Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial

OBJECTIVE: To test the hypotheses that wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center and community. PARTICIPANTS: Twenty community-based manual wheelchair users (15 men, 5 women; age range, 21-77 y), half with musculoskeletal and half with neurologic disorders. INTERVENTION: Participants were randomly allocated to the Wheelchair Skills Training Program (WSTP) or control groups. In 1-hour individualized sessions, the WSTP group participants received a mean +/- standard deviation of 4.5+/-0.7 hours of training. Caregivers participated whenever possible. In addition to training at the rehabilitation center, the trainer traveled to administer training in the community. MAIN OUTCOME MEASURES: Using the Wheelchair Skills Test (WST, version 3.1), an objective test of 57 skills, we calculated total and subtotal percentage scores (percentage number of skills passed of those possible) and individual skill success rates. RESULTS: The WSTP group's improvement in total WST score was significantly greater than the control group's (P<.005). The mean total WST score for the WSTP group increased from a pretraining value of 63.3%+/-6.0% to 78.5%+/-8.3% posttraining, a relative improvement of 24.0% (P=.002). The control group increased from a baseline value of 70.8%+/-14.0% to 74.2%+/-11.8% at follow-up, a relative improvement of 4.8% (P=.03). The WSTP group had clinically significant pre- and posttraining improvements (> or = 20%) in the success rates of 25 of the 57 individual WST skills, compared with only 5 skills for the control group. There were no adverse incidents, and the WSTP participants' comments were all positive. CONCLUSIONS: Wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. These findings have implications for the standard of rehabilitation care.     

Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students

OBJECTIVE: To test the hypothesis that a brief formalized period of wheelchair skills training, added to the standard curriculum, results in significantly greater overall improvements in wheelchair skills than a standard undergraduate occupational therapy (OT) curriculum alone. SETTING: Rehabilitation center. DESIGN: Randomized controlled trial. PARTICIPANTS: Eighty-two students in a university undergraduate OT program. INTERVENTIONS: All students received the standard university curriculum. The 22 second-year students, randomly allocated to the Wheelchair Skills Training Program (WSTP) group, were also trained (on a single occasion each, in groups of 1-3 at a time) on the 50 skills that make up the WSTP. The mean +/- standard deviation (SD) training time was 121.2+/-33.5 minutes per group. MAIN OUTCOME MEASURE: Total percentage score on the Wheelchair Skills Test (WST), Version 2.4. RESULTS: From before to after intervention, second-year students in the WSTP group increased their mean percentage WST scores +/- SD from 64.8%+/-9.0% to 81.0%+/-5.2%, a 25% improvement (P<.001). Over a comparable period, the 18 students in the second-year control group increased from 66.0%+/-8.0% to 72.4%+/-7.1%, a 9.7% improvement (P=.015). The WSTP group improved to a significantly greater extent (P=.005). For a subset of 8 students in the WSTP group who were retested 9 to 12 months later, the mean WST score was 79.7%+/-4.1%, not significantly less than their WST 2 scores (P=.29). The mean WST score for the 42 students in the fourth-year control group was 73.9%+/-4.1%, significantly lower than the mean postintervention WST score of the second-year students in the WSTP group (P< .0001) and not different from the second-year control group (P=.58). CONCLUSIONS: The WSTP is an effective way to improve the wheelchair-skills performance of OT students. This has implications for the education of all rehabilitation clinicians.     

The wheelchair skills test, version 2.4: Validity of an algorithm-based questionnaire version

OBJECTIVE: To test the hypothesis that an algorithm-based questionnaire version of the Wheelchair Skills Test (WST) would provide a valid assessment of manual wheelchair skills. DESIGN: Within-participant comparisons. SETTING: Rehabilitation center in Nova Scotia, Canada. PARTICIPANTS: Twenty wheelchair users, 11 with musculoskeletal and 9 with neurologic disorders, with a wide range of wheelchair experience (1wk-20y). INTERVENTION: Each participant completed the questionnaire (WST-Q) and then the objective skills testing (WST, version 2.4). MAIN OUTCOME MEASURE: The WST-Q consisted of 3 components, reported as separate versions: the knowledge version (WST-Q [K]) (structured oral questions only); the visual-aid version (WST-Q [VA]) (visual aids added for 6 of the skills); and the categorical perceived-ability version (WST-Q [PA]). RESULTS: The mean total percentage scores for the WST-Q (K), WST-Q (VA), WST-Q (PA), and WST were 60.5%, 62.2%, 64.0%, and 59.8%, respectively. Only the WST-Q (PA) differed significantly from the WST (P<.05). Positive correlations existed between the objective WST and the WST-Q (K) (r=.91), WST-Q (VA) (r=.91), and WST-Q (PA) (r=.83). The percentage agreement on the individual skill scores ranged from 55% to 100%. CONCLUSIONS: The algorithm-based WST-Q has excellent concurrent validity in comparison with objective testing, when assessing the overall manual wheelchair skill levels of wheelchair users with a wide range of experience. It may be useful as a screening tool or when objective testing is impractical.     

Learning to perform wheelchair wheelies: comparison of 2 training strategies

OBJECTIVE: To test the hypotheses that, during wheelie training, adding the proactive balance strategy (PBS) to the conventional reactive balance strategy (RBS) increases the success rate, decreases training time, and lessens postural sway during the wheelie. DESIGN: Randomized controlled trial. SETTING: Kinesiologic laboratory in a rehabilitation center. PARTICIPANTS: Twenty-two participants (12 wheelchair users, 10 able-bodied) randomly assigned to the RBS group or to the PBS+RBS group; the groups were balanced according to gender, age, and diagnostic category. INTERVENTION: Participants were trained to perform stationary wheelies in 2 highly structured settings. MAIN OUTCOME MEASURES: Success rate in achieving wheelie competence, training time, and postural sway on a force platform. RESULTS: Success rate was 100% for both groups. The RBS group required a mean +/- standard deviation of 43+/-31 minutes of training time and the PBS+RBS group required 45+/-28 minutes (P=.54). There was no significant difference between training groups with respect to postural sway measures (P=.50). Age correlated with both training time (r=.70, P=.001) and postural sway (r=.52, P=.03). Qualitatively, we identified 3 take-off patterns and confirmed the use of the 2 balance patterns. CONCLUSIONS: The addition of the PBS to RBS training did not improve wheelie success rate, training time, or postural sway. Although older wheelchair users require more training time, many such users can learn this useful skill if given the opportunity.     

Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial

Kirby RL, Corkum CG, Smith C, Rushton P, MacLeod DA, Webber A. Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial.

Objective

To test the hypotheses that, compared with participants using manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new RAD design that deploys through an arc (Arc-RAD) perform RAD-relevant wheelchair skills better and as safely.

Design

A randomized controlled study.

Setting

A rehabilitation center.

Participants

Participants (N=30) including 16 able-bodied and 14 wheelchair users.

Intervention

Participants were provided with wheelchair skills training (up to 2.4h).

Main Outcome Measures

Total percentage score on a set of 23 RAD-relevant skills of the Wheelchair Skills Test (WST, version 3.2) administered a minimum of 3 days after training.

Results

For the C-RAD and Arc-RAD groups, the mean ± standard deviation RAD-relevant WST scores were 32.3%±8.5% and 85.1%±18.9% (Kruskal-Wallis, P<.001). Of the 23 RAD-relevant individual skills, the success rates for the Arc-RAD group were at least 20% higher (the criterion we set for clinical significance) in 17 (74%). For the C-RAD group, the success rate was 0% for the 12 wheelie-dependent skills, the 13-cm-high obstacle, and the 15-cm level change ascent. There were no serious adverse effects in either group.

Conclusions

The new RAD design allows much better performance on relevant wheelchair skills than the conventional design without compromising safety.     

A comparison of spinergy versus standard steel-spoke wheelchair wheels

OBJECTIVES: To compare the energy efficiency of straight-line wheeling using Spinergy wheels as compared with standard steel-spoke wheels, and to assess the 2 wheels in terms of user comfort and wheeling preference during a wheeling course with multiple turns and surfaces. DESIGN: Nonblinded randomized crossover trial. SETTING: Rehabilitation center. PARTICIPANTS: Twenty persons with paraplegia (neurologic level T6 and below). INTERVENTION: Wheeling a straight line and obstacle course with Spinergy or standard spoke wheelchair wheels. MAIN OUTCOME MEASURES: Velocity and Physiological Cost Index (PCI) while wheeling over ground at a self-selected pace, and the User Preference Questionnaire after wheeling an obstacle course, using Spinergy or standard spoke wheelchair wheels. RESULTS: There was no significant difference in wheeling energy efficiency between the Spinergy and the steel-spoke wheels as measured by PCI ( P =.975). When rated for overall comfort, the Spinergy wheels were preferred over steel-spoke wheels ( P =.002). CONCLUSIONS: Spinergy wheels provided a more comfortable ride, but did not differ from standard steel-spoked wheels in terms of energy efficiency. The increased comfort may have important implications in patient management of pain and spasticity.     

Wheelchair curb climbing: randomized controlled comparison of highly structured and conventional training methods

Kirby RL, Bennett S, Smith C, Parker K, Thompson K. Wheelchair curb climbing: randomized controlled comparison of highly structured and conventional training methods.

Objectives

Our primary objective was to test the hypothesis that a highly structured training method for wheelchair curb-climbing requires less training time than conventional training. Our secondary objectives were to test the hypotheses that this training method increases success rate, reduces the need for spotter interventions, and reduces the participants' perceptions of difficulty.

Design

Randomized controlled trial.

Setting

Rehabilitation center.

Participants

Able-bodied participants (N=16), randomly allocated to intervention (n=7) and control (n=9) groups.

Interventions

Both groups received up to 5 training sessions. Each session included instruction, practice, and feedback. The participants in the intervention and control groups used 18- and 9-step approaches, respectively. Training in the intervention group also included video demonstration, trainer demonstrations, mirror feedback, and standardized feedback phrases.

Main Outcome Measures

Total training time, success rate at climbing a 15cm-high curb, the number of spotter interventions during training, and a questionnaire.

Results

The mean ± SD training times for the successful participants in the intervention and control groups were 42.5±24.4 minutes and 87.4±45.3 minutes (P=.084). The curb-climbing success rates of the intervention and control groups were 86% and 89% (P=1.000). There were no significant differences between the groups regarding the number of spotter interventions (P=.203) or for participants' perceptions of difficulty (P=.050).

Conclusions

In comparison with a conventional method for curb-climbing, a highly structured method seems to require less than 50% of the training time for able-bodied participants, although this finding is only a trend statistically. This has implications for clinical training.     

The manual wheelchair-handling skills of caregivers and the effect of training

OBJECTIVE: To test the hypothesis that the Wheelchair Skills Training Program (WSTP) is effective in improving the wheelchair-handling skills of untrained caregivers. DESIGN: Within-participant comparisons. SETTING: Rehabilitation center and community. PARTICIPANTS: Twenty-four caregivers of manual wheelchair users. INTERVENTIONS: Caregiver participants underwent the WSTP, version 2.4, adapted for caregivers. Training was individualized on the basis of an integrated testing-and-training protocol that took place on a single occasion (total, approximately 50 min). MAIN OUTCOME MEASURES: Total percentage scores on the objective Wheelchair Skills Test (WST), version 2.4, for the pretraining (N=24), posttraining (N=24), and retention (n=9) evaluations. For the skill-transfer evaluation (n=10), we used the questionnaire version (WST-Q), administered by telephone to participants after return to their communities. RESULTS: There were no serious adverse incidents. The mean pretraining total WST score +/- standard deviation was 77.8%+/-12.0%. Posttraining, this increased to 94.7%+/-7.1% (P <.001), a 22% relative increase. At retention testing, a median latency of 7 days later, the mean value, 94.2%+/-7.1%, did not decrease significantly from the posttraining level (P =.38). At skill-transfer testing, a median latency of 179 days posttraining, the mean value, 92.5%+/-8.7%, did not decrease significantly from the posttraining level (P =.73). The greatest improvements were at the advanced skill level. CONCLUSIONS: The WSTP is a safe, practical, and effective method of improving the wheelchair-handling skills of untrained caregivers. Skill improvements are generally well retained and transfer well to the community. Such training could play an important role in the rehabilitation process.     

Reliability of the performance and safety scores of the wheelchair skills test version 4.1 for manual wheelchair users

Lindquist NJ, Loudon PE, Magis TF, Rispin JE, Kirby RL, Manns PJ. Reliability of the performance and safety scores of the Wheelchair Skills Test Version 4.1 for manual wheelchair users.

Objective

To evaluate the interrater, intrarater, and test-retest reliability of the total performance and safety scores of the Wheelchair Skills Test version 4.1 (WST 4.1) for manual wheelchairs operated by adult wheelchair users.

Design

Cohort study.

Setting

University research setting.

Participants

People (N=11) who used manual wheelchairs for community locomotion.

Interventions

Not applicable.

Main Outcome Measure

Participants were videotaped as they completed the WST 4.1 (30 skills) on 2 separate occasions 1 to 2 weeks apart. Subsequently, raters scored the WST 4.1 from the video recordings and each participant received a total score for performance and safety. Using those scores, interrater, intrarater, and test-retest reliability were determined by using intraclass correlation coefficients (ICCs). Percentages of agreement between raters for individual skills also were calculated.

Results

Mean ± SD overall WST 4.1 scores for performance and safety were 80.1%±8.5% and 98.0%±2.8%. ICCs for the interrater, intrarater, and test-retest reliability of the performance component were .855, .950, and .901 (P<.001). Safety component ICC scores were .061 (P=.243), .228 (P=.048), and .254 (P=.041). Percentages of agreement between raters for each test item for both the performance and safety scales ranged from 68% to 100%.

Conclusions

Reliability of the performance component of the WST 4.1 was excellent, whereas ICCs for the safety component indicated only slight to fair agreement, probably because of the low variability in safety scores. Additional study is needed to further evaluate the reliability of the safety component with a larger and more diverse sample group.     

Extent to Which Caregivers Enhance the Wheelchair Skills Capacity and Confidence of Power Wheelchair Users: A Cross-Sectional Study

Objective

To test the hypothesis that caregivers enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance, and to describe the nature of that assistance.

Efficacy and retention of the French-Canadian version of the wheelchair skills training program for manual wheelchair users: a randomized controlled trial

Routhier F, Kirby RL, 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.ObjectivesTo test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months.DesignMulticenter, single-blind, randomized controlled trial.SettingThree rehabilitation centers in Montréal, Quebec, Canada.ParticipantsManual wheelchair users (N=39), a sample of convenience.InterventionParticipants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min).Main Outcome MeasuresThe French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2).ResultsAt t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by ≤0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P≥.017 at a Bonferroni-adjusted α level of .005).ConclusionWSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months.     

Wheelchair-related accidents: relationship with wheelchair-using behavior in active community wheelchair users

Chen W-Y, Jang Y, Wang J-D, Huang W-N, Chang C-C, Mao H-F, Wang Y-H. Wheelchair-related accidents: relationship with wheelchair-using behavior in active community wheelchair users.

Objective

To report the prevalence, mechanisms, self-perceived causes, consequences, and wheelchair-using behaviors associated with wheelchair-related accidents.

Design

A case-control study.

Setting

Community.

Participants

A sample of experienced, community-dwelling, active manual and powered wheelchair users (N=95) recruited from a hospital assistive technology service center.

Interventions

Not applicable.

Main Outcome Measures

Wheelchair-using behaviors, wheelchair-related accidents over a 3-year period, and the mechanisms and consequences of the accidents.

Results

Among the 95 participants, 52 (54.7%) reported at least 1 accident and 16 (16.8%) reported 2 or more accidents during the 3 years prior to the interview. A total of 74 accidents, were categorized into tips and falls (87.8%), accidental contact (6.8%), and dangerous operations (5.4%). A logistic regression found individuals who failed to maintain their wheelchairs regularly (odds ratio [OR]=11.28; 95% confidence interval [CI], 2.62–48.61) and used a wheelchair not prescribed by professionals (OR=4.31; 95% CI, 1.10–16.82) had significantly greater risks of accidents. In addition to the risk factor, lack of regular wheelchair maintenance, the Poisson regression corroborated the other risk factor, seat belts not used (incident rate ratio=2.14; 95% CI, 1.08–4.14), for wheelchair-related accidents.

Conclusions

Wheelchair-related accidents are closely related to their wheelchair-using behaviors. Services including professional evaluation, repair, maintenance, and an educational program on proper wheelchair use may decrease the risks of wheelchair accidents.     

Are wheelchair-skills assessment and training relevant for long-standing wheelchair users? Two case reports

Purpose.?We present two case reports that shed light on the question of whether routine periodic wheelchair-skills assessment and training are relevant for long-standing wheelchair users.

Case 1.?A 60-year-old man with a 15-year history of T12 complete paraplegia sustained an intertrochanteric fracture of his femur due to a tip-over accident that occurred 2 days after a follow-up clinic visit at which no limitations in wheelchair-skill performance were identified. If a procedure had been in place to identify and correct his wheelchair-skill deficiencies, this injury might have been prevented.

Case 2.?A 34-year-old woman with spina bifida, whose wheelchair use had gradually increased, came to our attention during the provision of a new wheelchair. She was able to significantly improve her wheelchair abilities through training. The newly learned skills enhanced her community participation.

Conclusions.?These cases suggest that, even in long-standing wheelchair users, wheelchair skills should be routinely assessed as part of the periodic functional assessment and, when the skill level is determined to be less than appropriate for that person, formal training should be offered.     

The effect of visual biofeedback on the propulsion effectiveness of experienced wheelchair users

OBJECTIVE: To determine the effect of visual feedback on the propulsion effectiveness of experienced manual wheelchair users. DESIGN: Controlled trial. SETTING: A motion analysis laboratory. PARTICIPANTS: A convenience sample of 16 healthy men and 2 healthy women with T4-L2 traumatic paraplegia, a mean age of 38+/-9 years, and a mean duration of manual wheelchair-based mobility of 14+/-8 years. INTERVENTION: Propulsion was assessed as the subjects propelled an instrumented wheelchair (with and without visual biofeedback) on a custom-built dynamometer at propulsion intensities of .15 and .25W/kg for 10 minutes. MAIN OUTCOME MEASURES: The primary outcome variable was the fraction of effective force (FEF) (ie, the ratio of effective to total force) applied by the subject to the wheelchair's pushrim. Secondary variables included velocity, stroke frequency, and stroke angle. RESULTS: A 2-factor analysis of variance with repeated measurements was used to detect significant differences between the outcome variables. The FEF ratio was 73.9% without feedback and 72.5% with feedback at the lower-intensity level. Propulsion during the higher intensity condition both with and without feedback resulted in a statistically significant improvement in the FEF (73.9%-78.7% with no feedback, 72.5%-80.2% with feedback), compared with the lower-intensity level. Stroke angle increased from 84.3 degrees to 98.7 degrees and frequency decreased from 66 to 57.8 strokes/min with feedback. CONCLUSIONS: Visual biofeedback may have little utility in improving the force effectiveness of manual wheelchair propulsion in experienced wheelchair users. Experienced wheelchair users may have already optimized their stroke in a manner that balances energy expenditure with stroke efficiency. Other variables such as stroke length and frequency may be more amenable to visual biofeedback.     

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.

     

Subject- and injury-related factors influencing the course of manual wheelchair skill performance during initial inpatient rehabilitation of persons with spinal cord injury

OBJECTIVES: To study changes in wheelchair skills in subjects with spinal cord injury (SCI) during rehabilitation; to determine whether changes in wheelchair skill performance are related to the subject, lesion characteristics, secondary complications, and upper extremity pain; and to investigate if wheelchair skill performance at discharge can be predicted from these features. DESIGN: Longitudinal. Subjects performed the Wheelchair Circuit 3 times during rehabilitation: at admission (t1), 3 months later (t2), and at discharge (t3). SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: One hundred twenty-one subjects with SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. RESULTS: All the scores of the Wheelchair Circuit improved significantly between t1 and t2, and between t2 and t3. The scores were related to age and lesion level, whereas changes in scores were related to age, sex, lesion level, and secondary complications. The variables age, body mass index, sex, lesion level, motor completeness, and secondary complications contributed significantly to the prediction of the scores at t3. CONCLUSIONS: Wheelchair skill performance improved during rehabilitation. Personal and lesion characteristics are most important for improving wheelchair skill performance and predicting wheelchair skill performance.     

Ability of People With Stroke to Learn Powered Wheelchair Skills: A Pilot Study

Mountain AD, Kirby RL, Eskes GA, Smith C, Duncan H, MacLeod DA, Thompson K. Ability of people with stroke to learn powered wheelchair skills: a pilot study.

Objectives

Our primary objective was to test the hypothesis that people with stroke can learn to use powered wheelchairs safely and effectively. Our secondary objective was to explore the influence of visuospatial neglect on the ability to learn powered wheelchair skills.

Design

Prospective, uncontrolled pilot study using within-participant comparisons.

Setting

Rehabilitation center.

Participants

Inpatients (N=10; 6 with visuospatial neglect), all with a primary diagnosis of stroke.

Interventions

Participants received 5 wheelchair skills training sessions of up to 30 minutes each using the Wheelchair Skills Training Program (version 3.2).

Main Outcome Measures

Powered wheelchair skills were tested before and after training using the Wheelchair Skills Test, Power Mobility version 3.2 (WST-P).

Results

The group's total mean WST-P scores improved from 25.5% of skills passed at baseline to 71.5% posttraining (P=.002). The participants with neglect improved their WST-P scores to the same extent as the participants without neglect, although their pretraining and posttraining scores were lower. The training and testing sessions were well tolerated by the participants, and there were no serious adverse events.

Conclusions

Many people with stroke, with or without visuospatial neglect, can learn to use powered wheelchairs safely and effectively with appropriate training.     

Cross-cultural adaptation of wheelchair skills test (version 4.3) for wheelchair users and caregivers to the Portuguese language (Brazil)

Abstract

Objective: To perform cross-cultural adaptation of the Wheelchair Skills Test of manual wheelchair users and their caregivers into the Brazilian Portuguese language.

Methods: The study was composed of translation, synthesis of translations, back-translation, review by an expert committee and pre-test, when the test was applied in the target population. Included were translators, subject specialists and coordinators to carry out the cross-cultural adaptation process, and manual wheelchair users and their caregivers with at least six months of wheelchair experience for the pre-test.

Results: Forty-three people participated in the study, 30 for the pre-test and 13 for the stages that preceded the pre-test. The mean age of manual wheelchair users was 40.2 (±10.7) years and of caregivers was 44.2 (±15.7) years. Of the 47 phrases translated in the first stage, 36 discrepancies were found and resolved. During the analysis by the committee of experts the instrument underwent 13 modifications in order to achieve the best possible equivalence between the original version and the final version and was understandable by the people evaluated. The total pre-test scores of wheelchair users and their caregivers were 66.2 (±24.6) and 88.7 (±14.2), respectively.

Conclusions: This instrument was able to evaluate the abilities of wheelchair users and their caregivers in Brazil, as well as being useful for training in rehabilitation programs.

• Implications for rehabilitation

• The need to use wheelchair (WC) properly has made clinicians and rehabilitation professionals more concerned with assessing and training users' abilities with their WC.

• Cross-cultural adaptation allows for the linguistic modification of the original language of the evaluation tool into a new language and enables the comparison of research results in different countries.

• Immediate use of the instrument for WC users and caregivers in Brazil, both for evaluation and for training, is necessary and may be a means for rehabilitation professionals to improve their evaluations, their treatments and optimize the skills that aim at independence.