A description of manual wheelchair skills training: current practices in Canadian rehabilitation centers

Purpose: To describe current practices for manual wheelchair (MWC) skills training in Canadian rehabilitation centers. Methods: An online survey was sent to practice leaders in occupational (OT) and physical therapy (PT) at 87 Canadian rehabilitation centers. Responses were solicited from individuals who could report about wheelchair skills training at facilities with at least 10 beds designated for rehabilitation. Thirty-four questions asked about: (1) demographics, (2) components of MWC training, (3) amount of MWC skills training, (4) use of validated programs and (5) perceived barriers to using validated programs. Data were analyzed using summary statistics. Results: About 68/87 responses were received primarily from OTs (42/68). Basic MWC skills training (e.g. wheel-locks) was consistently part of clinical practice (45/68), while advanced skills training (e.g. curb-cuts) was rare (8/68). On an average, 1–4?h of training was done (29/68). Validated training programs were used by 16/68, most of whom used them “rarely” (7/16). Common barriers to using validated programs were lack of time (43/68) and resources (39/68). Conclusions: Learning to use a wheelchair is important for those with ambulation impairments because the wheelchair enables mobility and social participation. Providing opportunities for advanced wheelchair skills training may enhance mobility and social participation in a safe manner.

• Implications for Rehabilitation

• There is evidence confirming the benefits of a validated wheelchair skills program, yet most clinicians do no not use them. A variety of perceived barriers may help to explain the limited use of existing programs, such as time, resources and knowledge.

• Effective knowledge translation efforts may help alleviate some of these barriers, and novel wheelchair training approaches may alleviate some burden on clinicians to help accommodate the increasing number of older wheelchair users.

     

An in-depth analysis of ethics teaching in Canadian physiotherapy and occupational therapy programs

Abstract

Purpose: The purpose of this study was to examine current approaches and challenges to teaching ethics in entry-level Canadian physiotherapy (PT) and occupational therapy (OT) programs. Methods: Educators responsible for teaching ethics in the 28 Canadian PT and OT programs (n?=?55) completed an online survey. Results: The quantity of ethics teaching is highly variable, ranging from 5 to 65?h. Diverse obstacles to ethics teaching were reported, relating to the organization and structure of academic programs, student issues and the topic of ethics itself. Specific challenges included time constraints, large class sizes, a lack of pedagogical tools adapted to teaching this complex subject, a perceived lack of student interest for the subject and a preference for topics related to clinical skills. Of note, 65% of ethics educators who participated in the survey did not have any specialized training in ethics. Conclusion: Significant cross-program variation in the number of hours dedicated to ethics and the diversity of pedagogical methods used suggests that there is little consensus about how best to teach ethics. Further research on ethics pedagogy in PT and OT programs (i.e. teaching and evaluation approaches and effectiveness of current ethics teaching) would support the implementation of more evidence-based ethics education.

• Implications for Rehabilitation

• Ethics educators in Canadian PT and OT programs are experimenting with diverse educational approaches to teach ethical reasoning and decision-making to students, including lectures, problem-based learning, directed readings, videos, conceptual maps and clinical elective debriefing, but no particular method has been shown to be more effective for developing ethical decision-making/reasoning. Thus, research on the effectiveness of current methods is needed to support ethics educators and programs to implement evidence-based ethics education training.

• In our survey, 65% of ethics educators did not have any specialized training in ethics. Ensuring that educators are well equipped to support the development of necessary theoretical and applied competencies can be promoted by initiatives including the creation of tailored ethics teaching and evaluation tools, and by establishing communities of practice among ethics educators.

• This survey identified heterogeneity in ethics teaching content, format and duration, and location within the curriculum. In order to be able to assess more precisely the place accorded to ethics teaching in PT and OT programs, careful mapping of ethics content inside and across rehabilitation programs is needed – both in Canada and internationally. These initiatives would help advance understanding of ethics teaching practices in rehabilitation.

     

A condensed wheelchair skills training ‘bootcamp’ improves students’ self-efficacy for assessing,training, spotting,and documenting manual and power wheelchair skills

Abstract

Objectives: To determine the influence of a bootcamp training approach on students’ self-efficacy for assessing, training, spotting, documenting, and performing manual and power wheelchair skills.

Methods: In a pre-post design, students in their final year of an entry-to-practice master of occupational therapy program completed a two-day manual (6.5?h) and power (6.5?h) wheelchair skills bootcamp. Outcomes for self-efficacy (in assessing, training, spotting and documenting manual and power wheelchair skills; primary) and capacity (manual and power wheelchair skills; secondary) were collected at baseline and immediately after the bootcamp.

Results: Participants (n?=?44) were 27.3?±?4.3?years of age (41 female). Most students (81.8%) reported little previous experience using manual and power wheelchairs at baseline. Students’ self-efficacy for assessing, training, spotting, and documenting manual and power wheelchair skills improved by between 28.4% and 35.3%, representing a change from ‘somewhat confident’ to ‘fairly confident’. Students’ manual and power wheelchair skills capacity increased by 47.2% and 37.1% respectively.

Conclusions: Wheelchair skills training bootcamps may help prepare occupational therapy students to assess, train, spot, and document manual and power wheelchair skills of future clients, while improving students’ wheelchair skills capacity; thus may provide an option for integrating wheelchair skills training into the curriculum of time-intensive programs.

• Implications for rehabiliation

• A two-day condensed wheelchair skills training workshop improves occupational therapy

• students’ self-efficacy for assessing, training, spotting and documenting power and

• manual wheelchair skills.

• A two-day condensed wheelchair skills training workshop improves occupational

• therapy students’ power and manual wheelchair skills.

• Self-efficacy is an indicator of future behaviours. Therefore, improving students’ selfefficacy

• for assessing training and documenting wheelchair skills may influence their future practice.

     

Validity of the WST and the WST-Q in children with spina bifida: a pilot project

Abstract

Objective: To begin exploring use of the manual wheelchair versions of the Wheelchair Skills Test (WST) and the Wheelchair Skills Test-Questionnaire (WST-Q) in children with spina bifida who use manual wheelchairs.

Design: Cross-sectional, psychometric study.

Setting: A university-based laboratory setting.

Subjects: A total of 12 children 5–21 years of age with spina bifida participated in the study.

Interventions: Assessment of manual wheelchair skills by direct observation and parent report.

Main measures: The WST, the WST-Q and the manual wheelchair short scale within the Mobility domain of the Pediatric Evaluation of Disability-Computer Adapted Test (MWC PEDI-CAT), an existing validated parent-report measure of manual wheelchair skills in children.

Results: Moderate to excellent positive associations were found amongst all test scores. Spearman’s rank order correlations were as follows: r?=?0.87 between the WST and WST-Q, r?=?0.78 between the WST-Q and MWC PEDI-CAT and r?=?0.62 between scores on the WST and MWC PEDI-CAT. These associations suggest that the WST and the WST-Q may be appropriate for use with children who have spina bifida and therefore should be further explored in this population. Using the WST-Q as a parent-report measure may help clinicians to assess manual wheelchair skills in children with spina bifida without adding additional time to an examination session.

• Implications for Rehabilitation

• The associations found in this pilot project suggest that the Wheelchair Skills Test and the Wheelchair Skills Test-Questionnaire (WST-Q) may be appropriate for use with children who have spina bifida.

• Using the WST-Q as a parent-report measure may help clinicians to assess manual wheelchair skills in children with spina bifida without adding additional time to an examination session.

     

Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives

Purpose: The purpose of this project was to identify wheelchair skills currently being taught to new manual wheelchair users, identify areas of importance for manual wheelchair skills' training during initial rehabilitation, identify similarities and differences between the perspectives of health care professionals and manual wheelchair users and use the ICF to organize themes related to rehabilitation and learning how to use a manual wheelchair. Method: Focus groups were conducted with health care professionals and experienced manual wheelchair users. ICF codes were used to identify focus group themes. Results: The Activities and Participation codes were more frequently used than Structure, Function and Environment codes. Wheelchair skills identified as important for new manual wheelchair users included propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain. Health care professionals and manual wheelchair users identified the need to incorporate the environment (home and community) into the wheelchair training program. Conclusions: Identifying essential components for training the proper propulsion mechanics and wheelchair skills in new manual wheelchair users is an important step in preventing future health and participation restrictions.

• Implications for Rehabilitation

• Wheelchair skills are being addressed frequently during rehabilitation at the activity-dependent level.

• Propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain are important skills to address during wheelchair training.

• Environment factors (in the home and community) are important to incorporate into wheelchair training to maximize safe and multiple-environmental-setting uses of manual wheelchairs.

• The ICF has application to understanding manual wheelchair rehabilitation for wheelchair users and therapists for improving the understanding of manual wheelchair use.

     

Power wheelchair driving challenges in the community: a users’ perspective

Purpose: There is limited information on the difficulties individuals experience in manoeuvring their power wheelchairs during daily activities. The aim of this study was to describe the nature and context of power wheelchair driving challenges from the perspective of the user. Methods: A qualitative design using semi-structured interviews with power wheelchair users. Qualitative content analysis was used to identify themes. Results: Twelve experienced power wheelchair users were interviewed. Findings revealed that power wheelchair driving difficulties were related to the accomplishment of activities of daily living, and the influence of environmental context. Four key themes emerged: (1) difficulties accessing and using public buildings-facilities, (2) outdoor mobility, (3) problems in performing specific wheelchair mobility tasks/manoeuvres and (4) barriers and circumstances that are temporary, unforeseen or specific to a particular context. Conclusion: This qualitative study furthers our understanding of the driving difficulties powered wheelchair (PW) users experience during daily activities. This knowledge will assist clinicians and researchers in two areas: in choosing assessment measures that are ecologically valid for power wheelchair users; and, in identifying and refining the content of training programs specific to the use of power wheelchairs.

• Implications for Rehabilitation

• A better understanding of the everyday challenges individuals experience in driving their power wheelchair will assist clinicians and researchers in:

• Choosing assessment measures and identifying training programs for this population.

• Refining the content of power wheelchair training programs.

     

Manual wheelchair propulsion on ramp slopes encountered when boarding public transit buses

Abstract

Objective: To compare the kinetics of manual wheelchair (MWC) propulsion on ramps of varying slopes that may be encountered when accessing large accessible transit vehicles (LATVs).

Design: Observational study.

Setting: Biomechanics research laboratory.

Participants: A convenience sample of able-bodied adults (n?=?7) having no propulsion experience propelled a MWC on ramps of slope 3.5°, 9.5° and 15°.

Interventions: Not applicable.

Main outcome measures: Resultant (F_res), radial (F_r) and tangential (F_t) forces applied to the wheelchair pushrim, rate of rise of resultant force (ROR), peak power output (P), temporal characteristics and thigh to trunk angle were analyzed across three ramp slopes.

Results: Pushrim forces and power output significantly increased with increasing slope, with peak F_res more than doubling from 107?N on a 3.5° slope to 230?N on a 15° slope. ROR was 1.76 times higher at 9.5° and 2.47 times higher at 15° compared to a 3.5° slope. Minimum thigh to trunk angle decreased sharply from 80° (3.5° slope) to 50° (9.5° slope) and then to 30° (15° slope) as ramp slope increased.

Conclusions: Ascending bus ramps require greater power and pushrim force on steeper ramp slopes, presenting a potential barrier to transportation accessibility. Given this finding, it is imperative that bus operators minimize ramp slope to assure MWC users are able to access LATVs.

• Implications for Rehabilitation

• Although transit bus ramps are intended to provide wheelchair access to public transportation, limitations in MWC user physical strength and function may prevent safe access.

• Transit bus ramp slopes encountered during ingress can present a challenge to MWC users given power output and pushrim force requirements to ascend the ramp.

• MWC users and therapists should be aware of ramp slopes that may be encountered when boarding transit buses; wheelchair training should incorporate skills needed to ascend transit bus ramps.

     

Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users

Purpose of state: The aims of this study were to develop a Wheelchair Maintenance Training Programme (WMTP) as a tool for clinicians to teach wheelchair users (and caregivers when applicable) in a group setting to perform basic maintenance at home in the USA and to develop a Wheelchair Maintenance Training Questionnaire (WMT-Q) to evaluate wheelchair maintenance knowledge in clinicians, manual and power wheelchair users.

Methods: The WMTP and WMT-Q were developed through an iterative process.

Results: A convenience sample of clinicians (n?=?17), manual wheelchair (n ∞ 5), power wheelchair users (n?=?4) and caregivers (n?=?4) provided feedback on the training programme. A convenience sample of clinicians (n?=?38), manual wheelchair (n?=?25), and power wheelchair users (n?=?30) answered the WMT-Q throughout different phases of development. The subscores of the WMT-Q achieved a reliability that ranged between ICC(3,1)?=?0.48 to ICC(3,1)?=?0.89. The WMTP and WMT-Q were implemented with 15 clinicians who received in-person training in the USA using the materials developed and showed a significant increase in all except one of the WMT-Q subscores after the WMTP (p?<?0.007).

Conclusion: The WMTP will continue to be revised as it is further implemented. The WMT-Q is an acceptable instrument to measure pre- and post-training maintenance knowledge.

• Implications for Rehabilitation

• The Wheelchair Maintenance Training Program can be used to educate rehabilitation clinicians and technicians to improve wheelchair service and delivery to end users.

• This training complements the World Health Organization basic wheelchair service curriculum, which only includes training of the clinicians, but does not include detailed information to train wheelchair users and caregivers.

• This training program offers a time efficient method for providing education to end users in a group setting that may mitigate adverse consequences resulting from wheelchair breakdown.

• This training program has significant potential for impact among wheelchair users in areas where access to repair services is limited.

     

Learning to use a rear-mounted power assist for manual wheelchairs

Abstract

Objectives: 1) To investigate how much training manual wheelchair users perceive is required to learn to use a rear-mounted power assist safely and confidently. 2) To evaluate how the power assist affected wheelchair users’ ability to negotiate a standardized obstacle course, wheelchair skills capacity and wheelchair mobility confidence.

Method: This study used a pre- versus post-test intervention design. Outcome measures included a standardized obstacle course, and modified versions of the Wheelchair Skills Test 4.2 (WST) and the Wheelchair Confidence Measure.

Results: The 11 participants felt safe and confident using the power assist within one to two training sessions. However, some potential safety concerns were noted. Participants performed two obstacle course tasks significantly more quickly with the power assist.

Conclusions: Participants felt safe using the device with limited training and the device facilitated some mobility task performance. Further research is needed to understand the outcomes of long-term, community use.

• Implications for Rehabilitation

• Most experienced wheelchair users wanted only one or two training sessions with a new rear mounted power assist device; however, some safety concerns were noted.

• The device did not appear to affect user’s confidence.

• The device enabled users to perform some mobility tasks more quickly and allowed some users to perform some mobility tasks they were unable to perform in their regular MWC.

     

Wheelchair skills training for occupational therapy students: comparison of university-course versus “boot-camp” approaches

Abstract

Objective: To test the hypothesis that occupational therapy students who receive wheelchair skills training education using a distributed-practice university-course approach versus a condensed-practice boot-camp approach results in greater improvements post-intervention in relevant outcomes.

Design: A quasi-experimental, nonequivalent control group design.

Setting: A university occupational therapy program.

Participants: Occupational therapy students (experimental group) and recent occupational therapy graduates (control group) (N?=?58).

Interventions: A 15-week, 45-hour wheelchair provision course in which a total of 24?hours were dedicated to wheelchair skills testing and training education (experimental group) versus an 8-hour wheelchair skills training boot-camp (control group).

Main outcome measures: Assessments were conducted pre- and post-intervention using the Wheelchair Skills Test Questionnaire (WST-Q), Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon) and Self-Efficacy on Assessing, Training and Spotting wheelchair skills (SEATS).

Results: Compared to baseline, the WST-Q, WheelCon and SEATS scores improved significantly for both groups (p?<?.001). There were no significant differences in change scores (post-intervention – baseline values) between the groups for WST-Q, WheelCon or SEATS scores, however, the experimental group demonstrated a trend (p?<?.051) of higher scores for all outcome measures.

Conclusions: Occupational therapy students who received wheelchair skills training using either a distributed-practice university-course or condensed-practice boot-camp approach demonstrated significant post-training improvements in their WST-Q, WheelCon and SEATS scores, but no significant differences were found between groups.

• Implications for Rehabilitation

• Both a distributed-practice university-course approach and a condensed-practice bootcamp approach for training wheelchair skills to occupational therapy students results in large post-intervention improvements in wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills.

• The pre-education (optional course) wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills scores found in this cohort of occupational therapy students confirms the need to include this wheelchair content in mandatory occupational therapy curricula.

     

Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings

Purpose: This study was conducted to compare the performance of three types of chairs in a low-resource setting. The larger goal was to provide information which will enable more effective use of limited funds by wheelchair manufacturers and suppliers in low-resource settings. Methods: The Motivation Rough Terrain and Whirlwind Rough Rider were compared in six skills tests which participants completed in one wheelchair type and then a day later in the other. A hospital-style folding transport wheelchair was also included in one test. For all skills, participants rated the ease or difficulty on a visual analogue scale. For all tracks, distance traveled and the physiological cost index were recorded. Data were analyzed using repeated measures analysis of variance. Results: The Motivation wheelchair outperformed Whirlwind wheelchair on rough and smooth tracks, and in some metrics on the tight spaces track. Motivation and Whirlwind wheelchairs significantly outperformed the hospital transport wheelchair in all metrics on the rough track skills test. Conclusion: This comparative study provides data that are valuable for manufacturers and for those who provide wheelchairs to users. The comparison with the hospital-style transport chair confirms the cost to users of inappropriate wheelchair provision.

• Implications for Rehabilitation

• For those with compromised lower limb function, wheelchairs are essential to enable full participation and improved quality of life. Therefore, provision of wheelchairs which effectively enable mobility in the cultures and environments in which people with disabilities live is crucial. This includes low-resource settings where the need for appropriate seating is especially urgent.

• A repeated measures study to measure wheelchair performances in everyday skills in the setting where wheelchairs are used gives information on the quality of mobility provided by those wheelchairs.

• This study highlights differences in the performance of three types of wheelchairs often distributed in low-resource settings. This information can improve mobility for wheelchair users in those settings by enabling wheelchair manufacturers to optimize wheelchair design and providers to optimize the use of limited funds

     

Wheeled mobility skills of wheelchair basketball players: a randomized controlled study

Purpose: The aim of this study was to assess the influence of wheelchair basketball sport on the functional abilities of wheelchair users.

Method: This is a randomized controlled study. Wheelchair basketball players (n?=?111) and non-player (n?=?85) were included in this study. We administered the questionnaire version of the wheelchair skills test questionnaire (WST_Q), recording the participants’ capacity and performance scores on each of 32 skills.

Results: Player group have the baseline values of WST_Q higher than control group. The mean total percentage score of player group was significantly greater than control group (p?<?0.05). The get over 15?cm level (respectively, rations of capacity and performance of groups: player/control: 50.5–20% and 54.1–24.7%) and the ascends 10° incline (player/control 96.4–48.2% and 98.2–54.1%).

Conclusions: Participation in regular wheelchair basketball sport may preserve and augment functional abilities in with wheelchair user

• Implications for rehabilitation

• The skills-sports relationship is reciprocal. With increased wheelchair skills, people may be more inclined to engage in sports; subsequently, with greater sports, wheelchair skills could improve.

• Wheelchair mobility skills during clinical rehabilitation should reflect the daily activities and needs of each wheelchair user. WST-Q provides advantages in terms of requiring less time and material in using of clinical.

     

Driving performance in a power wheelchair simulator

Purpose: A power wheelchair simulator can allow users to safely experience various driving tasks. For such training to be efficient, it is important that driving performance be equivalent to that in a real wheelchair. This study aimed at comparing driving performance in a real and in a simulated environment. Method: Two groups of healthy young adults performed different driving tasks, either in a real power wheelchair or in a simulator. Smoothness of joystick control as well as the time necessary to complete each task were recorded and compared between the two groups. Driving strategies were analysed from video recordings. The sense of presence, of really being in the virtual environment, was assessed through a questionnaire. Results: Smoothness of joystick control was the same in the real and virtual groups. Task completion time was higher in the simulator for the more difficult tasks. Both groups showed similar strategies and difficulties. The simulator generated a good sense of presence, which is important for motivation. Conclusions: Performance was very similar for power wheelchair driving in the simulator or in real life. Thus, the simulator could potentially be used to complement training of individuals who require a power wheelchair and use a regular joystick.

Implications for Rehabilitation

• Individuals who require a power wheelchair for mobility often lack sufficient training, which may be supplemented through the use of a simulator.

• For such training to be efficient, it is important that performance in the simulator and in a real wheelchair be equivalent.

• This study showed that driving performance, strategies used and difficulties encountered were very similar, for groups of healthy adults driving in the simulator or in a real power wheelchair.

     

Everyday life for users of electric wheelchairs – a qualitative interview study

Purpose: The aim of this paper is to explore how users of electric wheelchairs experience their everyday life and how their electric wheelchairs influence their daily occupation. Occupation is defined as a personalized dynamic interaction between person, task and environment, and implies the value and meaning attached. Method: Nine semi-structured interviews were conducted with experienced electric wheelchair users. ValMo was used as the theoretical framework for both interviewing and the analysis. The transcribed interviews were analysed using thematic analysis. Results: Findings revealed key elements in electric wheelchair users’ experience of how the use of a wheelchair influences everyday life and occupation. Four central themes emerged from the participants’ experiences 1) The functionality of the wheelchair, 2) The wheelchair as an extension of the body, 3) The wheelchair and social life, and 4) The wheelchair and identity issues. The themes were interrelated and show how all levels of occupation were influenced both in a positive and negative way, and how it affected identity. Conclusions: It is essential that professionals working with electric wheelchair users are aware of how all levels of occupation and identity are influenced by using a wheelchair. This will assist professionals in supporting the users living an autonomous and meaningful life.

Implications for Rehabilitation

• All levels of occupation and identity are influenced by using a wheelchair.

• It is important that the electric wheelchair functions as an extension of the user’s body and that surroundings are made as accessible as possible.

• When choosing an electric wheelchair it is important that professionals make assessments that embrace all levels of the user’s occupation.

     

An exploration of participant experience of a communication training program for people with traumatic brain injury and their communication partners

Purpose: To investigate the experiences of participants who attended communication training programs for people with traumatic brain injury (TBI) and their everyday communication partners (CP) as part of a non-randomised controlled trial. Method: The participants were people with TBI and their CP, who were family members or carers of the people with TBI. Twenty-six participants (13 participants with TBI and 13 CP) completed the JOINT program, which involved participants with TBI and CP attending the program together. Fourteen participants with TBI completed the TBI SOLO training program, which did not involve the participation of a CP. Semi-structured videotaped interviews were completed by all participants at the end of the training. Using a six-step generic analysis procedure, data were categorised into topics and then subtopics to identify conceptually discrete units. Results: Participants described improvements in communication skills, the impact of improved communication skills, valuable components of the programs and components that needed changes. Conclusion: The accounts of participants provided additional evidence for the effectiveness of the training programs, assisted with identifying helpful components of the training and demonstrated the usefulness of a qualitative research methodology as part of evaluating the outcomes of the clinical trial.

Implications for Rehabilitation

• Participants in social communication skills training programs for people with traumatic brain injury report positive outcomes.

• Including communication partners in training programs is reported to be beneficial, although there are some challenges.

• Qualitative methodologies are a useful way of understanding the processes and outcomes of complex interventions such as communication skills training programs.

     

Changes in wheelchair biomechanics within the first 120 minutes of practice: spatiotemporal parameters,handrim forces,motor force,rolling resistance and fore-aft stability

Abstract

Purpose: During manual wheelchair (MWC) skill acquisition, users adapt their propulsion technique through changes in biomechanical parameters. This evolution is assumed to be driven towards a more efficient behavior. However, when no specific training protocol is provided to users, little is known about how they spontaneously adapt during overground MWC locomotion. For that purpose, we investigated this biomechanical spontaneous adaptation within the initial phase of low-intensity uninstructed training.

Materials and methods: Eighteen novice able-bodied subjects were enrolled to perform 120?min of uninstructed practice with a field MWC, distributed over 4?weeks. Subjects were tested during the very first minutes of the program, and after completion of the entire training protocol. Spatiotemporal parameters, handrim forces, motor force, rolling resistance and fore-aft stability were investigated using an instrumented field wheelchair.

Results: Participants rapidly increased linear velocity of the MWC, thanks to a higher propulsive force. This was achieved thanks to higher handrim forces, combined with an improved fraction of effective force for startup but not for propulsion. Despite changes in mechanical actions exerted by the user on the MWC, rolling resistance remained constant but the stability index was noticeably altered.

Conclusion: Even if no indication is given, novice MWC users rapidly change their propulsion technique and increase their linear speed. Such improvements in MWC mobility are allowed by a mastering of the whole range of stability offered by the MWC, which raises the issue of safety on the MWC.

• Implications for rehabilitation

• The learning process of manual wheelchair locomotion induces adaptations for novice users, who change their propulsion technique to improve their mobility.

• Several wheelchair biomechanical parameters change during the learning process, especially wheelchair speed, handrim forces, motor force, rolling resistance and fore-aft stability.

• Fore-aft stability on the wheelchair rapidly reached the tipping limits for users. Technical solutions that preserve stability but do not hinder mobility have to beimplemented, for instance by adding anti-tipping wheels rather than moving the seat forwards with respect to the rear wheels axle.

     

Occupational therapists’ pain knowledge: a national survey

Purpose: This study surveyed Canadian occupational therapists to identify whether their pain knowledge is current or if the gaps identified in past studies have remained the same. The findings will provide information to guide the development of targeted pain knowledge translation strategies for occupational therapists. Method: A self-report survey, including demographic questions and part of the City of Boston’s Rehabilitation Professionals’ Knowledge and Attitude Survey (COBS), was disseminated electronically to all members of the Canadian Association of Occupational Therapists. Results: A total of 354 therapists, most came from Ontario, Alberta and Nova Scotia and working in the community, acute care and private practice, participated. Over 50% had 10 years or less of experience. Deficit knowledge areas were identified in pediatric pain, chronic versus acute pain, pain assessment and medications. These findings are largely consistent with deficits identified in pre-2000 studies. Conclusions: Pain knowledge gaps persist among Canadian occupational therapists and this can, and should, be addressed within the occupational therapist (OT) curriculum and in professional development initiatives. It is concerning that this study identified similar knowledge gaps as those identified in previous studies of OT students and clinicians. Pain is a growing and complex issue with negative impact on occupational performance across the lifespan. Knowledge dissemination of occupational therapy pain assessment and management approaches should be a priority for the profession.

• Implications for Rehabilitation

• Pain is a prevalent condition in all age groups of occupational therapists’ clients.

• There appear to be gaps in occupational therapists’ evidence-based knowledge of aspects of pain.

• Occupational therapy training programs and occupational therapy associations should provide education with a particular focus on identified pain knowledge gaps.