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.

     

Wheelchair Mobility Confidence Scale for Dutch youth using a manual wheelchair

Abstract

Purpose: The objective of this study was to develop a questionnaire to assess confidence in wheelchair mobility in Dutch youth (WheelCon-Mobility Dutch Youth).

Methods: (1) A forward–backward translation process was used to translate the original WheelCon-M from English to Dutch. (2) Items related to wheelchair mobility in Dutch youth were selected and adapted based on focus groups with youth, parents and health care professionals to create the WheelCon-Mobility Dutch Youth. (3) The WheelCon-Mobility Dutch Youth and the Utrecht Pediatric Wheelchair Mobility Skills Test 2.0 (UP-WMST 2.0) were administered to 62 participants to evaluate internal consistency and construct validity.

Results: Translation and cultural adaptation led to general adaptations in instructions, sentence structure and response scale. At the item level, 24 items were included with (n = 17) and without (n = 7) adaptation, 10 items were deleted and 7 new items were included. The WheelCon-Mobility Dutch Youth had an excellent Cronbach’s alpha of 0.924 and a significant correlation (r = 0.44, p < .001) with the UP-WMST 2.0.

Conclusions: This study resulted in the adaptation of the WheelCon-M into the WheelCon-Mobility for Dutch youth using a manual wheelchair. Our study suggests there is evidence supporting the internal consistency and construct validity of the WheelCon-Mobility Dutch Youth.

• Implications for Rehabilitation

• The WheelCon-Mobility Dutch Youth is a newly developed tool for assessing confidence in wheelchair mobility in Dutch youth using a manual wheelchair.

• It is important to assess performance and confidence in wheelchair mobility in paediatric rehabilitation.

     

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.

     

Translation and cross-cultural adaptation of the Wheelchair Skills Test (WST) version 4.3 form from English to Colombian Spanish

Abstract

Introduction: The World Health Organization estimates that in 2010, 15% of the world’s population lived with some form of disability and 10% of these people required wheelchairs. Colombia and other Spanish-speaking countries lack reliable scales, and ones that are in Spanish, to assess wheelchair handling skills such as that provided by the Wheelchair Skills Test 4.3.

Objective: To translate and cross-culturally adapt the Wheelchair Skills Test 4.3 form to Spanish, to be used with the Colombian population that uses a wheelchair.

Materials and method: The design of this research uses a methodology that centres on validation studies and transcultural adaptation following the stages of translation, back translation and evaluation of translations by the author and expert judgement.

Results: The adaptation had a global agreement index of 93.3 (Total Agreement Level). The three indicators were 92% relevance, 93.3% coherence and 94.5% sufficiency; and 22 of the 51 items evaluated (43.1%) had a 100% agreement level.

Conclusions: The outcome of this transcultural adaptation was the Colombian Spanish version of the Wheelchair Skills Test (WST) 4.3 Form.

• Implications for rehabilitation

• Fifteen per cent of the world’s population (2010), and 10% of people with disabilities need wheelchairs.

• The Colombian population requiring the use of a manual wheelchair, 51% are limited in terms of “walking, running, jumping” and permanently limited in their movement for walk (29.32%).

• The use of reliable and cross-culturally adapted scales, such as the Wheelchair Wheelchair Skills Test (WST), is essential for rehabilitation personnel.

• The assessment of wheelchair user skills is fundamental to identify the level of participation in their respective communities as well as the development of their basic activities.

     

Pain,fatigue, function and participation among long-term manual wheelchair users partnered with a mobility service dog

Purpose: To assess the effects of a mobility service dog (MSD) on pain, fatigue, wheelchair-related functional tasks, participation and satisfaction among manual wheelchair users over a nine-month period.

Method: A longitudinal study with repeated assessment times before and three, six and nine months after intervention was achieved. Intervention consisted in partnering each participant with a MSD. The setting is a well-established provincial service dog training school and participants homes. A convenience sample of 24 long-term manual wheelchair users with a spinal cord injury was involved. Outcome measures were: Wheelchair User’s Shoulder Pain Index (WUSPI), Rate of Perceived Exertion (RPE), vitality scale from the SF-36, grip strength, Wheelchair Skills Test (WST), Canadian Occupational Performance Measure (COPM), Reintegration to Normal Living Index (RNLI), Life Space Assessment, Psychosocial Impact of Assistive Devices Scale (PIADS) and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0).

Results: Shoulder and wrist pain as well as fatigue decreased significantly over time with the use of a MSD as evidenced by scores from WUSPI, RPE and SF-36 (feeling less worn out). Manual wheelchair propulsion skills (steep slopes, soft surfaces and thresholds) improved significantly over time as confirmed by the WST. Participation increased significantly over time as revealed by the COPM (for five occupations) and the RNLI (for five items). Satisfaction with the MSD was high over time (QUEST: nine items) and with a high positive psychosocial impact (PIADS: 10 items).

Conclusion: MSD represents a valuable mobility assistive technology option for manual wheelchair users.

• IMPLICATIONS FOR REHABILITATION

• For manual wheelchair users partenered with mobility service dog ??Shoulder pain and fatigue significantly decreased and continued to decrease between the third and sixth month and the ninth month.

• ??Performance with propelling the wheelchair up steep slopes increased from 41 to 88% and on soft surfaces increased from 53 to 100% after 3 months, respectively.

• ??Occupational performance satisfaction was significantly increased for mobility in relation with the transfers, navigating in a natural environment and picking up objects.

• ??High satisfaction towards psychosocial competency, psychosocial adequacy and self-esteem were reported at months three, six and nine.

     

Development of a contextually appropriate,reliable and valid basic Wheelchair Service Provision Test

Purpose: Currently, there is no internationally accepted way to measure the competency of wheelchair service professionals. The International Society of Wheelchair Professionals aims to develop a Wheelchair Service Provision – Basic Test as a preliminary step towards establishing a certification process. Method: A team of wheelchair service provision experts developed test questions and conducted alpha and beta testing in order to validate them. Low-performing test items were eliminated. A pilot test was then conducted, which focused on developing a pass score, determining language barriers and validating the test as a measure of competency. Results: 90 participants completed one of three versions of the Wheelchair Service Provision – Basic Test. A pass score of 70% was established and 135 questions were accepted for the final test. Analysis of variance indicated there was a difference in scores based on language (p?=?0.001), but not based on experience level. This result motivated translation in to the United Nations’ official languages. Conclusions: The results indicate that the Wheelchair Service Provision – Basic Test is a valid method for measuring basic competency of wheelchair professionals. Additionally, researchers recommend a skills assessment to help to ensure only qualified wheelchair professionals receive the certificate.

• Implications for Rehabilitation

• Identify key steps in contextually appropriate test development.

• Describe the components of a contextually appropriate, reliable, and valid test for basic wheelchair service provision.

• Identify methods used for contextually appropriate test validation.

     

Effectiveness of the Wheelchair Skills Training Program: a systematic review and meta-analysis*

Objective: To conduct a systematic review synthesizing the evidence for the effectiveness of the Wheelchair Skills Training Program (WSTP).

Data Sources: We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to 10 October 2017.

Study Selection: Randomized controlled trials (RCTs) assessing the effectiveness of the WSTP.

Data Extraction: Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane’s Risk of Bias Tool.

Data Synthesis: Meta-analyses (including sub-group analyses) were conducted for the Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen articles (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; p?Conclusions: There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes.

• Implications for rehabilitation

• A systematic review and meta-analysis of 13 randomized controlled trials on a total of 581 participants, using the Wheelchair Skills Training Program (WSTP) as the intervention, found that the WSTP increased Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores by 21.2% relative to baseline.

• Subgroup analyses showed that training was more effective for new wheelchair users.

• The WSTP was found to have positive effects on some other outcomes and no serious adverse events were reported.

• The WSTP warrants cautious implementation in clinical and educational settings.

     

Interrater and intrarater reliability of the wheelchair skills test version 4.2 for power wheelchair users

Purpose: The purpose of this study is to estimate the interrater and intrarater reliability of the Wheelchair Skills Test (WST) Version 4.2 for powered wheelchairs operated by adult users.

Materials and methods: Cohort study with a convenience sample of occupational therapists (n?=?10). For the main outcome measure, participants viewed and scored eight videos of adult power wheelchair users completing the 30 skills of the WST Version 4.2 on two occasions, a minimum of two weeks apart. Using these scores, we calculated intraclass correlation coefficients to estimate interrater and intrarater reliability.

Results: The interrater reliability intraclass correlation coefficient was 0.940 (95%CI 0.862–0.985). Intrarater reliability intraclass correlation coefficients ranged from 0.923 to 0.998.

Conclusions: The WST Version 4.2 has excellent interrater and intrarater reliability and is a reliable tool for use in clinical and research practice to evaluate a power wheelchair user’s skill capacity.

• Implications for Rehabilitation

• The Wheelchair Skills Test for Powered Wheelchair Users (WST-P 4.2) is a useful addition to the clinical tools available for clinicians who assess and train for powered wheelchair use.

• The WST-P 4.2 has excellent reliability and potential for clinical use as a pre-post measure of powered wheelchair skills.

• Clinicians using the WST-P 4.2 should attempt to maintain consistent scoring procedures, particularly for those skills that may require subjective assessment of skill safety.

     

The influence of operator and wheelchair factors on wheelchair propulsion effort

Abstract

Purpose: The goal of this study was to evaluate the relative influence of operator and wheelchair factors on propulsion effort during over-ground wheelchair manoeuvres.

Method: This observational study included 23 full-time manual wheelchair users and 13 able-bodied subjects. The operator factors included shoulder position, aerobic capacity and propulsion strength. The wheelchair factors included system mass, weight distribution, and frictional loss in straight and turning trajectories. The performance of over-ground manoeuvres was defined as the propulsion effort measured by VO₂ as operators propelled along a modified figure-8 course on tile and carpet surfaces.

Results: According to our regression model, shoulder position was the only significant contributor within operator factors, whereas weight distribution was the only significant contributor within wheelchair factors in influencing propulsion efforts. When combining operator and mechanical factors in the regression model, weight distribution became the only significant contributor to influence propulsion effort.

Conclusion: Weight distribution and shoulder position had a significant influence on propulsion effort. These variables are related to the operator’s relationship to the drive wheels. However, system mass and muscle strength had the least influence on wheelchair manoeuvres. Our finding can help clinicians to improve wheelchair configurations and manufacturers to improve wheelchair design by understanding the importance of shoulder position and weight distribution.

• Implication for rehabilitation

• Studying wheelchair manoeuvers by considering both wheelchair and operator factors might provide a unique insight to address the complex interactions among wheelchair designs and users.

• Propulsion effort decreases as percentage weight is increased on the drive wheels and the shoulder becomes more aligned with the axle position, which highlights the need to optimize wheelchair axle position.

• Wheelchair configuration, as represented by weight distribution, had a more significant influence on everyday manoeuvre than wheelchair mass does.

• It is essential for wheelchair users to choose a wheelchair that can match their daily needs and anthropometric measurements for saving propulsion efforts.

     

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.

     

The Wheelchair Use Confidence Scale: Italian translation,adaptation, and validation of the short form

Objective: We developed an Italian version of the Wheelchair Use Confidence Scale for Manual Users-Short Form (WheelCon-M-I-short form) and examined its reliability and validity.

Methods: The original scale was translated from English to Italian using the “Translation and Cultural Adaptation of Patient Reported Outcomes Measures–Principles of Good Practice” guidelines. The WheelCon-M-I-short form was administered to experienced manual wheelchair users who had a variety of diagnoses. Its internal consistency and test–retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Wheelchair Outcome Measure (WhOM-I) and the Italian version of the Barthel index (BI).

Results: The WheelCon-M-I-short form was administered to 31 subjects. The mean?±?SD of the WheelCon-M-I-short form score was 7.5?±?1.9. All WheelCon-M-I-short form items were either identical or similar in meaning to the WheelCon-M-short form items. Cronbach’s α for the WheelCon-M-I-short form was 0.95 (p?p?p?p?Conclusions: The WheelCon-M-I-short form was found to be reliable and a valid outcome measure for assessing manual wheelchair confidence in the Italian population.

• Implication for Rehabilitation

• The WheelCon-M-I-short form is a valid outcome measure available for assessing wheelchair confidence, according to Bandura’s social cognitive theory, self-efficacy is a better predictor of future behavior than skill itself.

• Translation of the WheelCon-M-short form into the WheelCon-M-I-short form provides a new tool for Italian professionals.

• Clinicians now have a method to measure this invisible barrier to wheelchair use, and they will be able to make informed decisions when prescribing the use of manual wheelchairs and when training clients in their use.

• The WheelCon-M-I-short form also provides researchers with a tool in an important and relevant area of study for future research.

     

Development of modified dental chair to accomodate both wheelchair bound patients and general population

Abstract

Background: Dental chairs are a vital tool in modern dentistry. Their design has paved the way for increasing improvement in dental treatment. Since the 1900's, the dental chair design has continuously evolved and transformed from manually operated mechanisms to recently automated mechanism, in spite of advancements a common obstacle faced by these wheelchair bound populations in using present dental chair is transfer. Wheelchair users need to be transferred from the wheelchair to other places many times a day. In most of the cases the wheelchair user does not possess the capability of transferring to a dental chair independently. Therefore assistance is needed either from dental clinic staff or from family and friends. This transfer of patients from wheelchair not just requires manpower but also creates unnecessary anxiety among the wheel chair bound patients.

Solution: Thus a modified dental chair was constructed which would accommodate the wheelchair bound patients to the dental chair without any transfer. This study highlights the mechanism of action of the modified dental chair.

• Implication for rehabilitation

• Improve access among wheelchair bound patients to dental care services

• Decreases anxiety among the disadvantaged population in clinical set up

     

Comparison of carbon fibre and aluminium materials in the construction of ultralight wheelchairs

Abstract

Carbon fibre-reinforced polymers have been used in the sporting goods industry for decades, and wheelchairs have incorporated the material since the late 1980s. There is no independently collected data available on carbon fibre-reinforced polymer wheelchairs’ performance on the ANSI/RESNA testing standards, however. This study evaluated three full carbon fibre wheelchair specimens to determine their performance versus similar wheelchairs. Testing determined that while the frames survived more testing cycles than any other wheelchair, the casters and rear tires failed similarly to other devices. Overall, due to the purchase cost, the cost benefit of the tested wheelchair model was similar to aluminium wheelchairs.

• Implications for rehabilitation

• Carbon fibre wheelchair construction is a viable alternative to aluminium, titanium, or steel construction, and decreasing costs will continue to improve the benefits of carbon fibre over these models

• Carbon fibre wheelchair found to be more durable than aluminium models, but are also much more expensive. The additional cost may be justified for some users that need the increased durability, however

• Increased durability will reduce the number of repairs and warranty claims, potentially reducing the burden on a wheelchair user, and also improving their ability to travel and participate in their community

• The low weight of carbon fibre wheelchairs may increase the mobility of some users by allowing them to transfer more easily into and out of vehicles and manoeuvre throughout the environment

     

Translation,reliability, and clinical utility of the Melbourne Assessment 2

Objective: The aims were to (i) provide a German translation of the Melbourne Assessment 2 (MA2), a quantitative test to measure unilateral upper limb function in children with neurological disabilities and (ii) to evaluate its reliability and aspects of clinical utility.

Methods: After its translation into German and approval of the back translation by the original authors, the MA2 was performed and videotaped twice with 30 children with neuromotor disorders. For each participant, two raters scored the video of the first test for inter-rater reliability. To determine test–retest reliability, one rater additionally scored the video of the second test while the other rater repeated the scoring of the first video to evaluate intra-rater reliability. Time needed for rater training, test administration, and scoring was recorded.

Results: The four subscale scores showed excellent intra-, inter-rater, and test–retest reliability with intraclass correlation coefficients of 0.90–1.00 (95%-confidence intervals 0.78–1.00). Score items revealed substantial to almost perfect intra-rater reliability (weighted kappa k_w?=?0.66–1.00) for the more affected side. Score item inter-rater and test–retest reliability of the same extremity were, with one exception, moderate to almost perfect (k_w?=?0.42–0.97; k_w?=?0.40–0.89). Furthermore, the MA2 was feasible and acceptable for patients and clinicians.

Conclusions: The MA2 showed excellent subscale and moderate to almost perfect score item reliability.

• Implications for Rehabilitation

• There is a lack of high-quality studies about psychometric properties of upper limb measurement tools in the neuropediatric population.

• The Melbourne Assessment 2 is a promising tool for reliable measurement of unilateral upper limb movement quality in the neuropediatric population.

• The Melbourne Assessment 2 is acceptable and practicable to therapists and patients for routine use in clinical care.

     

Ramps remain a barrier to safe wheelchair user transit bus ingress/egress

Abstract

Background: Wheelchair users (WCUs) often rely on ramps for access to transit buses. Previous studies indicate WCUs have difficulty using ramps for bus ingress/egress and many transportation-related incidents occur on ramps. However, experiences of WCU ramp usage during ingress/egress have not been fully described.

Methods: Cross-sectional, internet-based survey of WCUs who ride transit buses was conducted. The participants were queried on frequency of bus usage, difficulty and incidents involving ramps, and factors contributing to difficulty and incidents. Wheelchair characteristics, primary condition, and whether participants received travel training were also captured. Chi-square was used to describe relationships between wheelchair type and frequency of difficulties and incidents, and odd ratios were used to determine likelihood of the incidents.

Results: The majority (55.7%) of 384 participants reported using public transportation ≥ 1 per week. Seventy-eight percent of WCUs had ≥ 1 ramp incident over the past 3?years, with an increased likelihood of incidents occurring during ingress (OR = 1.53; CI 1.21–1.86). Of those who had an incident, 22% were injured or had damage to their wheelchair. Over 60% of those who had an incident identified steep ramp slope as being the contributing factor. Steep ramp slope, exterior ramp thresholds and wet surfaces were the most common contributing factors to difficulty using ramps.

Conclusion: This is the first large-scale US study enabling WCUs to describe their experiences using transit bus ramps. Despite ADA guidelines, steep ramps remain the primary factor contributing to incidents and difficulty when using ramps to access transit buses.

• Implications for rehabilitation

• The discrepancy between ADA maximum allowable ramp slopes for the built environment and transit buses may require an increased level of effort that is a barrier to transportation accessibility for some wheelchair users.

• Wheelchair users who access transit buses should be made aware of, and trained, to navigate ramp configurations found in the environment.

• We suggest rehabilitation therapists provide skills training specific to navigating transit bus ramp slopes that may be steeper and narrower than building ramps.

     

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.

     

Measurement properties of the WheelCon for powered wheelchair users

Purpose: To evaluate the measurement properties of the Wheelchair Use Confidence Scale for power wheelchair users (WheelCon-P).

Design: One-month test–retest design, using data from a longitudinal study of power wheelchair use.

Participants: Volunteer sample of 73 community dwelling, older adult experienced power wheelchair users who had a mean age of 60.5?±?7.1 years.

Methods: Participants completed the WheelCon-P twice to assess retest reliability. Concurrent validity was assessed by evaluating hypothesized relationships between the WheelCon-P and relevant variables.

Results: The baseline mean (standard deviation) WheelCon-P score was 78.8?±?14.5. Cronbach’s α was 0.92. The one-month test–retest intraclass correlation coefficient was 0.85 (CI 0.77–0.90). Correlations ranging from r?=?0.26 (social support) to r?=?0.49 (wheelchair skills) were found between the WheelCon-P and the validation outcome measures.

Conclusion: The WheelCon-P has high internal consistency, strong retest reliability and evidence supporting its validity. Although further work is needed, the WheelCon-P may serve as a useful clinical and research tool for measuring power wheelchair confidence.

• Implications for rehabilitation

• The WheelCon-P is a reliable and valid outcome measure for assessing wheelchair confidence.

• This tool can be used to identify individuals with low power wheelchair confidence who require a confidence-enhancing intervention.

     

Integration of wheelchair service provision education: current situation,facilitators and barriers for academic rehabilitation programs worldwide

Abstract

Purpose: An estimated 75 million people with disabilities need wheelchairs globally, of whom 5–15% have one. Access to an appropriate wheelchair requires rehabilitation professionals trained to provide wheelchair service. One aim of the International Society of Wheelchair Professionals (ISWP) is to promote and facilitate the integration of wheelchair service provision education into academic rehabilitation programs worldwide. To inform the development of integration strategies, the purpose of this study was to develop an in-depth global portrait of the wheelchair service provision education offered in academic rehabilitation programs, the process of its integration and the associated facilitators and barriers.

Method: Semi-structured qualitative interviews were conducted with a purposive sample of 14 representatives from academic rehabilitation programs (i.e., occupational therapy, physical therapy, and prosthetics and orthotics) in 11 countries, including low, middle and upper resourced settings.

Findings: Thematic data analyses identified three overarching themes. The first theme, “impact of context”, portrays factors related to local population needs, governance and supply chain of equipment and service delivery. The second theme, “current and planned wheelchair education”, describes the content, pedagogic approach, student evaluation and feedback process. The third theme, “integration process”, details five states of this process.

Conclusions: This study describes in-depth the wheelchair service provision education across academic rehabilitation programs and resource settings, illustrating the context-dependent nature of its integration. This understanding may assist the global community of educators in preparing future rehabilitation professionals to better serve wheelchair users. This work has informed the development of ISWP’s Seating and Mobility Academic Resource Toolkit (http://smart.wheelchairnetwork.org/).

• Implications for Rehabilitation

• The Dynamics of Context-Dependent Integration of Wheelchair Service Provision Education in Curricula model, depicting the findings of this study, may help to inform key stakeholders (i.e., academic institutions, health care providers and policy makers) about potential barriers and facilitators to the implementation of adequate wheelchair service provision education in the curricula of academic rehabilitation program.

• Study findings may lead to creative strategies, such as the expansion of ISWP’s Seating and Mobility Academic Resource Toolkit (SMART; http://smart.wheelchairnetwork.org/), that may enable academic rehabilitation programs to be a part of the solution to strengthening rehabilitation systems worldwide, through appropriately trained rehabilitation professionals in wheelchair service provision.

     

Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy: a systematic review

Purpose: Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP).

Method: A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters.

Results: Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II–IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n?=?3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n?=?2, all Evidence Level II) and Physical Fitness Training (n?=?4, Evidence Level II–V). Weak positive evidence was available for Modified Sport (n?=?3, Evidence Level IV–V) and Non-Immersive Virtual Reality (n?=?12, Evidence Level II–V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n?=?4, all Evidence Level II).

Interpretation: Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP.

• Implications for rehabilitation

• Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy.

• Gross Motor Activity Training is the most common and effective intervention.

• Practice variability is essential to improve gross motor function.

• Participation was rarely measured and requires further research, particularly in interventions that embed real-world participation opportunities like Modified Sport.