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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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Ossada VAY, Souza JG, Cruz DMC, Campos LCB, Medola FO, Costa VDSP. Cross-cultural adaptation of wheelchair skills test (version 4.3) for wheelchair users and caregivers to the Portuguese language (Brazil). Disabil Rehabil Assist Technol 2019; 15:491-498. [PMID: 31145013 DOI: 10.1080/17483107.2019.1604826] [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] [Indexed: 10/26/2022]
Abstract
Objective: To perform cross-cultural adaptation of the Wheelchair Skills Test of manual wheelchair users and their caregivers into the Brazilian Portuguese language.Methods: The study was composed of translation, synthesis of translations, back-translation, review by an expert committee and pre-test, when the test was applied in the target population. Included were translators, subject specialists and coordinators to carry out the cross-cultural adaptation process, and manual wheelchair users and their caregivers with at least six months of wheelchair experience for the pre-test.Results: Forty-three people participated in the study, 30 for the pre-test and 13 for the stages that preceded the pre-test. The mean age of manual wheelchair users was 40.2 (±10.7) years and of caregivers was 44.2 (±15.7) years. Of the 47 phrases translated in the first stage, 36 discrepancies were found and resolved. During the analysis by the committee of experts the instrument underwent 13 modifications in order to achieve the best possible equivalence between the original version and the final version and was understandable by the people evaluated. The total pre-test scores of wheelchair users and their caregivers were 66.2 (±24.6) and 88.7 (±14.2), respectively.Conclusions: This instrument was able to evaluate the abilities of wheelchair users and their caregivers in Brazil, as well as being useful for training in rehabilitation programs.Implications for rehabilitationThe need to use wheelchair (WC) properly has made clinicians and rehabilitation professionals more concerned with assessing and training users' abilities with their WC.Cross-cultural adaptation allows for the linguistic modification of the original language of the evaluation tool into a new language and enables the comparison of research results in different countries.Immediate use of the instrument for WC users and caregivers in Brazil, both for evaluation and for training, is necessary and may be a means for rehabilitation professionals to improve their evaluations, their treatments and optimize the skills that aim at independence.
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Affiliation(s)
- Vinícius Aparecido Yoshio Ossada
- Department of Physiotherapy, Universidade Pitágoras Unopar (UNOPAR), Londrina, Brazil.,Department of Physiotherapy, Centro Universitário Filadélfia (UniFil), Londrina, Brazil
| | - Jônatas Garcia Souza
- Department of Physiotherapy, Universidade Pitágoras Unopar (UNOPAR), Londrina, Brazil
| | | | | | - Fausto Orsi Medola
- Department of Design, Universidade Estadual Paulista (UNESP), Bauru, Brazil
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Ribeiro Neto F, Costa RRG, Carregaro RL. The addition of three new items in the Adapted Manual Wheelchair Circuit improves the discrimination between different levels of spinal cord injury. Physiother Theory Pract 2019; 36:1329-1339. [PMID: 30686099 DOI: 10.1080/09593985.2019.1571139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To determine whether the inclusion of three additional items improved the discriminative capacity of the Adapted Manual Wheelchair Circuit (AMWC). Design: Cross-sectional study. Methods: A total of 126 men (median age 28.9 years [percentiles 25 and 75: 23.7; 38.5 years]) with spinal cord injury were consecutively enrolled and divided into three subgroups: high paraplegia (HP), medium paraplegia (MP), and low paraplegia (LP). The participants performed the AMWC with three additional items. Ability score and total time of AMWC (AMWCAS and AMWCTT) and AMWC plus the three additional items (AMWC+3AS and AMWC+3TT), 3 min of overground wheeling test and performance score were evaluated. Results: AMWC was not able to discriminate HP from MP and LP (Wilks' lambda = 0.93; P= 0.07). In contrast, AMWC+3 was able to discriminate between the three subgroups (Wilks' lambda = 0.86; P≤ 0.05). AMWC+3AS presented a better sensitivity compared to AMWCAS (lower success rate for all subgroups, 38.5% vs. 82.1% for HP; 49.0% vs. 75.5% for MP; 78.9% vs. 94.7% for LP). The LP group presented a significant higher AMWC+3AS compared to MP and HP (17.0 vs. 16.5 and 16.5, respectively, P≤ 0.05). AMWC+3TT was significantly lower in LP compared to MP and HP (139.85 s vs. 242.52 s and 326.21 s, respectively, P≤ 0.05). Conclusion: The AMWC+3 outcomes were able to discriminate between HP, MP, and LP subgroups, and the addition of the three items enhanced the sensitivity of the wheelchair circuit. The performance of LP was more evident with significant differences compared to HP and MP for all AMWC+3 outcomes.
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Affiliation(s)
- Frederico Ribeiro Neto
- College of Physical Education, Universidade de Brasilia (UnB) , Brasília/DF, Brazil.,Spinal Cord Injury Department , SARAH Rehabilitation Hospital Network/SARAH Brasilia , Brasilia/DF, Brazil
| | | | - Rodrigo Luiz Carregaro
- College of Physical Education, Universidade de Brasilia (UnB) , Brasília/DF, Brazil.,School of Physical Therapy, Universidade de Brasilia (UnB) , Brasília/DF, Brazil
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Sol ME, Verschuren O, de Groot L, de Groot JF. Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise. BMC Pediatr 2017; 17:51. [PMID: 28193204 PMCID: PMC5307781 DOI: 10.1186/s12887-017-0809-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 02/07/2017] [Indexed: 12/01/2022] Open
Abstract
Background Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents. Methods Mixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the ‘COnsensus-based Standards for the selection of health Measurement Instruments’ (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing. Results Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons. Conclusions The newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0809-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marleen Elisabeth Sol
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, Utrecht, 3501 AA, The Netherlands. .,Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. .,De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | | | - Janke Frederike de Groot
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, Utrecht, 3501 AA, The Netherlands.,Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Effects of Seated Postural Stability and Trunk and Upper Extremity Strength on Performance during Manual Wheelchair Propulsion Tests in Individuals with Spinal Cord Injury: An Exploratory Study. Rehabil Res Pract 2016; 2016:6842324. [PMID: 27635262 PMCID: PMC5007374 DOI: 10.1155/2016/6842324] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/17/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation.
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Sprigle S, Huang M, Lin JT. Inertial and frictional influences of instrumented wheelchair wheels. J Rehabil Assist Technol Eng 2016; 3:2055668316649892. [PMID: 31186904 PMCID: PMC6453031 DOI: 10.1177/2055668316649892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 04/06/2016] [Indexed: 11/15/2022] Open
Abstract
Background Instrumented wheelchair wheels can be used to study the kinematics and
kinetics of manual wheelchair propulsion. The objective of this study was to
evaluate the impact of instrumented wheels on the inertial and frictional
parameters of a wheelchair system. Methods This study compared mechanical parameters of an ultralightweight rigid frame
wheelchair configured with pairs of SMARTwheels and spoke pneumatic wheels
and loaded with an ISO 75 kg wheelchair dummy. Rectilinear and turning
inertia of the occupied wheelchair and the rotational inertia of drive
wheels were measured. A coast-down test measured frictional energy loss
during straight and turning trajectories. Findings The addition of instrumented wheels increased occupied system mass by about
6% and turning inertia by about 16%. Frictional energy loss increased by
over 40% in a straight trajectory and over 30% during turning. Interpretation Addition of instrumented increased the inertia and frictional energy loss of
the wheelchair system. These relative effects will impact the wheelchair
operator and increase the instantaneous propulsion torque during wheelchair
maneuvers. The impacts will be less under conditions involving little or no
change in velocity. Researchers should be encouraged to report changes in
mass and weight distribution induced by addition of instrumented wheelchair
wheels.
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Affiliation(s)
- Stephen Sprigle
- Stephen Sprigle, PhD, PT, Rehabilitation
Engineering and Applied Research Lab, Georgia Institute of Technology, 490 Tenth
Street NW, Atlanta, GA 30332-0156, USA.
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Gagnon DH, Roy A, Verrier MC, Duclos C, Craven BC, Nadeau S. Do Performance-Based Wheelchair Propulsion Tests Detect Changes Among Manual Wheelchair Users With Spinal Cord Injury During Inpatient Rehabilitation in Quebec? Arch Phys Med Rehabil 2016; 97:1214-8. [PMID: 26987621 DOI: 10.1016/j.apmr.2016.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 01/19/2016] [Accepted: 02/25/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To quantify and compare the responsiveness and concurrent validity of 3 performance-based manual wheelchair propulsion tests among manual wheelchair users with subacute spinal cord injury (SCI) undergoing inpatient rehabilitation. DESIGN Quasi-experimental repeated-measures design. SETTING Publicly funded comprehensive inpatient SCI rehabilitation program. PARTICIPANTS Consenting adult manual wheelchair users with a subacute SCI admitted and discharged from inpatient rehabilitation (N=14). INTERVENTION Participants performed 20-m propulsion at both self-selected natural and maximal speeds, the slalom, and the 6-minute propulsion tests at rehabilitation admission and discharge. MAIN OUTCOME MEASURES Time required to complete the performance-based wheelchair propulsion tests. Standardized response means (SRMs) were computed for each performance test and Pearson correlation coefficients (r) were calculated to explore the associations between performance tests. RESULTS The slalom (SRM=1.24), 20-m propulsion at maximum speed (SRM=.99), and 6-minute propulsion tests (SRM=.84) were the most responsive. The slalom and 20-m propulsion at maximum speed were strongly correlated at both admission (r=.93) and discharge (r=.92). CONCLUSIONS The slalom and 6-minute propulsion tests best document wheelchair propulsion performance change over the course of inpatient rehabilitation. Adding the 20-m propulsion test performed at maximal speed provides a complementary description of performance change.
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Affiliation(s)
- Dany H Gagnon
- Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, Montreal, QC, Canada; School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.
| | - Audrey Roy
- Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, Montreal, QC, Canada
| | - Molly C Verrier
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Lyndhurst Center, Toronto, ON, Canada; Department of Physical Therapy and Graduate Department of Rehabilitation Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cyril Duclos
- Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, Montreal, QC, Canada; School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
| | - B Cathy Craven
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Lyndhurst Center, Toronto, ON, Canada; Division of Physiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sylvie Nadeau
- Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, Montreal, QC, Canada; School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
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