Adapted manual wheelchair circuit: test-retest reliability and discriminative validity in persons with spinal cord injury

Cowan RE, Nash MS, de Groot S, van der Woude LH. Adapted manual wheelchair circuit: test-retest reliability and discriminative validity in persons with spinal cord injury.

Objective

To assess the test-retest reliability and discriminative validity of a 14-item manual wheelchair circuit adapted from previous research (AMWC).

Design

Two AMWC trials per subject completed within 15 days.

Setting

Two clinical research and 3 rehabilitation centers.

Participants

Convenience sample of individuals with spinal cord injury (N=50) from centers in the United States (n=38) and the Netherlands (n=12). Mean age ± SD was 46±13 years, and mean injury duration ± SD was 12±11 years. Fifteen had cervical injuries, and 42 were men.

Interventions

An existing 8-task manual wheelchair circuit was modified to remove the need for a wheelchair treadmill and expanded to 14 tasks to attenuate floor and ceiling effects: 5 original tasks—figure-of-8, .012-m doorstep crossing, .10-m platform, 15-m sprint, and making a level transfer; 3 modified tasks—3% and 6% ramp, and 3-minute overground wheeling; and 6 new tasks—.04-m doorstep crossing, propelling over artificial grass, opening/closing a door, 3% side slope, holding a wheelie for 10 seconds, and propelling in a wheelie.

Main Outcome Measures

Reliability of the primary outcomes, sum ability score (sum of all tasks; 0–14 [no.]) and sum performance time (figure-of-8 + sprint + grass; 0–360 [s]), was determined by intraclass correlation coefficients (ICCs) for the whole sample and paraplegia (PP) and tetraplegia (TP) subsets. Independent t tests compared PP and TP trial 1 sum ability score and sum performance time.

Results

Sum ability and sum performance time ICCs exceeded .90 for the full sample and the PP/TP subsets. Sum ability was higher for PP than TP (PP, 12.9±1.2; TP, 9.8±2.8; P<.00), and sum performance times were lower for PP than TP (20.0±4.0s vs 32.0±1.97s, P<.00).

Conclusions

AMWC primary outcomes, sum ability score and sum performance time, are reliable and discriminate between TP and PP.     

The timed manual wheelchair slalom test: a reliable and accurate performance-based outcome measure for individuals with spinal cord injury

Gagnon D, Décary S, Charbonneau M-F. The timed manual wheelchair slalom test: a reliable and accurate performance-based outcome measure for individuals with spinal cord injury.

Objectives

To describe the timed manual wheelchair slalom test (MWST) and to quantify its test-retest reliability, standard error of measurement, and minimum detectable change (MDC).

Design

Repeated-measures design.

Setting

Pathokinesiology laboratory.

Participants

Manual wheelchair users (N=15) with spinal cord injury (SCI) (vertebral levels, C6 to T12; American Spinal Injury Association Impairment Scale: A, B, or C) participated in this study. Participants were 40.7±12.6 years of age, measured 1.77±.08m in height, weighed 79.6±23.9kg, and had been using a manual wheelchair as their primary mode of mobility for 5.9±7.5 years.

Interventions

Participants propelled their own wheelchair at a self-selected maximum velocity along a slalom trajectory (linear length, 18m) defined by 7 cones aligned in a straight line and set 3m, 2m, and 1m apart from one another. Three trials (T=3) of the MWST were performed on 2 separate visits (V=2) 6.3±5.4 days apart. The generalizability theory was used to determine the reliability, standard error of measurement, and MDC and to propose testing protocols for the MWST.

Main Outcome Measure

The time needed to complete the MWST expressed in seconds.

Results

All participants successfully completed the MWST. No adverse effect was reported. The time required to complete the MWST at visits 1 and 2 was 16.8±4.4 and 16.5±4.3 seconds, respectively. The reliability coefficient (φ=.981) and accuracy (standard error of measurement=3.47%, MDC=8.097%) were high when the time required for a participant to perform 3 MWST trials during a single visit (T=3, V=1) was averaged.

Conclusions

The timed MWST is a safe, reliable, and accurate performance-based outcome measure that can be administered easily and quickly in individuals with SCI who rely on a manually propelled wheelchair for mobility.     

Issues for the selection of wheelchair-specific activity and participation outcome measures: a review

Mortenson WB, Miller WC, Auger C. Issues for the selection of wheelchair-specific activity and participation outcome measures: a review.

Objectives

To use the World Health Organization's International Classification of Functioning, Disability and Health as a framework to identify and to evaluate wheelchair-specific outcome instruments that are useful for measuring activity and participation.

Data Sources

CINHAL, PsychInfo, EMBASE, Google Scholar, Dissertation Abstracts Medline databases, and conference proceedings.

Study Selection

Activity and participation measures that were specifically intended for adults who use wheelchairs and that were published in English in a peer-reviewed journal were included in this review. Based on electronic database searches using a variety of search terms, articles were identified by title, and appropriate abstracts were retrieved. Articles were obtained for all relevant abstracts. For peer-reviewed measures included in the review, we obtained any instruction manuals and related publications, frequently published in conference proceedings and theses or available electronically, on the development and testing of the measure.

Data Extraction

Tools included in the review were evaluated based on their conceptual coverage, reliability, validity, responsiveness, usefulness, and wheelchair contribution, which indicated how well the tool isolated the effect of the wheelchair on activity and participation outcomes.

Data Synthesis

A number of conceptual, psychometric, and applicability issues were identified with the 11 wheelchair-specific measures included in the review. A majority of the measures were mobility focused. No single tool received excellent ratings in all areas of the review. Some of the most frequent issues identified included a failure to account for differences attributable to different wheelchairs and wheelchair seating, limited psychometric testing, and high administrative and respondent burden.

Conclusions

Good reliability evidence was reported for most of the measures, but validity information was only available for 6 of the 11 measures, and responsiveness information for 3. This review suggests that these measures could be improved with further psychometric testing and with some modification to ensure that the contribution of the wheelchair to activity and participation outcomes is clearly identified.     

Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury

Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, Dyson-Hudson TA. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury.

Objectives

To investigate the presence of ultrasound (US) abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight.

Design

Case series.

Setting

National Veterans' Wheelchair Games 2005 and 2006.

Participants

Volunteer sample of manual wheelchair users with SCI participating in the National Veterans' Wheelchair Games.

Interventions

Not applicable.

Main Outcome Measures

Presence of relationships between US findings, PE findings, pain, and subject characteristics.

Results

The USPRS correlated with age, duration of SCI, and weight (all P<.01), and showed a positive trend with the total Wheelchair User's Shoulder Pain Index (WUSPI) score (r=.258, P=.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI (r=.679, P<.001) and duration of SCI (P<.05). The presence of untreated shoulder pain that curtailed activity was noted in 24.5% of subjects, and this was related to increased WUSPI scores (P=.002).

Conclusions

PE and US abnormalities are common in manual wheelchair users with SCI. The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is indicated.     

Mechanical efficiency and user power requirement with a pushrim activated power assisted wheelchair

The objective of this study was to quantify the difference in mechanical efficiency and user power generation between traditional manual wheelchairs and a pushrim activated power assisted wheelchair (PAPAW). Ten manual wheelchair users were evaluated in a repeated measures design trial with and without the PAPAW for propulsion efficiency. Subjects propelled a Quickie GP equipped with the PAPAW and their own chair on a computer controlled wheelchair dynamometer at five different resistance levels. Power output, user power with the PAPAW hubs, subjects' oxygen consumption per minute and mechanical efficiency were analyzed. Metabolic energy and user power were significantly lower (p<0.05), and mechanical efficiency significantly higher with the PAPAW than with subjects' own chairs. Subjects needed to generate on average 3.65 times more power when propelling their own wheelchairs as compared to PAPAW. Mean mechanical efficiency over all trials was 80.33% higher with the power assisted hubs. PAPAW provides on average 73% of the total power when subjects propel with power assistance. Significantly increased efficiency and reduced requirement of user power is achieved using the PAPAW. With use, the PAPAW may contribute to delaying secondary injuries of manual wheelchair users. In addition, it may be suitable for people who have (or at risk for) upper extremity joint degeneration, reduced exercise capacity, low strength or endurance who currently use electric powered wheelchairs.     

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.

     

Conservative Treatment of Neuromuscular Scoliosis in Adult Tetraplegia: A Case Report

We report successful correction of new onset neuromuscular scoliosis without spinal surgery in a man who is 30-years post-American Spinal Injury Association Impairment Scale grade A C6 injury with new onset of left neuromuscular scoliosis (Cobb angle 45°) after a motor vehicle collision. Interventions included nightly low-load prolonged stretching (LLPS) (4h left side lying over bolster), a series of 6 botulinum toxin injections (BTIs) at 3-month intervals, and progressive seating adjustments to counteract the spinal curvature. Monthly seating adjustments included rear quadrant wedging, lateral supports, and hip blocking to promote erect and symmetrical posture. A normative Cobb angle (5°) was achieved after 8 months of treatment. Improvements in alignment were demonstrated in physical examination outcome measures at the final session and follow-up. LLPS, seating adjustments, and paraspinal BTI are nonsurgical options for treating neuromuscular scoliosis in adults with tetraplegia. Further studies are necessary to determine optimum protocols and examine generalizability of these treatment methods.