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Measurement Properties of Clinical Instruments for Assessing Manual Wheelchair Mobility in Individuals With Spinal Cord Injury: Systematic Review

  • Gabriel Ribeiro de Freitas
    Affiliations
    Neuroscience Graduate Program, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil

    Spinal Cord Injury Rehabilitation Research Group (SCIR-group), Department of Physiotherapy, College of Health and Sport Science, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
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  • Libak Abou
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Aline de Lima
    Affiliations
    Spinal Cord Injury Rehabilitation Research Group (SCIR-group), Department of Physiotherapy, College of Health and Sport Science, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
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  • Laura A. Rice
    Affiliations
    Department of Kinesiology and Community Health, College of Applied Health Sciences, the University of Illinois at Urbana-Champaign, Urbana, IL

    Center on Health, Aging, and Disability, College of Applied Health Sciences, the University of Illinois at Urbana-Champaign, Urbana, IL
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  • Jocemar Ilha
    Correspondence
    Corresponding author Jocemar Ilha, PT, PhD, Rua Pascoal Simone, 358 Coqueiros Florianópolis, SC, Brazil CEP 88080-350.
    Affiliations
    Neuroscience Graduate Program, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil

    Spinal Cord Injury Rehabilitation Research Group (SCIR-group), Department of Physiotherapy, College of Health and Sport Science, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
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Published:October 19, 2022DOI:https://doi.org/10.1016/j.apmr.2022.10.002

      Abstract

      Objective

      To evaluate the measurement properties of clinical instruments used to assess manual wheelchair mobility in individuals with spinal cord injury (SCI).

      Data Sources

      This systematic review was conducted according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was conducted up to December 2021 on MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Biblioteca Regional de Medicina, and Cumulative Index to Nursing and Allied Health databases without time restriction.

      Study Selection

      Peer-reviewed original research articles that examined any clinical wheelchair mobility and/or skill assessment instrument among adults with SCI and reported data on at least one measurement property or described the development procedure were evaluated independently by two reviewers.

      Data Extraction

      Data were independently extracted according to Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. Measurement property results from each study were independently rated by two reviewers as sufficient, insufficient, indeterminate, or inconsistent. The evidence for each measurement property was rated as high, moderate, low, or very low (Grading of Recommendations, Assessment, Development, and Evaluation). Recommendations for highly-rated instruments were performed.

      Data Synthesis

      Twenty-nine studies with 21 instruments were identified. The methodological quality of studies ranged from insufficient to sufficient, and the quality of evidence ranged from very low to high. Six instruments reported content validity. Reliability and construct validity were the most studied measurement properties. Structural validity and invariance for cross-cultural measurement were not reported. The highly rated instruments were the Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire.

      Conclusions

      Although numerous instruments for assessing wheelchair mobility and/or skills among individuals with SCI were identified, not many measurement properties have been sufficiently established. The Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire show the current best potential to be recommended for clinical and research use. Further studies are needed to strengthen or change these recommendations.

      Keywords

      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments), 5AML-FIM (5 Additional Mobility and Locomotor in FIM), GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), PROM (patient-reported outcome measure), QEWS (Queensland Evaluation of Wheelchair Skills), SCI (spinal cord injury), SEWM (Self-efficacy in Wheeled Mobility Scale), TOWM (Test of Wheeled Mobility), WC-PFP (Wheelchair Physical Functional Performance), WhOM (Wheelchair Outcome Measure), WPT (Wheelchair Propulsion Test), WST (Wheelchair Skills Test), WST-Q (Wheelchair Skills Test Questionnaire), WUFA (Wheelchair Users Functional Assessment)
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