        • Tulsky D.S.
        • Kisala P.A.
        • Victorson D.
        • et al.
        Overview of the Spinal Cord Injury – Quality of Life (SCI-QOL) measurement system.
        J Spinal Cord Med. 2015; 38: 257-269
      5. National Institute of Neurological Disorders and Stroke (NINDS) user manual for the Quality of Life in Neurological Disorders (Neuro-QoL) measures, version 1.0; September 2010. Available at: http://www.neuroqol.org/. Accessed May 20, 2015.

        • Amtmann D.
        • Cook K.F.
        • Jensen M.P.
        • et al.
        Development of a PROMIS item bank to measure pain interference.
        Pain. 2010; 150: 173-182
        • Gershon R.
        • Rothrock N.E.
        • Hanrahan R.T.
        • Jansky L.J.
        • Harniss M.
        • Riley W.
        The development of a clinical outcomes survey research application: Assessment Center.
        Qual Life Res. 2010; 19: 677-685
        • Perneger T.V.
        What is wrong with Bonferroni adjustments.
        Br Med J. 1998; 136: 1236-1238
        • Askari S.
        • Kirby R.L.
        • Parker K.
        • Thompson K.
        • O'Neill J.
        Wheelchair Propulsion Test: development and measurement properties of a new test for manual wheelchair users.
        Arch Phys Med Rehabil. 2013; 94: 1690-1698
        • Rushton P.W.
        • Kirby R.L.
        • Miller W.C.
        Manual wheelchair skills: objective testing versus subjective questionnaire.
        Arch Phys Med Rehabil. 2012; 93: 2313-2318
        • Newton A.M.
        • Kirby R.L.
        • MacPhee A.H.
        • Dupuis D.J.
        • MacLeod D.A.
        Evaluation of manual wheelchair skills: is objective testing necessary or would subjective estimates suffice?.
        Arch Phys Med Rehabil. 2002; 83: 1295-1299
        • Mountain A.D.
        • Kirby R.L.
        • Smith C.
        The Wheelchair Skills Test, version 2.4: validity of an algorithm-based questionnaire version.
        Arch Phys Med Rehabil. 2004; 85: 416-423
        • Inkpen P.
        • Parker K.
        • Kirby R.L.
        Manual wheelchair-skills capacity versus performance.
        Arch Phys Med Rehabil. 2012; 93: 1009-1013
        • Jenkins S.
        Wheelchair training provision by NHS wheelchair services.
        Whizz-Kidz, London2002
        • Karmarkar A.M.
        • Collins D.M.
        • Wichman T.
        • et al.
        Prosthesis and wheelchair use in veterans with lower-limb amputation.
        J Rehabil Res Dev. 2009; 46: 567-576
        • Zanka J.M.
        • Natale A.
        • LaBarbera J.
        • Schroeder S.T.
        • Gassaway J.
        • Backus D.
        Group physical therapy during inpatient rehabilitation for acute spinal cord injury: findings from the SCIRehab Study.
        Phys Ther. 2012; 91: 1877-1891
        • Cowan R.E.
        • Boninger M.L.
        • Sawatzky B.J.
        • Mazoyer B.D.
        • Cooper R.A.
        Preliminary outcomes of the SmartWheel users' group database: a proposal framework for clinicians to objectively evaluate manual wheelchair propulsion.
        Arch Phys Med Rehabil. 2008; 89: 260-268
      6. World Health Organization. Guidelines on the provision of wheelchairs in less resourced settings. Available at: http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/. Accessed May 20, 2015.