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Glinsky JV, Harvey LA. Physiotherapy management of people with spinal cord injuries: an update. J Physiother 2024; 70:256-264. [PMID: 39370372 DOI: 10.1016/j.jphys.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 09/19/2024] [Indexed: 10/08/2024] Open
Affiliation(s)
- Joanne V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia; Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Lisa A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
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Sakaguchi T, Heyder A, Tanaka M, Uotani K, Omori T, Kodama Y, Takamatsu K, Yasuda Y, Sugyo A, Takeda M, Nakagawa M. Rehabilitation to Improve Outcomes after Cervical Spine Surgery: Narrative Review. J Clin Med 2024; 13:5363. [PMID: 39336849 PMCID: PMC11432758 DOI: 10.3390/jcm13185363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/06/2024] [Accepted: 09/07/2024] [Indexed: 09/30/2024] Open
Abstract
PURPOSE The increasing elderly patient population is contributing to the rising worldwide load of cervical spinal disorders, which is expected to result in a global increase in the number of surgical procedures in the foreseeable future. Cervical rehabilitation plays a crucial role in optimal recovery after cervical spine surgeries. Nevertheless, there is no agreement in the existing research regarding the most suitable postsurgical rehabilitation program. Consequently, this review assesses the ideal rehabilitation approach for adult patients following cervical spine operations. MATERIALS AND METHODS This review covers activities of daily living and encompasses diverse treatment methods, including physiotherapy, specialized tools, and guidance for everyday activities. The review is organized under three headings: (1) historical perspectives, (2) patient-reported functional outcomes, and (3) general and disease-specific rehabilitation. RESULTS Rehabilitation programs are determined on the basis of patient-reported outcomes, performance tests, and disease prognosis. CSM requires strengthening of the neck and shoulder muscles that have been surgically invaded. In contrast, the CCI requires mobility according to the severity of the spinal cord injury and functional prognosis. The goal of rehabilitation for CCTs, as for CCIs, is to achieve ambulation, but the prognosis and impact of cancer treatment must be considered. CONCLUSIONS Rehabilitation of the cervical spine after surgery is essential for improving physical function and the ability to perform daily activities and enhancing overall quality of life. The rehabilitation process should encompass general as well as disease-specific exercises. While current rehabilitation protocols heavily focus on strengthening muscles, they often neglect the crucial aspect of spinal balance. Therefore, giving equal attention to muscle reinforcement and the enhancement of spinal balance following surgery on the cervical spine is vital.
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Affiliation(s)
- Tomoyoshi Sakaguchi
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.)
| | - Ahmed Heyder
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (A.H.); (K.U.); (T.O.); (Y.K.)
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (A.H.); (K.U.); (T.O.); (Y.K.)
| | - Koji Uotani
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (A.H.); (K.U.); (T.O.); (Y.K.)
| | - Toshinori Omori
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (A.H.); (K.U.); (T.O.); (Y.K.)
| | - Yuya Kodama
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (A.H.); (K.U.); (T.O.); (Y.K.)
| | - Kazuhiko Takamatsu
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.)
| | - Yosuke Yasuda
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.)
| | - Atsushi Sugyo
- Department of Rehabilitation, Spinal Injuries Center, 550-4 Igisu, Fukuoka 820-8508, Japan;
| | - Masanori Takeda
- Department of Rehabilitation, Kansai Rosai Hospital, 3-1-69 Inabasou, Amagasaki City 660-8511, Japan;
| | - Masami Nakagawa
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.)
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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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Silveira SL, de Groot S, Cowan RE. Association between individual wheelchair skills and fitness in community-dwelling manual wheelchair users with spinal cord injuries. Disabil Rehabil Assist Technol 2024; 19:60-65. [PMID: 35426353 DOI: 10.1080/17483107.2022.2061607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Wheelchair skills are a key component to promotion of community participation among persons with spinal cord injury (SCI). The objective of this secondary analysis was to examine the association between individual wheelchair skills from the Wheelchair Skills Test Questionnaire (WST-Q) and fitness among community-dwelling adults with SCI. MATERIALS AND METHODS Twenty-six adults were recruited to complete the WST-Q and a standard graded aerobic wheelchair exercise test on a motorized treadmill for assessing peak power output (POpeak). RESULTS Spearman Rho rank-order correlation (ρ) analyses indicated statistically significant correlations between POpeak and six basic (ρ = 0.41-0.57), eight intermediate (ρ = 0.44-0.59), and nine advanced (ρ = 0.42-0.80) WST-Q skill scores. After controlling for sex and injury level (Partial Spearman Rho rank order) significant correlations persisted for four advanced skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position; ρ = 0.46-0.59) and one additional skill (i.e., ascends high curb ρ = 0.51). CONCLUSIONS More advanced wheelchair skills are significantly associated with fitness in persons with SCI. The directionality of the skills-fitness relationship, specifically whether wheelchair skills facilitate greater fitness or fitness is a prerequisite for certain wheelchair skills needs to be determined in future, larger studies. However, results from this study provide a comprehensive list of wheelchair skills that are associated with fitness that can be directly applied to guide further research and practice promoting community participation among persons with SCI.Implications for RehabilitationSignificant positive associations exist between advanced wheelchair skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position and ascends high curb) and fitness in manual wheelchair users with spinal cord injury (SCI).This study provides a list of skills associated with fitness to guide clinical practice and areas for further rehabilitation research assessing the directionality of the relationship between fitness and wheelchair skills.
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Affiliation(s)
- Stephanie L Silveira
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Rachel E Cowan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, Miami, FL, USA
- Department of Physical Medicine and Rehabilitation, University of Alabama Birmingham, Birmingham, AL, USA
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Rusek CT, Kleven M, Walker C, Walker K, Heeb R, Morgan KA. Perspectives of inpatient rehabilitation clinicians on the state of manual wheelchair training: a qualitative analysis. Disabil Rehabil Assist Technol 2023; 18:1154-1162. [PMID: 34686071 DOI: 10.1080/17483107.2021.1993359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to identify clinician knowledge regarding manual wheelchair (MWC) training in an inpatient rehabilitation (IPR) setting, identify current MWC education provided to new manual wheelchair users (MWUs), and determine how MWC training resources can be developed or modified to promote use among IPR clinicians. METHODS Semi-structured interviews were conducted with 20 licenced IPR clinicians who work with MWUs. Using a traditional qualitative research design, researchers completed open, data-driven coding of interview transcripts. Overarching themes were determined through content analysis. RESULTS Participants included 12 physical therapists, six occupational therapists, one physical therapy assistant, and one occupational therapy assistant. Five themes emerged from the interviews: (1) clinician knowledge, education, and experience (2) current training content (3) training environment, (4) desired programme components (5) barriers to implementation. Participants reported receiving minimal education in school and from their employers on training MWUs. While clinicians expressed the importance of MWU education, they used varying training approaches with little standardization. Participants identified that training protocols for IPR are beneficial if they are quick, straightforward, and flexible. CONCLUSIONS While MWC training occurs during IPR stays, it appears to be inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to evidence-based practices. This is likely due to limited feasibility and awareness of existing MWC training resources. Clinician input gathered from these interviews provides information for how to best integrate MWC training programmes into the rehabilitative process. Findings may inform the development and assessment of more clinically feasible MWC training protocols. Implications for RehabilitationNew manual wheelchair users must learn numerous wheelchair-related skills in order to participate in everyday life activities.Manual wheelchair education for new users during inpatient rehabilitation is often inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to existing evidence-based practices.Systematic challenges often act as a barrier to the implementation of more comprehensive, structured manual wheelchair training protocols.Manual wheelchair training resources must be concise, flexible, customisable, and easy to follow in order to promote increased implementation among inpatient rehabilitation clinicians.
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Affiliation(s)
- Carly T Rusek
- Programme in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO, USA
| | - Micki Kleven
- Programme in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO, USA
| | - Carla Walker
- Programme in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO, USA
| | - Kim Walker
- Programme in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO, USA
| | - Rachel Heeb
- Programme in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO, USA
| | - Kerri A Morgan
- Programme in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO, USA
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de Serres-Lafontaine A, Labbé D, Batcho CS, Norris L, Best KL. Social participation of individuals with spinal injury using wheelchairs in rural Tanzania after peer training and entrepreneurial skills training. Afr J Disabil 2023; 12:975. [PMID: 36756462 PMCID: PMC9900306 DOI: 10.4102/ajod.v12i0.975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Individuals with spinal cord injury (SCI) in less-resourced settings reported barriers to community integration, including inaccessible rehabilitation services, restricted environments and limited social integration. Peer training and entrepreneurial skills training are provided by Motivation, a nonprofit organisation, and Moshi Cooperative University to enhance occupational engagement of individuals with SCI in less-resourced settings. Objective This study aimed to explore the impact of peer training and entrepreneurial skills training on the social participation of individuals with SCI living in Tanzania. Method Using a qualitative photovoice approach, 10 participants captured meaningful photos and provided captions according to five standardised questions (PHOTO technique) to convey their messages. Participants selected up to 34 photos that best illustrated their experiences in the community. A mixed inductive-deductive thematic analysis was guided by the International Classification of Functioning, Disability and Health. Results Two interrelated themes emerged: (1) 'influencing factors', which revealed how participants' inclusion in the community was influenced by their activities and personal and environmental factors and (2) 'empowerment', which highlighted participants' desire to advocate and promote awareness of needs and hopes. Conclusion Participants emphasised the importance of accessibility and equal opportunities. Whilst some were able to overcome obstacles, others experienced continued inaccessibility that inhibited meaningful occupations. Daily participation challenges of individuals with SCI in rural Tanzania were highlighted. Although the Motivation programmes were perceived to have powerful impacts on social participation, continued efforts and advocacy are needed to overcome accessibility issues and to meet the physical, psychological and social needs of Tanzanians living with SCI. Contribution This article highlights the importance of accessibility and equal opportunities for individuals with disability living in rural Tanzania. Peer-training and entrepreneurial programs offer community-based rehabilitation services that were perceived by people with disabilities to have a powerful impact on social participation and vocation. However, continued efforts and advocacy are needed to meet the needs of Tanzanians living with spinal cord injury.
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Affiliation(s)
- Annabelle de Serres-Lafontaine
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
| | - Delphine Labbé
- Department of Disability and Human Development, University of Illinois at Chicago, Illinois, United States
| | - Charles S. Batcho
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
| | - Lucy Norris
- Motivation Charitable Trust, Bristol, United Kingdom
| | - Krista L. Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
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Worobey LA, Kirby RL, Cowan RE, Dyson-Hudson TA, Shea M, Heinemann AW, Pedersen JP, Hibbs R, Boninger ML. Using remote learning to teach clinicians manual wheelchair skills: a cohort study with pre- vs post-training comparisons. Disabil Rehabil Assist Technol 2022; 17:752-759. [PMID: 32809896 PMCID: PMC8204376 DOI: 10.1080/17483107.2020.1804633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To test the hypothesis that remote learning to teach clinicians manual wheelchair skills is efficacious. MATERIALS AND METHODS A convenience sample of therapists (physical and occupational) and students were enrolled in pairs in a cohort study with pre- versus post-training comparisons. The intervention was a hybrid of self-study and hands-on practice paired with remote feedback for ten intermediate and advanced manual wheelchair skills. Participants practiced with self-selected frequency and duration, uploading a session log and video(s) to an online platform. A remote trainer provided asynchronous feedback prior to the next practice session. Capacity and confidence in completing the ten skills were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q). Knowledge of wheelchair skills training and motor learning was assessed using a 62-item Knowledge Test. Secondary outcome measures included skill achievement, as confirmed by submitted video recordings, and participant feedback about the training. RESULTS Across 41participants, scores were higher at follow-up compared to baseline for WST-Q capacity (73.9 ± 19.1 vs 16.8 ± 15.6, p < 0.001), WST-Q confidence (80.1 ± 12.2 vs 47.6 ± 18.2, p = 0.003) and knowledge (70.8 ± 7.5 vs 67.0 ± 5.4, p = 0.004). CONCLUSIONS Remote learning can increase wheelchair skills capacity and confidence as well as knowledge about such training and assessment. This model should be further investigated as a delivery method for training rehabilitation professionals. CLINICAL TRIAL REGISTRATION NUMBER NCT01807728.Implications for rehabilitationWheelchair skills training is one of the 8 steps of wheelchair provision as outlined by the World Health Organization.Wheelchair skills are not a core part of most clinical curriculums and many clinicians cite a lack of resources and uncertainty on how to implement wheelchair skills training into practice as major barriers to providing such training.Remote learning offers the benefits of structured wheelchair skills training with expert feedback on an individual's own schedule that is not afforded by one-day "bootcamp"-type courses or on-the-job training, which are how many clinicians currently learn wheelchair skills.In a sample of physical and occupational therapists and students, remote learning was effective at increasing capacity and confidence to perform manual wheelchair skills as well as knowledge of wheelchair training.
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Affiliation(s)
- Lynn A Worobey
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA, USA
| | - R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada
| | - Rachel E Cowan
- Department of Physical Medicine & Rehabilitation, University of Alabama, Birmingham, AB, USA
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mary Shea
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Allen W Heinemann
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Shirley Ryan Ability Lab, Chicago, IL, USA
| | | | - Rachel Hibbs
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA, USA
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Serres-Lafontaine AD, Labbé D, Batcho CS, Norris L, Best KL. Social participation of individuals with spinal injury using wheelchairs in rural Tanzania after peer training and entrepreneurial skills training. Afr J Disabil 2022. [DOI: 10.4102/ajod.v11i0.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Goldberg M, Alharbi M, Kandavel K, Burrola-Mendez Y, Augustine N, Toro-Hernández ML, Pearlman J. An exploratory analysis of global trends in wheelchair service provision knowledge across different demographic variables: 2017-2020. Assist Technol 2021; 35:142-152. [PMID: 34705605 DOI: 10.1080/10400435.2021.1992541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To explore global trends in manual wheelchair service provision knowledge across geographic, professional, and socioeconomic domains. DESIGN A secondary analysis of a dataset from the International Society of Wheelchair Professionals' Wheelchair Service Provision Basic Knowledge Test was conducted. SETTING The dataset included test takers from around the world and was extracted from Test.com and International Society of Wheelchair Professionals' Wheelchair International Network. PARTICIPANTS 2,467 unique test takers from 86 countries. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES International Society of Wheelchair Professionals' Wheelchair Service Provision Basic Knowledge Test. RESULTS We identified significant inverse associations between pass rate and the following variables: education (high school and some college), test taker motivation (required by academic program or employer), and country income setting (low and middle). There were significant positive associations between pass rate and the following variables: training received (offered by Mobility India or 'other NGO'), and age group served (early childhood). CONCLUSION Global wheelchair knowledge trends related to key variables such as training, occupation, and income setting have been preliminarily explored. Future work includes further validation of the primary outcome measure and recruitment of a larger sample size to further explore significant associations between additional test taker variables.
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Affiliation(s)
- Mary Goldberg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, USA.,Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, USA.,International Society of Wheelchair Professionals, Pittsburgh, USA
| | - Mohammed Alharbi
- Geoinformatics Laboratory, School of Computing and Information, University of Pittsburgh, Pittsburgh, USA.,College of Computer Science and Engineering, Taibah University, Medina, Saudi Arabia
| | - Krithika Kandavel
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, USA.,International Society of Wheelchair Professionals, Pittsburgh, USA
| | - Yohali Burrola-Mendez
- International Society of Wheelchair Professionals, Pittsburgh, USA.,Université de Montréal, Montreal, Quebec, Canada
| | - Nancy Augustine
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, USA.,International Society of Wheelchair Professionals, Pittsburgh, USA
| | | | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, USA.,International Society of Wheelchair Professionals, Pittsburgh, USA
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Giesbrecht E, Faieta J, Best K, Routhier F, Miller WC, Laberge M. Impact of the TEAM Wheels eHealth manual wheelchair training program: Study protocol for a randomized controlled trial. PLoS One 2021; 16:e0258509. [PMID: 34644350 PMCID: PMC8513836 DOI: 10.1371/journal.pone.0258509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/20/2021] [Indexed: 12/05/2022] Open
Abstract
Background Variable, and typically inadequate, delivery of skills training following manual wheelchair (MWC) provision has a detrimental impact on user mobility and participation. Traditional in-person delivery of training by rehabilitation therapists has diminished due to cost, travel time, and most recently social distancing restrictions due to COVID-19. Effective alternative training approaches include eHealth home training applications and interactive peer-led training using experienced and proficient MWC users. An innovative TEAM Wheels program integrates app-based self-training and teleconference peer-led training using a computer tablet platform. Objective This protocol outlines implementation and evaluation of the TEAM Wheels training program in a randomized control trial using a wait-list control group. Setting The study will be implemented in a community setting in three Canadian cities. Participants Individuals ≥ 18 years of age within one year of transitioning to use of a MWC. Intervention Using a computer tablet, participants engage in three peer-led teleconference training sessions and 75–150 minutes of weekly practice using a video-based training application over 4 weeks. Peer trainers individualize the participants’ training plans and monitor their tablet-based training activity online. Control group participants also receive the intervention following a 1-month wait-list period and data collection. Measurements Outcomes assessing participation; skill capacity and performance; self-efficacy; mobility; and quality of life will be measured at baseline and post-treatment, and at 6-month follow-up for the treatment group. Impact statement We anticipate that TEAM Wheels will be successfully carried out at all sites and participants will demonstrate statistically significant improvement in the outcome measures compared with the control group.
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Affiliation(s)
- Ed Giesbrecht
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
- * E-mail:
| | - Julie Faieta
- Department of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Krista Best
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Quebec, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Quebec, Canada
| | - William C. Miller
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maude Laberge
- Département d’opérations et systèmes de décision, Université Laval, Quebec City, Quebec, Canada
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11
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Charlton K, Murray C, Boucaut R, Berndt A. Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study. Aust Occup Ther J 2021; 68:490-503. [PMID: 34318937 PMCID: PMC9290744 DOI: 10.1111/1440-1630.12759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/03/2022]
Abstract
Introduction The manual wheelchair skills training programme is used to structure teaching manual wheelchair use for people following injury or disability. This pilot study aimed to explore the outcomes of introducing a group wheelchair skills training programme on skill performance, confidence and frequency of wheelchair use for people with lower limb amputation in a rehabilitation setting from the perspective of participants and group facilitators. Method This pilot study used a two‐phase mixed methods nested design. Eleven people with lower limb amputations received a minimum of two 45‐min wheelchair skills sessions, using the Wheelchair Skills Training Program, delivered in a mix of group and one‐to‐one sessions. In phase one, wheelchair skill performance, confidence and frequency were measured using the Wheelchair Skills Test Questionnaire‐Version 5.0, goal achievement was measured through the Functional Independence Measure and Goal Attainment Scale. These measures were repeated in phase two. Nested within phase two was qualitative data collection. Interviews were conducted with eight participants and a focus group held with three programme facilitators, to gather their perceptions of the training process. Descriptive statistics were used to analyse and report quantitative data and thematic analysis was used to combine qualitative data from the two participant groups. Results Post intervention, the mean Wheelchair Skills Test Questionnaire score increased in performance (42.3 ± 13.4), confidence (33.9 ± 20.7) and frequency (33.9 ± 27.3). Goal Attainment was achieved or exceeded by 91% of all participants. Four themes were developed from qualitative data including, “motivators driving learning,” “delivery methods, structure and profile of the Wheelchair Skills Training Program,” “managing risk and safety” and “confidence in wheelchair use.” Conclusions The pilot study found that The Wheelchair Skills Training Program can improve wheelchair performance, confidence and frequency to support enhanced safety, independence and quality of life for people with lower limb amputations.
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Affiliation(s)
- Kimberly Charlton
- Central Adelaide Local Health Network, Department of Health and Wellbeing, South Australian Government, Hampstead Rehabilitation Centre, Lightsview, South Australia, Australia.,Allied Health Science and Human Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carolyn Murray
- Allied Health and Human Performance, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
| | - Rose Boucaut
- Allied Health and Human Performance, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
| | - Angela Berndt
- Allied Health and Human Performance, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
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Effectiveness of Group Wheelchair Maintenance Training for People with Spinal Cord Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 103:790-797. [PMID: 34174224 DOI: 10.1016/j.apmr.2021.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of group wheelchair maintenance training and investigate participant characteristics associated with responsiveness to training. DESIGN Randomized controlled trial with an immediate group and a waitlist control group (WLCG) who received the intervention after a 6-month delay. SETTING Four Spinal Cord Injury Model Systems Centers. PARTICIPANTS Manual (MWC; n=80) and power wheelchair (PWC; n=67) users with spinal cord injury (N=147). INTERVENTIONS Two 90-minute structured wheelchair maintenance training program classes with 12-20 people per class and separate classes for MWC and PWC users. Each class included in-person hands-on demonstrations and practice of wheelchair maintenance. MAIN OUTCOME MEASURES Separate analysis was completed for MWC and PWC users using the Wheelchair Maintenance Training Questionnaire (WMT-Q) capacity (ability to complete), performance (frequency of completion) and knowledge at baseline, 1 month, 6 months, 6 months pretraining (WLCG only), and 1 year (immediate only). RESULTS After the intervention, participants in both the immediate and WLCG improved in maintenance capacity (MWC and PWC, P<.001) and performance (MWC and PWC, P<.001) with training. Only PWC users improved knowledge of wheelchair maintenance (P<.001). For both WLCGs (MWC and PWC), there was no difference between the 6-month pretraining time point and baseline. MWC users who responded to training had lower WMT-Q scores for all domains, whereas this was only the case for knowledge for PWC users. CONCLUSIONS Group wheelchair skills training is effective at improving capacity to complete maintenance and performance of maintenance activities for MWC and PWC users, even in a cohort of experienced wheelchair users. For MWC users, improvements were tied to lower WMT-Q scores at baseline, whereas PWC users improved in capacity and performance independent of baseline score. Delivering this training in a structured group format has a lower cost, which might improve adoption into clinical practice.
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13
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Worobey LA, Kirby RL, Cowan RE, Dyson-Hudson TA, Shea M, Heinemann AW, Pedersen JP, Boninger ML. Efficacy of a Remote Train-the-Trainer Model for Wheelchair Skills Training Administered by Clinicians: A Cohort Study with Pre- vs. Post-Training Comparisons. Arch Phys Med Rehabil 2021; 103:798-806. [PMID: 34090853 DOI: 10.1016/j.apmr.2021.03.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypotheses that remote training improves trainer confidence and, when these trainers train others, the capacity and confidence of the trainees improves. DESIGN Cohort study with pre- vs post-training comparisons. SETTING Four Spinal Cord Injury Model Systems Centers. PARTICIPANTS Convenience sample of 7 clinician trainers and 19 able-bodied trainees. INTERVENTION Part 1 focused on trainer skill acquisition with self-study of the Wheelchair Skills Program Manual and instructional videos focused on motor learning, spotting, and 10 intermediate and advanced wheelchair skills. Trainers practiced in pairs, receiving asynchronous feedback on video-recordings from a remote instructor. Part 2 included additional video modules targeted at "how to" assess and train others in four wheelchair skills: gets over obstacle, ascends low curb, ascends high curb with caregiver assistance, and performs stationary wheelie. Upon completion, the trainers each provided 1:1 in-person training for 2-3 trainees. MAIN OUTCOME MEASURES Trainer confidence was assessed using the Self-Efficacy on Assessing, Training, and Spotting (SEATS) Test for Manual Wheelchairs. Trainee capacity ("Can you do it?") and confidence ("How confident are you?") were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q). RESULTS Trainer confidence increased for assessment (p=0.003) and training (p=0.002), but not spotting (p=0.056). Trainee 4-item median [IQR] WST-Q scores significantly increased with training for capacity (13% [6,31] to 88% [75,88], p < 0.001) and confidence (13% [0,31] to 88% [81,100], p < 0.001). CONCLUSIONS Remote training improves trainers' confidence with respect to wheelchair-skills testing and training, and the wheelchair-skills capacity and confidence of their trainees.
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Affiliation(s)
- Lynn A Worobey
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA.
| | - R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, NS, Canada
| | - Rachel E Cowan
- Department of Physical Medicine & Rehabilitation, University of Alabama, Birmingham, AB
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Mary Shea
- Kessler Institute for Rehabilitation, West Orange, NJ
| | - Allen W Heinemann
- Feinberg School of Medicine, Northwestern University, Chicago, IL; Shirley Ryan Ability Lab, Chicago, IL
| | | | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA
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14
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Quinby E, McKernan G, Eckstein S, Joseph J, Dicianno BE, Cooper RA. The voice of the consumer: A survey of consumer priorities to inform knowledge translation among Veterans who use mobility assistive technology. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2021. [DOI: 10.3138/jmvfh-2019-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
LAY SUMMARY Mobility assistive technology (AT) can improve the lives of people with disabilities by helping them get around in their communities. Today, over 23.9 million Americans use a wheelchair or assistive device, and over 85,000 wheelchairs, scooters, or other mobility devices are provided to Veterans each year. In order to find out how people learn about AT to improve efforts to disseminate information about AT, a survey of people who use mobility AT was conducted. The majority of people who completed the survey were Veterans (82%). It was determined that these people most often learned about AT through other users and/or from Veterans and the Internet, and that some people wish to receive information in other ways. Researchers can use these findings to better reach the people who could benefit from the new mobility AT they are creating.
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Affiliation(s)
- Eleanor Quinby
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Gina McKernan
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Stacy Eckstein
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - James Joseph
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Brad E. Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Rory A. Cooper
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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15
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Field-Fote EC. Therapeutic Interventions to Improve Mobility with Spinal Cord Injury Related Upper Motor Neuron Syndromes. Phys Med Rehabil Clin N Am 2020; 31:437-453. [PMID: 32624104 DOI: 10.1016/j.pmr.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mobility is essential for quality of life and social participation. Some individuals with spinal cord injury have sufficient residual lower extremity motor control to walk. Improving walking function incorporates practice and training, and assistive devices or stimulation to augment function and balance. Overground robotic exoskeletons may have the potential to transform upright mobility in the future. Most individuals with spinal cord injury use a wheelchair for at least some of their mobility needs. Wheelchair skills training can open up new possibilities for participation. Regardless of the means of mobility, developing habits that protect joint health are essential for optimal lifelong mobility.
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Affiliation(s)
- Edelle C Field-Fote
- Spinal Cord Injury Research, Crawford Research Institute, Shepherd Center, 2020 Peachtree Road Northwest, Atlanta, GA 30309, USA; Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA; Georgia Institute of Technology, School of Biological Sciences, Atlanta, GA, USA.
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16
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Effects of Motor Skill-Based Training on Wheelchair Propulsion Biomechanics in Older Adults: A Randomized Controlled Trial. Arch Phys Med Rehabil 2019; 101:1-10. [PMID: 31493382 DOI: 10.1016/j.apmr.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/12/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify whether motor skill-based training improves wheeling biomechanics in older adults and whether transfer or retention occurs. DESIGN Randomized controlled trial. SETTING Human mobility laboratory. PARTICIPANTS Able-bodied older adults 50 years and older deemed ready to participate in physical activity (N=34). INTERVENTION Participants were randomized to 1 of 3 groups: experimental group with 6 motor skill-based training sessions, active control group with dose-matched uninstructed practice, and the inactive control group (no training or practice). The experimental group's training sessions consisted of two 5-minute blocks of wheelchair propulsion training, separated by a 5-minute break, for a total of 60 minutes of wheeling. Breaks included education and discussion related to wheelchair propulsion. Training focused on increasing push angle, decreasing push frequency, decreasing negative braking forces, and using a circular wheeling pattern with smooth pushes. MAIN OUTCOME MEASURES Temporal spatial and kinetic variables (ie, push angle, push frequency, total and tangential forces, negative force) were evaluated during steady-state wheeling and biomechanical variables were assessed with the SmartWheel Clinical Protocol to identify transfer. RESULTS The training group significantly increased push angle and decreased push frequency compared with the practice (P<.05) and control groups (P<.05), which were retained over time and transferred to overground wheeling on tile (P≤.05). The dose-matched practice group did not differ from the inactive control group for any variables (P>.05). CONCLUSIONS Older adults improve select biomechanical variables following motor skill-based training, which are retained over time and transfer to overground wheeling. Participants in the active control group did not improve with uninstructed practice compared with the inactive control group.
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17
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Sol ME, de Groot JF, Zwinkels M, Visser-Meily JMA, Kruitwagen CLJJ, Verschuren O. Utrecht Pediatric Wheelchair Mobility Skills Test: Reliability, Validity, and Responsiveness in Youths Using a Manual Wheelchair. Phys Ther 2019; 99:1098-1106. [PMID: 30939199 DOI: 10.1093/ptj/pzz061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 01/01/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The assessment of wheelchair mobility skills (WMS) in youths using a manual wheelchair is important. More information is needed regarding the psychometric properties of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST). OBJECTIVE The purpose of this study was to evaluate the reliability, content validity, construct validity, and responsiveness of the UP-WMST 2.0 in youths using a manual wheelchair. DESIGN This was a repeated-measurements, cross-sectional study. METHODS A total of 117 children and adolescents who use a manual wheelchair participated in this study. The UP-WMST 2.0 contains the same 15 WMS items as the original UP-WMST but has an adaptation of the scoring method. Test-retest reliability was estimated in 30 participants. Content validity was assessed through floor and ceiling effect analyses. Construct validity was assessed through hypothesis testing. Preliminary estimates of responsiveness were assessed in 23 participants who participated in a WMS training program. RESULTS Test-retest reliability analysis showed weighted Cohen kappa coefficients ranging from 0.63 to 0.98 for all but 1 item. The total UP-WMST 2.0 score had an intraclass correlation coefficient of 0.97. No floor or ceiling effects were detected. Independent-sample t test analysis confirmed our hypotheses regarding direction and difference in scores between age and diagnostic groups. Within-group analysis in the responsiveness study showed a positive significant change in UP-WMST 2.0 score (8.3 points). LIMITATIONS The small sample size used in the responsiveness study was a limitation of this study. CONCLUSIONS This study provided evidence of the test-retest reliability, content, and construct validity of the UP-WMST 2.0. It also provided initial evidence of the responsiveness of the UP-WMST 2.0 for measuring change in WMS in youths using a manual wheelchair.
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Affiliation(s)
- Marleen E Sol
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Janke F de Groot
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht; and Netherlands Institute for Healthcare Services Research (NIVEL), Utrecht, the Netherlands
| | - Maremka Zwinkels
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht; and De Hoogstraat Rehabilitation
| | - J M Anne Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht; Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht; and De Hoogstraat Rehabilitation
| | - Cas L J J Kruitwagen
- Department of Biostatistics and Research Support, Julius Center, University Medical Center Utrecht
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht; and De Hoogstraat Rehabilitation
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18
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Influence of Peer-led Wheelchair Training on Wheelchair Skills and Participation in Older Adults: Clinical Outcomes of a Randomized Controlled Feasibility Trial. Arch Phys Med Rehabil 2019; 100:1023-1031. [DOI: 10.1016/j.apmr.2018.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/27/2018] [Accepted: 10/18/2018] [Indexed: 11/18/2022]
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19
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Divanoglou A, Trok K, Jörgensen S, Hultling C, Sekakela K, Tasiemski T. Active Rehabilitation for persons with spinal cord injury in Botswana - effects of a community peer-based programme. Spinal Cord 2019; 57:897-905. [PMID: 31127198 DOI: 10.1038/s41393-019-0300-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective cohort study with a repeated measures analysis. OBJECTIVES To measure the effects of the Active Rehabilitation (AR) training programme for community-dwelling individuals with spinal cord injury (SCI) in Botswana on physical independence, wheelchair mobility, self-efficacy, life satisfaction, level of physical activity and community participation. SETTING The inaugural AR training programme in Botswana, a community peer-based programme for people with SCI. The 10-day residential programme in Botswana was led by an international team of peer mentors and health professionals. METHODS Participants with SCI (on average 4 years after injury) completed a survey comprising a battery of standardised outcome measures at three timepoints: at the start, on completion and at 5 months after the programme (n = 14). Participants also completed a practical wheelchair skills test at start and completion of the programme (n = 17). RESULTS Participants improved in the mobility subscale of the Spinal Cord Independence Measure Self Report on completion (p = 0.011, d = 0.85) and at 5-month follow-up (p = 0.005, d = 0.93) as compared to baseline. They also achieved moderate improvement in self-efficacy to manage their condition (physical function domain of Moorong Self-Efficacy Scale) and large improvements in wheelchair mobility as assessed through the Queensland Evaluation of Wheelchair Skills test and the Wheelchair Skills Test Questionnaire. All positive results were retained at 5-month follow-up. CONCLUSIONS Findings indicate that the peer-based programme AR can play an important role in promoting physical independence, wheelchair mobility and injury-management self-efficacy in community-dwelling individuals with SCI in Botswana.
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Affiliation(s)
- Anestis Divanoglou
- School of Health Sciences, University of Iceland, Reykjavik, Iceland. .,School of Health, Medical and Applied Sciences, Central Queensland University, Queensland, Australia.
| | | | - Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | | | | | - Tomasz Tasiemski
- Department of Adapted Physical Activity, Poznań University of Physical Education, Poznań, Poland
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20
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Lam JF, Gosselin L, Rushton PW. Use of Virtual Technology as an Intervention for Wheelchair Skills Training: A Systematic Review. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Self-management interventions for skin care in people with a spinal cord injury: part 2-a systematic review of use of theory and quality of intervention reporting. Spinal Cord 2018; 56:837-846. [PMID: 29795415 PMCID: PMC6128816 DOI: 10.1038/s41393-018-0136-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To examine use of theory and quality of reporting in skin care self-management interventions for people with SCI. SETTING International. METHODS The Theory Coding Scheme (TCS) and the Template for Intervention Description and Replication (TIDieR) checklist were applied by two independent researchers to 17 interventions identified in a systematic review of self-management interventions for skin care in people with SCI. RESULTS Six (35%) of the 17 interventions reviewed were reported to have a theoretical basis. Theories used included three of the most commonly featured in health behavior research (the Health Belief Model, Social Cognitive Theory, and the Transtheoretical Model). In these six interventions, theory was used to design content but not to select participants or tailor strategies. None of the interventions were used to test theories in the SCI population, or to propose theoretical refinements. Reporting quality was found to vary by TIDieR item, with 6-100% of interventions including recommended information. Information on two intervention fidelity items was missing in 53 and 82% of descriptions. CONCLUSIONS Use of theory and reporting quality in SCI self-management research remains suboptimal, potentially slowing down advancements in this area of research. Rehabilitation researchers should direct their efforts toward improving these practices to help build a science of SCI self-management that is cumulative and reproducible by clinicians, scientists, and policy makers. SPONSORSHIP This work was funded through a postdoctoral fellowship awarded to the first author by the Rick Hansen Institute.
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22
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Baron JS, Sullivan KJ, Swaine JM, Aspinall A, Jaglal S, Presseau J, White B, Wolfe D, Grimshaw JM. Self-management interventions for skin care in people with a spinal cord injury: part 1-a systematic review of intervention content and effectiveness. Spinal Cord 2018; 56:823-836. [PMID: 29802393 PMCID: PMC6128818 DOI: 10.1038/s41393-018-0138-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
Abstract
Study design Systematic review. Objectives To review the content and effectiveness of skin care self-management interventions for people with SCI. Setting International. Methods We searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied. Results In all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were “instructions on how to perform behavior” (16 interventions), “credible source” (12 interventions), and “social support (unspecified)” (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting. Conclusions There is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.
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Affiliation(s)
- Justine S Baron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Katrina J Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jillian M Swaine
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Arlene Aspinall
- Rick Hansen Institute, Vancouver, BC, Canada.,Vancouver General Hospital, Vancouver, BC, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Barry White
- Rick Hansen Institute, Vancouver, BC, Canada
| | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada.,University of Western Ontario, London, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Passuni D, Dalzotto E, F Gath C, Buffetti E, Elizalde M, Jarmoluk V, Russo MJ, Intruvini S, Olmos LE, Freixes O. Reliability of the Spanish version of the wheelchair skills test 4.2 for manual wheelchair users with spinal cord injury. Disabil Rehabil Assist Technol 2018; 14:788-791. [PMID: 29722580 DOI: 10.1080/17483107.2018.1463404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Study design: Cross-sectional.Objectives: The majority of people with a spinal cord injury (SCI) are dependent on wheelchair for their mobility. Approximately, 36% of wheelchair users reported that obstacles such as curbs, uneven terrain, flooring surfaces and thresholds were barriers to mobility. Several studies have shown that assessment and training of wheelchair skills leads to improvements in those skills. The purpose of our study was to translate the Wheelchair Skill Test (4.2) and its report form into Spanish and then determine the inter-rater reliability of the WST 4.2 for manual wheelchairs operated by their users.Setting: Rehabilitation Unit, FLENI Institute, Buenos Aires, Argentina.Methods: The translation was performed by a physical therapist with advanced English language skills and specialized in the treatment of SCI subjects. We administrated and video-recorded the WST 4.2 manual Spanish version in 11 SCI subjects. Two physical therapists received specific training for administering the test and scoring the record. The reliability of the total percentage WST score were statistically quantified by intraclass correlation coefficient (ICC).Results: ICC values for Interrater were 0.998 (p < .0001). 17 out of the 32 skills had a 100 percentage of agreement. Percentage of agreement in the three skills that presented less rating agreement was 73%, 81 % and 82 %, respectively.Conclusion: The results show that the Spanish version of WST 4.2 is a reliable assessment tool to evaluate the skills capacity of spinal cord manual wheelchair users.Implications for rehabilitationWheelchair users require a proficient management of various wheelchair skills to achieve maximum independence in daily life. Determining which wheelchair skills should be addressed during the rehabilitation process is of great importance for their correct training. The WST 4.2 is an appropriate assessment tool to determine the functional capacity of wheelchair users.Making available the WST 4.2 in the Spanish language and demonstrating its reliability in this language allows its use in the Spanish-speaking world. A reliable wheelchair skills test is needed in the Spanish language.
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Affiliation(s)
- Diego Passuni
- Physical Therapy Unit, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Elisa Dalzotto
- Physical Therapy Unit, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Christian F Gath
- Physical Therapy Unit, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Eliana Buffetti
- Physical Therapy Unit, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Milagros Elizalde
- Physical Therapy Unit, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Verónica Jarmoluk
- Physical Therapy Unit, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Maria J Russo
- Department of Neurology, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Silvia Intruvini
- Department of Neurology, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Lisandro E Olmos
- Department of Rehabilitation Medicine, FLENI Rehabilitation Institute, Buenos Aires, Argentina
| | - Orestes Freixes
- Physical Therapy Unit, FLENI Rehabilitation Institute, Buenos Aires, Argentina
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Keeler L, Kirby RL, Parker K, McLean KD, Hayden JA. Effectiveness of the Wheelchair Skills Training Program: a systematic review and meta-analysis .. Disabil Rehabil Assist Technol 2018; 14:391-409. [PMID: 29616832 DOI: 10.1080/17483107.2018.1456566] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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 < .0001) compared to no treatment, standard care or educational controls, a relative increase over baseline of 21.2%. Subgroup analyses showed that training was more effective for new wheelchair users. Retention of training effects was suggested by the absence of significant declines between tests post-training and at follow-up. The WSTP was found to have positive effects on some other outcomes. No serious adverse events were reported. 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.
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Affiliation(s)
- Laura Keeler
- a Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada
| | - R Lee Kirby
- a Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada.,b Division of Physical Medicine and Rehabilitation, Department of Medicine , Dalhousie University , Halifax , NS , Canada
| | - Kim Parker
- c Assistive Technology Program, Nova Scotia Health Authority , Halifax , NS , Canada
| | - Katie D McLean
- d Library Services , Nova Scotia Health Authority , Halifax , NS , Canada
| | - Jill A Hayden
- a Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada
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Bazant ES, Himelfarb Hurwitz EJ, Onguti BN, Williams EK, Noon JH, Xavier CA, Garcia FDS, Gichangi A, Gabbow M, Musakhi P, Lee Kirby R. Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines. Afr J Disabil 2017; 6:318. [PMID: 29134178 PMCID: PMC5675920 DOI: 10.4102/ajod.v6i0.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/03/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The World Health Organisation recommends that services accompany wheelchair distribution. This study examined the relationship of wheelchair service provision in Kenya and the Philippines and wheelchair-use-related outcomes. METHOD We surveyed 852 adult basic manual wheelchair users. Participants who had received services and those who had not were sought in equal numbers from wheelchair-distribution entities. Outcomes assessed were daily wheelchair use, falls, unassisted outdoor use and performance of activities of daily living (ADL). Descriptive, bivariate and multivariable regression model results are presented. RESULTS Conditions that led to the need for a basic wheelchair were mainly spinal cord injury, polio/post-polio, and congenital conditions. Most Kenyans reported high daily wheelchair use (60%) and ADL performance (80%), while these practices were less frequent in the Philippine sample (42% and 74%, respectively). Having the wheelchair fit assessed while the user propelled the wheelchair was associated with greater odds of high ADL performance in Kenya (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1) and the Philippines (OR 2.8, 95% CI 1.8, 4.5). Wheelchair-related training was associated with high ADL performance in Kenya (OR 3.2, 95% CI 1.3, 8.4). In the Philippines, training was associated with greater odds of high versus no daily wheelchair use but also odds of serious versus no falls (OR 2.5, 95% CI 1.4, 4.5). CONCLUSION Select services that were associated with some better wheelchair use outcomes and should be emphasised in service delivery. Service providers should be aware that increased mobility may lead to serious falls.
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Affiliation(s)
| | | | | | | | | | | | - Ferdiliza D S Garcia
- College of Allied Medical Professions, University of the Philippines, Manila, Philippines
| | | | - Mohammed Gabbow
- National Council for Persons With Disabilities, Government of Kenya, Kenya
| | - Peter Musakhi
- Ministry of East African Community (EAC), Labour and Social Protection, Government of Kenya, Kenya
| | - R Lee Kirby
- Division of Physical Medicine & Rehabilitation, Dalhousie University, Canada
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Sawatzky B, Mortenson WB, Wong S. Learning to use a rear-mounted power assist for manual wheelchairs. Disabil Rehabil Assist Technol 2017; 13:772-776. [DOI: 10.1080/17483107.2017.1375562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bonita Sawatzky
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Faculty of Medicine and VCH Research Institute, Vancouver, Canada
| | - W. Ben Mortenson
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Faculty of Medicine and VCH Research Institute, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Vancouver Coastal Health (VCH) Research Institute, Vancouver, Canada
| | - Stephanie Wong
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Williams E, Hurwitz E, Obaga I, Onguti B, Rivera A, Sy TRL, Kirby RL, Noon J, Tanuku D, Gichangi A, Bazant E. Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:22. [PMID: 28818075 PMCID: PMC5561585 DOI: 10.1186/s12914-017-0130-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study's purpose was to describe wheelchair users' experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines. METHODS Local researchers in Nairobi and Manila interviewed 48 adult basic wheelchair users, with even distribution of those who had and had not received wheelchair services along with their wheelchair. Recordings were transcribed in the local language and translated into English. The study team coded transcripts for predetermined and emergent themes, using Atlas-ti software. A qualitative content analysis approach was taken with the WHO service delivery process as an organizing framework. RESULTS Wheelchair users frequently described past experiences with ill-fitting wheelchairs and little formal training to use wheelchairs effectively. Through exposure to multiple wheelchairs and self-advocacy, they learned to select wheelchairs suitable for their needs. Maintenance and repair services were often in short supply. Participants attributed shorter duration of wheelchair use to lack of repair. Peer support networks emerged as an important source of knowledge, resources and emotional support. Most participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for, and despite challenges, they were grateful to have some means of mobility. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support. CONCLUSIONS Interventions are needed to provide wheelchairs services efficiently, at scale, in an environment facilitating physical access and peer support, and reduced social stigma. TRIAL REGISTRATION Not applicable since this was a descriptive study.
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Affiliation(s)
- Emma Williams
- Jhpiego, 1615 Thames St, Baltimore, MD 21231-3492 USA
| | | | - Immaculate Obaga
- Jhpiego, 14 Riverside (Off Riverside Drive) Arlington Block, 2nd Floor, P.O Box 66119-00800, Nairobi, Kenya
| | - Brenda Onguti
- Jhpiego, 14 Riverside (Off Riverside Drive) Arlington Block, 2nd Floor, P.O Box 66119-00800, Nairobi, Kenya
| | - Adovich Rivera
- Institute of Health Policy and Development Studies, University of Philippines, Room 105, National Institutes of Health Building, 623 Pedro Gil St., Ermita, 1000 Manila, Philippines
| | - Tyrone Reden L. Sy
- Institute of Health Policy and Development Studies, University of Philippines, Room 105, National Institutes of Health Building, 623 Pedro Gil St., Ermita, 1000 Manila, Philippines
| | - R. Lee Kirby
- Dalhousie University, c/o Room 206, Nova Scotia Rehabilitation Centre Site, 1341 Summer Street, Halifax, NS B3H 4K4 Canada
| | - Jamie Noon
- Noon Design, Box 208, Cerrillos, NM 87010 USA
| | - Deepti Tanuku
- Jhpiego, 1615 Thames St, Baltimore, MD 21231-3492 USA
| | - Anthony Gichangi
- Jhpiego, 14 Riverside (Off Riverside Drive) Arlington Block, 2nd Floor, P.O Box 66119-00800, Nairobi, Kenya
| | - Eva Bazant
- Jhpiego, 1615 Thames St, Baltimore, MD 21231-3492 USA
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Kirby RL, Mitchell D, Sabharwal S, McCranie M, Nelson AL. Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial. PLoS One 2016; 11:e0168330. [PMID: 28002472 PMCID: PMC5176312 DOI: 10.1371/journal.pone.0168330] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group. METHODS We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30-45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores. RESULTS Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021). CONCLUSIONS Individualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.
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Affiliation(s)
- R. Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Doug Mitchell
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, United States of America
| | - Sunil Sabharwal
- Veterans Administration Boston Health Care System and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark McCranie
- Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Audrey L. Nelson
- Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, College of Public Health, University of South Florida, Tampa, Florida, United States of America
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Chen Y, Heinemann AW. Current Research Outcomes From the Spinal Cord Injury Model Systems. Arch Phys Med Rehabil 2016; 97:1607-9. [DOI: 10.1016/j.apmr.2016.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 12/11/2022]
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