Wheelchair skills tests: a systematic review

Measurement Properties of Clinical Instruments for Assessing Manual Wheelchair Mobility in Individuals with Spinal Cord Injury: A Systematic Review

OBJECTIVE

To evaluate the measurement properties of clinical instruments used to assess manual wheelchair mobility in individuals with spinal cord injury (SCI).

DATA SOURCES

This systematic review was conducted according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was conducted up to December 2021 on MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Biblioteca Regional de Medicina, and Cumulative Index to Nursing and Allied Health databases without time restriction.

STUDY SELECTION

Peer-reviewed original research articles that examined any clinical wheelchair mobility and/or skill assessment instrument among adults with SCI and reported data on at least one measurement property or described the development procedure were evaluated independently by two reviewers.

DATA EXTRACTION

Data were independently extracted according to Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. Measurement property results from each study were independently rated by two reviewers as sufficient, insufficient, indeterminate, or inconsistent. The evidence for each measurement property was rated as high, moderate, low, or very low (Grading of Recommendations, Assessment, Development, and Evaluation). Recommendations for highly-rated instruments were performed.

DATA SYNTHESIS

Twenty-nine studies with 21 instruments were identified. The methodological quality of studies ranged from insufficient to sufficient, and the quality of evidence ranged from very low to high. Six instruments reported content validity. Reliability and construct validity were the most studied measurement properties. Structural validity and invariance for cross-cultural measurement were not reported. The highly rated instruments were the Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire.

CONCLUSIONS

Although numerous instruments for assessing wheelchair mobility and/or skills among individuals with SCI were identified, not many measurement properties have been sufficiently established. The Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire show the current best potential to be recommended for clinical and research use. Further studies are needed to strengthen or change these recommendations.

Cross-cultural adaptation and reliability of the Brazilian version of the wheelchair skills test-questionnaire 4.3 for manual wheelchair users

The Wheelchair Skills Test-Questionnaire form for Manual Wheelchairs Operated by Wheelchair Users (WSTQ-M-WCU 4.3) assesses wheelchair skills that may influence users' occupational performance in their daily activities. The purpose of this study was to cross-culturally adapt the WSTQ-M-WCU 4.3 to Brazilian Portuguese and to examine the inter-rater and test-retest reliabilities. This is a methodological study of cross-cultural adaptation and psychometric properties of reliability. The agreement achieved in the cross-cultural adaptation concerning idiomatic, cultural, conceptual and semantic aspects was 100%, 99.2%, 100% and 96.18%, respectively. We analyzed the test-retest and inter-rater reliabilities in a convenience sample of 46 manual wheelchair users using Cronbach's Alpha and Bland-Altman plots. The Brazilian version has excellent internal consistency (α > 0.9) and strong inter-rater reliability (p < .05). This instrument can guide practitioners in training wheelchair skills, thus contributing to the planning of interventions and for evidence-based practice in Assistive Technology.

The effectiveness of community-based upper body exercise programs in persons with chronic paraplegia and manual wheelchair users: A systematic review

Context: Physical activity has been beneficial to health, functional independence and quality of life in individuals with spinal cord injury. However, there is no consensus concerning the effects of community-based upper-body exercise for people with paraplegia who use a manual wheelchair.Objective: Conduct a systematic review of evidence of upper-body exercise effects able to be developed in a community-setting, on both functional independence and quality of life, for individuals with chronic paraplegia who use a manual wheelchair.Methods: PubMed, Scopus, Ebsco, SportDiscus and Web of Science databases were browsed, searching for studies that combined words as paraplegia, exercise, functional independence and quality of life and their synonyms, published from January/1998 to December/2018 in English. PEDro scale and the Cochrane tool analyzed methodological quality and risk of bias, respectively.Results: Four studies were selected out of 4004. Studies conducted aerobic arm-ergometer and resistance training predominantly at home. Upper-limb functionality and wheelchair propulsion assessed functional independence, but only the first presented positive effects after resistance training. Resistance and aerobic arm-ergometer training seemed to improve health-related and subjective quality of life.Conclusion: Studies have shown low methodological quality and high risk of bias. Aerobic arm-ergometer and resistance training were the most upper-body exercises used. Resistance training improved functional independence while both types of exercise induced positive effects on quality of life. Future studies with uniform and high-quality methodology should be conducted with exercise in community-dwelling people with paraplegia who use a manual wheelchair.

Impact of the TEAM Wheels eHealth manual wheelchair training program: Study protocol for a randomized controlled trial

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.

[Psychometric properties of observational instruments to evaluate wheelchair skills in persons with a spinal cord injury: A systematic review]

A total of 60% of people with a spinal cord injury are completely dependent on a wheelchair. There is a wide variety of instruments that assess wheelchair skills, but they are not specific for this population. OBJECTIVE: To identify, assess, compare and summarize the psychometric properties of instruments that assess wheelchair skills in persons with a spinal cord injury. A systematic review was conducted and observational instruments were included that assessed wheelchair skills in persons with spinal cord injury. Eleven articles were identified that evaluated eight instruments. Most of them reported activities according to the International Classification of Functioning, Disability and Health. Reliability was the most frequently evaluated psychometric property. The Queensland Evaluation of Wheelchair Skills and the Adapted Manual Wheelchair Circuit had the best degrees of confidence in the evidence, and their application could guide the selection of pertinent therapeutic strategies. PROSPERO registration: CRD42020161430.

A study on the effects of modified wheelchair skills program (WSP) for hemiplegic clients

The purpose of this study was to evaluate the modified WSP for improving wheelchair skills capacity, perceived satisfaction and performance in daily activities for hemiplegia patients in Korea. The modified WSP was tailored to better fit the environment and the treatment needs of hemiplegic patients in Korea. The resulting training procedure was augmented to help hemiplegic patients understand the basic mechanics of the wheelchair. To assess the efficacy of the modified WSP, 24 hemiplegic patients were selected as subjects and WST, COPM, K-MBI, and subjective opinion surveys were utilized. The results of the training showed significant improvement of WST, COPM, K-MBI scores in the experimental group and especially, the WST and COPM score showed statistically insignificant improvement compared to the control group. A modified WSP may prove effective for hemiplegic patients who exhibit low volition or are experiencing wheelchair use for the first time.

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

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.

A scoping review of powered wheelchair driving tasks and performance-based outcomes

Introduction: Wheelchairs and scooters promote participation and have positive effects on quality of life. However, powered wheelchairs (PW) use can be challenging and can pose safety concerns. Adequate PW assessment and training is important. There is a wide variety of tasks and PW driving assessment measures used for training and assessing PW driving ability in the literature and little consensus as to which tasks and outcomes are the most relevant. A scoping review of the literature was performed in order to characterize this extensive variety of tasks and performance-based outcomes used for training and assessing PW skills.Methods: A search of the literature was conducted in January 2017. Four databases were searched: CINAHL, Embase, PsycInfo and Medline. Articles were included if they contained at least one PW driving task.Results: 827 articles were screened and 48 articles were retained. PW driving tasks from each article were identified and categorized in terms of the environment in which they were performed: Driving in a controlled environment, ecological driving tasks, 2D virtual environment (VE) tasks, 3D VE tasks. The assessment measures formed a separate category. Subjective and objective performance-based outcomes related to PW driving were also identified and grouped into outcomes assessing speed and outcomes assessing accuracy.Conclusion: This scoping review provides an overview of tasks and performance outcomes used in the literature when training and assessing PW skills. The results of this review could guide future research when choosing appropriate tasks and performance outcomes for PW driving ability.Implications for rehabilitationThere is wide variety of tasks and performance-based outcomes for PW driving.Results showed that available assessment measures are not commonly used in research and that tasks used often lacked consistency across studies.New methods to measure the interaction of speed and accuracy are needed.The contents of this review could be used by researchers as a starting point when designing a PW task and selecting appropriate performance-based outcomes.

The addition of three new items in the Adapted Manual Wheelchair Circuit improves the discrimination between different levels of spinal cord injury

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 (AMWC_AS and AMWC_TT) and AMWC plus the three additional items (AMWC+3_AS and AMWC+3_TT), 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+3_AS presented a better sensitivity compared to AMWC_AS (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+3_AS compared to MP and HP (17.0 vs. 16.5 and 16.5, respectively, P≤ 0.05). AMWC+3_TT 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.

Cross-cultural validation of a Brazilian version of the adapted manual wheelchair circuit (AMWC-Brazil)

Purpose: To translate, culturally adapt and validate the Adapted Manual Wheelchair Circuit (AMWC) into Brazilian-Portuguese. Design: Cross-sectional study. Methods: Sixty-six men (median age of 30.5 years [percentiles 25 and 75: 24.0; 38.3 years]) with traumatic spinal cord injury were consecutively enrolled and divided into two groups: tetraplegia (TP) and paraplegia (PP). The participants performed the AMWC-Brazil and were evaluated by the Spinal Cord Injury Measure version III (SCIM-III). Translation, translation synthesis, back-translation, committee review and construct validity were adopted for the cross-cultural adaptation. Construct validity was performed by testing whether the test scores were significantly correlated (Spearman's correlation coefficient) to the subjects' injury level, age, time since injury, body mass index (BMI) and SCIM-III scale. Results: All the AMWC-Brazil's outcomes were significantly correlated with SCIM-III total score and subscales (P ≤ 0.01). However, when the analyses were stratified over injury level, only the TP showed a high correlation between the AMWC-Brazil's outcomes and the SCIM-III. For construct validity, 4 of 5 hypotheses were confirmed. Only BMI was not a significant predictor of the AMWC-Brazil outcomes. Conclusion: The AMWC was successfully translated to the Brazilian-Portuguese (AMWC-Brazil) and presented high and satisfactory construct validity.

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

DATA EXTRACTION

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

DATA SYNTHESIS

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

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

OBJECTIVE

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

DESIGN

Multicenter cross-sectional study.

SETTING

Rehabilitation centers and communities.

PARTICIPANTS

Participants (N=152) included caregivers (n=76) and wheelchair users (n=76).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Version 4.3 of the Wheelchair Skills Test (WST) and the Wheelchair Skills Test-Questionnaire (WST-Q). For each of the 30 individual skills, we recorded data about the wheelchair user alone and in combination (blended) with the caregiver.

RESULTS

The mean total WST capacity scores ± SD for the wheelchair users alone and blended were 78.1%±9.3% and 92.4%±6.1%, respectively, with a mean difference of 14.3%±8.7% (P<.0001). The mean WST-Q capacity scores ± SD were 77.0%±10.6% and 93.2%±6.4%, respectively, with a mean difference of 16.3%±9.8% (P<.0001). The mean WST-Q confidence scores ± SD were 75.5%±12.7% and 92.8%±6.8%, respectively, with a mean difference of 17.5%±11.7% (P<.0001). The mean differences corresponded to relative improvements of 18.3%, 21.0%, and 22.9%, respectively. The nature and benefits of the caregivers' assistance could be summarized in 7 themes (eg, caregiver provides verbal support [cueing, coaching, reporting about the environment]).

CONCLUSIONS

Caregivers significantly enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance, and they do so in a variety of ways. These findings have significance for wheelchair skills assessment and training.

Detecting destabilizing wheelchair conditions for maintaining seated posture

PURPOSE

The purpose of this study was to detect and classify potentially destabilizing conditions encountered by manual wheelchair users with spinal cord injuries (SCI) to dynamically increase stability and prevent falls.

METHODS

A volunteer with motor complete T11 paraplegia repeatedly propelled his manual wheelchair over level ground and simulated destabilizing conditions including sudden stops, bumps and rough terrain. Wireless inertial measurement units attached to the wheelchair frame and his sternum recorded associated accelerations and angular velocities. Algorithms based on mean, standard deviation and minimum Mahalanobis distance between conditions were constructed and applied to the data off-line to discriminate between events. Classification accuracy was computed to assess effects of sensor position and potential for automatically selecting a dynamic intervention to best stabilize the wheelchair user.

RESULTS

The decision algorithm based on acceleration signals successfully differentiated destabilizing conditions and level over-ground propulsion with classification accuracies of 95.8, 58.3 and 91.7% for the chest, wheelchair and both sensors, respectively.

CONCLUSION

Mahalanobis distance classification based on trunk accelerations is a feasible method for detecting destabilizing events encountered by wheelchair users and may serve as an effective trigger for protective interventions. Incorporating data from wheelchair-mounted sensors decreases the false negative rate. Implications for Rehabilitation SCI has a significant impact on quality of life, compromising the ability to participate in social or leisure activities, and complete other activities of daily living for an independent lifestyle. Using inertial measurement units to build an event classifier for control the actions of a neuroprosthetic device for maintaining seated posture in wheelchair users. Varying muscle activation increases user stability reducing the risk of injury.

Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise

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.

Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial

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.

Wheeled mobility skills of wheelchair basketball players: a randomized controlled study

PURPOSE

The aim of this study was to assess the influence of wheelchair basketball sport on the functional abilities of wheelchair users.

METHOD

This is a randomized controlled study. Wheelchair basketball players (n = 111) and non-player (n = 85) were included in this study. We administered the questionnaire version of the wheelchair skills test questionnaire (WST_Q), recording the participants' capacity and performance scores on each of 32 skills.

RESULTS

Player group have the baseline values of WST_Q higher than control group. The mean total percentage score of player group was significantly greater than control group (p < 0.05). The get over 15 cm level (respectively, rations of capacity and performance of groups: player/control: 50.5-20% and 54.1-24.7%) and the ascends 10° incline (player/control 96.4-48.2% and 98.2-54.1%).

CONCLUSIONS

Participation in regular wheelchair basketball sport may preserve and augment functional abilities in with wheelchair user Implications for rehabilitation The skills-sports relationship is reciprocal. With increased wheelchair skills, people may be more inclined to engage in sports; subsequently, with greater sports, wheelchair skills could improve. Wheelchair mobility skills during clinical rehabilitation should reflect the daily activities and needs of each wheelchair user. WST-Q provides advantages in terms of requiring less time and material in using of clinical.

Do Performance-Based Wheelchair Propulsion Tests Detect Changes Among Manual Wheelchair Users With Spinal Cord Injury During Inpatient Rehabilitation in Quebec?

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.

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial

OBJECTIVES

To test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation centers and communities.

PARTICIPANTS

Powered wheelchair users (N=116).

INTERVENTION

Five 30-minute WSTP training sessions.

MAIN OUTCOME MEASURES

Assessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA).

RESULTS

There was no significant t2-t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3.

CONCLUSIONS

Powered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives

PURPOSE

The purpose of this project was to identify wheelchair skills currently being taught to new manual wheelchair users, identify areas of importance for manual wheelchair skills' training during initial rehabilitation, identify similarities and differences between the perspectives of health care professionals and manual wheelchair users and use the ICF to organize themes related to rehabilitation and learning how to use a manual wheelchair.

METHOD

Focus groups were conducted with health care professionals and experienced manual wheelchair users. ICF codes were used to identify focus group themes.

RESULTS

The Activities and Participation codes were more frequently used than Structure, Function and Environment codes. Wheelchair skills identified as important for new manual wheelchair users included propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain. Health care professionals and manual wheelchair users identified the need to incorporate the environment (home and community) into the wheelchair training program.

CONCLUSIONS

Identifying essential components for training the proper propulsion mechanics and wheelchair skills in new manual wheelchair users is an important step in preventing future health and participation restrictions. Implications for Rehabilitation Wheelchair skills are being addressed frequently during rehabilitation at the activity-dependent level. Propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain are important skills to address during wheelchair training. Environment factors (in the home and community) are important to incorporate into wheelchair training to maximize safe and multiple-environmental-setting uses of manual wheelchairs. The ICF has application to understanding manual wheelchair rehabilitation for wheelchair users and therapists for improving the understanding of manual wheelchair use.

Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings

PURPOSE

This study was conducted to compare the performance of three types of chairs in a low-resource setting. The larger goal was to provide information which will enable more effective use of limited funds by wheelchair manufacturers and suppliers in low-resource settings.

METHODS

The Motivation Rough Terrain and Whirlwind Rough Rider were compared in six skills tests which participants completed in one wheelchair type and then a day later in the other. A hospital-style folding transport wheelchair was also included in one test. For all skills, participants rated the ease or difficulty on a visual analogue scale. For all tracks, distance traveled and the physiological cost index were recorded. Data were analyzed using repeated measures analysis of variance.

RESULTS

The Motivation wheelchair outperformed Whirlwind wheelchair on rough and smooth tracks, and in some metrics on the tight spaces track. Motivation and Whirlwind wheelchairs significantly outperformed the hospital transport wheelchair in all metrics on the rough track skills test.

CONCLUSION

This comparative study provides data that are valuable for manufacturers and for those who provide wheelchairs to users. The comparison with the hospital-style transport chair confirms the cost to users of inappropriate wheelchair provision. Implications for Rehabilitation For those with compromised lower limb function, wheelchairs are essential to enable full participation and improved quality of life. Therefore, provision of wheelchairs which effectively enable mobility in the cultures and environments in which people with disabilities live is crucial. This includes low-resource settings where the need for appropriate seating is especially urgent. A repeated measures study to measure wheelchair performances in everyday skills in the setting where wheelchairs are used gives information on the quality of mobility provided by those wheelchairs. This study highlights differences in the performance of three types of wheelchairs often distributed in low-resource settings. This information can improve mobility for wheelchair users in those settings by enabling wheelchair manufacturers to optimize wheelchair design and providers to optimize the use of limited funds.

Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users

Elderly and aging manual wheelchair (MWC) users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review paper addresses important issues for preserving function and mobility for elderly and aging individuals who use a MWC by presenting the current available evidence and recommendations. These include recommendations for maximizing function, by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area.

Tests examining skill outcomes in sport: a systematic review of measurement properties and feasibility

BACKGROUND

A high level of participant skill is influential in determining the outcome of many sports. Thus, tests assessing skill outcomes in sport are commonly used by coaches and researchers to estimate an athlete's ability level, to evaluate the effectiveness of interventions or for the purpose of talent identification.

OBJECTIVE

The objective of this systematic review was to examine the methodological quality, measurement properties and feasibility characteristics of sporting skill outcome tests reported in the peer-reviewed literature.

DATA SOURCES

A search of both SPORTDiscus and MEDLINE databases was undertaken.

STUDY SELECTION

Studies that examined tests of sporting skill outcomes were reviewed. Only studies that investigated measurement properties of the test (reliability or validity) were included. A total of 22 studies met the inclusion/exclusion criteria.

STUDY APPRAISAL AND SYNTHESIS METHODS

A customised checklist of assessment criteria, based on previous research, was utilised for the purpose of this review.

RESULTS

A range of sports were the subject of the 22 studies included in this review, with considerations relating to methodological quality being generally well addressed by authors. A range of methods and statistical procedures were used by researchers to determine the measurement properties of their skill outcome tests. The majority (95%) of the reviewed studies investigated test-retest reliability, and where relevant, inter and intra-rater reliability was also determined. Content validity was examined in 68% of the studies, with most tests investigating multiple skill domains relevant to the sport. Only 18% of studies assessed all three reviewed forms of validity (content, construct and criterion), with just 14% investigating the predictive validity of the test. Test responsiveness was reported in only 9% of studies, whilst feasibility received varying levels of attention.

LIMITATIONS

In organised sport, further tests may exist which have not been investigated in this review. This could be due to such tests firstly not being published in the peer-review literature and secondly, not having their measurement properties (i.e., reliability or validity) examined formally.

CONCLUSIONS

Of the 22 studies included in this review, items relating to test methodological quality were, on the whole, well addressed. Test-retest reliability was determined in all but one of the reviewed studies, whilst most studies investigated at least two aspects of validity (i.e., content, construct or criterion-related validity). Few studies examined predictive validity or responsiveness. While feasibility was addressed in over half of the studies, practicality and test limitations were rarely addressed. Consideration of study quality, measurement properties and feasibility components assessed in this review can assist future researchers when developing or modifying tests of sporting skill outcomes.

Feasibility of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) program: study protocol for a randomized controlled trial

Background

Many older adults rely on a manual wheelchair for mobility but typically receive little, if any, training on how to use their wheelchair effectively and independently. Standardized skill training is an effective intervention, but limited access to clinician trainers is a substantive barrier. Enhancing Participation in the Community by Improving Wheelchair Skills (EPIC Wheels) is a 1-month monitored home training program for improving mobility skills in older novice manual wheelchair users, integrating principles from andragogy and social cognitive theory. The purpose of this study is to determine whether feasibility indicators and primary clinical outcome measures of the EPIC Wheels program are sufficiently robust to justify conducting a subsequent multi-site randomized controlled trial.

Methods

A 2 × 2 factorial randomized controlled trial at two sites will compare improvement in wheelchair mobility skills between an EPIC Wheels treatment group and a computer-game control group, with additional wheelchair use introduced as a second factor. A total of 40 community-dwelling manual wheelchair users at least 55 years old and living in two Canadian metropolitan cities (n = 20 × 2) will be recruited. Feasibility indicators related to study process, resources, management, and treatment issues will be collected during data collection and at the end of the study period, and evaluated against proposed criteria. Clinical outcome measures will be collected at baseline (pre-randomization) and post-intervention. The primary clinical outcome measure is wheelchair skill capacity, as determined by the Wheelchair Skills Test, version 4.1. Secondary clinical outcome measures include wheelchair skill safety, satisfaction with performance, wheelchair confidence, life-space mobility, divided-attention, and health-related quality of life.

Discussion

The EPIC Wheels training program offers several innovative features. The convenient, portable, economical, and adaptable tablet-based, home program model for wheelchair skills training has great potential for clinical uptake and opportunity for future enhancements. Theory-driven design can foster learning and adherence for older adults. Establishing the feasibility of the study protocol and estimating effect size for the primary clinical outcome measure will be used to develop a multi-site randomized controlled trial to test the guiding hypotheses.

Trial registration

Clinical Trials NCT01740635.

Design and validation of an intelligent wheelchair towards a clinically-functional outcome

BACKGROUND

Many people with mobility impairments, who require the use of powered wheelchairs, have difficulty completing basic maneuvering tasks during their activities of daily living (ADL). In order to provide assistance to this population, robotic and intelligent system technologies have been used to design an intelligent powered wheelchair (IPW). This paper provides a comprehensive overview of the design and validation of the IPW.

METHODS

The main contributions of this work are three-fold. First, we present a software architecture for robot navigation and control in constrained spaces. Second, we describe a decision-theoretic approach for achieving robust speech-based control of the intelligent wheelchair. Third, we present an evaluation protocol motivated by a meaningful clinical outcome, in the form of the Robotic Wheelchair Skills Test (RWST). This allows us to perform a thorough characterization of the performance and safety of the system, involving 17 test subjects (8 non-PW users, 9 regular PW users), 32 complete RWST sessions, 25 total hours of testing, and 9 kilometers of total running distance.

RESULTS

User tests with the RWST show that the navigation architecture reduced collisions by more than 60% compared to other recent intelligent wheelchair platforms. On the tasks of the RWST, we measured an average decrease of 4% in performance score and 3% in safety score (not statistically significant), compared to the scores obtained with conventional driving model. This analysis was performed with regular users that had over 6 years of wheelchair driving experience, compared to approximately one half-hour of training with the autonomous mode.

CONCLUSIONS

The platform tested in these experiments is among the most experimentally validated robotic wheelchairs in realistic contexts. The results establish that proficient powered wheelchair users can achieve the same level of performance with the intelligent command mode, as with the conventional command mode.

Wheelchair skills training to improve confidence with using a manual wheelchair among older adults: a pilot study

OBJECTIVE

To examine the effects of wheelchair skills training on confidence in older adults who are inexperienced wheelchair users.

DESIGN

Parallel group, single-blind randomized controlled trial.

SETTING

Research laboratory in a rehabilitation hospital.

PARTICIPANTS

Participants (N=20) who were community-living older adults at least 65 years old (mean age, 70y), 50% women, and who had no experience of using a wheelchair were randomly allocated to an intervention (n=10) or control (n=10) group.

INTERVENTIONS

The intervention group received two 1-hour training sessions that followed the Wheelchair Skills Training Program (WSTP) protocol. The control group received a single socialization contact.

MAIN OUTCOME MEASURE

The Wheelchair Use Confidence Scale-Manual (WheelCon-M) was used to evaluate confidence with using a manual wheelchair. The WheelCon-M is a self-report questionnaire that comprises 65 items in 6 conceptual areas.

RESULTS

A 1-way between-groups analysis of covariance revealed a significant difference in postintervention WheelCon-M scores between the intervention and control groups (F1,17=10.9, P=.004) after controlling for baseline WheelCon-M scores. A large effect size was also observed (partial η(2)=.39). Secondary analyses revealed that the WSTP had greater effects on confidence in areas related to maneuvering around the physical environment, knowledge and problem solving, advocacy, and managing emotions than in areas related to performing activities and behaving in social situations.

CONCLUSION

Two 1-hour WSTP sessions improve confidence with using a manual wheelchair among older adults who are inexperienced wheelchair users.

Habilidades motoras de cadeirantes influenciadas pelo controle de tronco

O objetivo deste estudo foi analisar a efetividade de um protocolo de treinamento de estabilização segmentar lombar (ESL) no controle de tronco e nas habilidades em cadeira de rodas (CR) em indivíduos paraplégicos. A amostra foi composta por 5 homens (31,2±12,9 anos) com lesão medular abaixo de T6. O deslocamento total (DT) e as amplitudes ântero-posterior (AP) e médio-lateral (ML) do centro de pressão (CP) foram analisados por meio de uma plataforma de força, em duas posições de teste (mãos no joelho e braços cruzados) e as habilidades na cadeira de rodas foram analisadas pelo Wheelchair Skills Test (WST), pré e pós protocolo de treinamento de ESL. A análise estatística foi realizada no software SPSS (15.0), utilizando o teste ANOVA para α ≤ 0,05. Na comparação pré e pós-treino, houve redução significativa do deslocamento total do CP na posição sentada com mãos nos joelhos (P<0,01) e braços cruzados (P<0,01). Não se observou mudança nas habilidades com CR do WST entre as avaliações pré e pós treinamento em nenhum dos níveis estudados. O protocolo de treinamento de ESL proposto foi efetivo para a melhora do controle de tronco, mas não modificou as habilidades no manejo de cadeira de rodas em indivíduos paraplégicos.

On the construction of a skill-based wheelchair navigation profile

Assisted wheelchair navigation is of key importance for persons with severe disabilities. The problem has been solved in different ways, usually based on the shared control paradigm. This paradigm consists of giving the user more or less control on a need basis. Naturally, these approaches require personalization: each wheelchair user has different skills and needs and it is hard to know a priori from diagnosis how much assistance must be provided. Furthermore, since there is no such thing as an average user, sometimes it is difficult to quantify the benefits of these systems. This paper proposes a new method to extract a prototype user profile using real traces based on more than 70 volunteers presenting different physical and cognitive skills. These traces are clustered to determine the average behavior that can be expected from a wheelchair user in order to cope with significant situations. Processed traces provide a prototype user model for comparison purposes, plus a simple method to obtain without supervision a skill-based navigation profile for any user while he/she is driving. This profile is useful for benchmarking but also to determine the situations in which a given user might require more assistance after evaluating how well he/she compares to the benchmark. Profile-based shared control has been successfully tested by 18 volunteers affected by left or right brain stroke at Fondazione Santa Lucia, in Rome, Italy.

Individual differences and their impact on the safety and the efficiency of human-wheelchair systems

OBJECTIVE

The extent to which individual differences in fine motor abilities affect indoor safety and efficiency of human-wheelchair systems was examined.

BACKGROUND

To reduce the currently large number of indoor wheelchair accidents, assistance systems with a high level of automation were developed. It was proposed to adapt the wheelchair's level of automation to the user's ability to steer the device to avoid drawbacks of highly automated wheelchairs. The state of the art, however, lacks an empirical identification of those abilities.

METHOD

A study with 23 participants is described. The participants drove through various sections of a course with a powered wheelchair. Repeatedly measured criteria were safety (numbers of collisions) and efficiency (times required for reaching goals). As covariates, the participants' fine motor abilities were assessed.

RESULTS

A random coefficient modeling approach was conducted to analyze the data,which were available on two levels as course sections were nested within participants.The participants' aiming, precision, and armhand speed contributed significantly to both criteria: Participants with lower fine motor abilities had more collisions and required more time for reaching goals.

CONCLUSION

Adapting the wheelchair's level of automation to these fine motor abilities can improve indoor safety and efficiency. In addition, the results highlight the need to further examine the impact of individual differences on the design of automation features for powered wheelchairs as well as other applications of automation.

APPLICATION

The results facilitate the improvement of current wheelchair technology.

Manual wheelchair skills: objective testing versus subjective questionnaire

OBJECTIVES

To test the hypothesis that the total scores of the Wheelchair Skills Test (WST) version 4.1, an observer-rated scale of wheelchair performance, and the Wheelchair Skills Test Questionnaire (WST-Q) version 4.1, a self-report of wheelchair skills, are highly correlated. We also anticipate that the WST-Q scores will be slightly higher, indicating an overestimation of capacity to perform wheelchair skills as compared with actual capacity.

DESIGN

A cross-sectional, within-subjects comparison design.

SETTING

Three Canadian cities.

PARTICIPANTS

Convenience sample of community-dwelling, experienced manual wheelchair users (N=89) ranging in age from 21 to 94 years.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Participants completed the subjective WST-Q version 4.1 followed by the objective WST version 4.1 in 1 testing session.

RESULTS

The mean ± SD total percentage scores for WST and WST-Q were 79.5%±14.4% and 83.0%±12.1% for capacity and 99.4%±1.5% and 98.9%±2.5% for safety, respectively. The correlations between the WST and WST-Q scores were ρ=.89 (P=.000) for capacity and ρ=.12 (P=.251) for safety. WST-Q total score mean differences were an average of 3.5%±6.5% higher than WST scores for capacity (P=.000) and .52%±2.8% lower for safety (P=.343). For the 32 individual skills, the percentage agreement between the WST and WST-Q scores ranged from 82% to 100% for capacity and from 90% to 100% for safety.

CONCLUSION

WST and WST-Q version 4.1 capacity scores are highly correlated although the WST-Q scores are slightly higher. Decisions on which of these assessments to use can safely be based on the circumstances and objectives of the evaluation.

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

OBJECTIVES

To test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months.

DESIGN

Multicenter, single-blind, randomized controlled trial.

SETTING

Three rehabilitation centers in Montréal, Quebec, Canada.

PARTICIPANTS

Manual wheelchair users (N=39), a sample of convenience.

INTERVENTION

Participants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min).

MAIN OUTCOME MEASURES

The French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2).

RESULTS

At t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by ≤0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P≥.017 at a Bonferroni-adjusted α level of .005).

CONCLUSION

WSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months.

Effectiveness of a wheelchair skills training programme for community-living users of manual wheelchairs in Turkey: a randomized controlled trial

Objective: To test the hypothesis that, in comparison with those in a control group, community-dwelling wheelchair users in Turkey who have completed the Wheelchair Skills Training Program have better total percentage performance and safety scores on the Wheelchair Skills Test.

Design: Randomized controlled trial.

Subjects: The study group comprised individuals ( n = 24) who have to use a wheelchair for mobility in daily life. The subjects were randomly allocated to training ( n = 14) and control groups ( n = 10).

Interventions: The training group attended a skill training session three times a week for four weeks. The control group did not participate in the training.

Main outcome measures: At the beginning of the study, subjects underwent a Wheelchair Skills Test (version 4.1), which evaluated their performance and safety for a range of skills. The test was repeated at the end of the study.

Results: The mean ± SD total percentage Wheelchair Skills Test performance scores increased significantly in both the training group ( P = 0.002) and control group ( P = 0.01), although the training group increased to a greater extent ( P = 0.034). The training group’s mean ± SD total percentage Wheelchair Skills Test safety scores increased significantly ( P = 0.001), but there was no significant change in the control group. A statistically significant improvement was found between the total percentage Wheelchair Skills Test safety scores in the training group compared with the control group ( P = 0.001).

Conclusion: Community-living wheelchair users who received wheelchair skills training increased their total performance and safety scores to a greater extent than a control group.

Development of a Community Mobility Skills Course for People Who Use Mobility Devices

OBJECTIVE. We assessed mobility device skills in a lived-in environment on a community mobility skills course (CMSC) and related those skills to previously demonstrated skills in a controlled environment on an inside mobility skills course (IMSC).

METHOD. Six mobility device users were selected from 91 adults who had previously completed the IMSC. Each of the following device groups was represented: power wheelchair, manual wheelchair, scooter, cane, crutch, and walker. CMSC tasks were modified from IMSC tasks and designed using materials in the community.

RESULTS. All participants completed at least half of the CMSC tasks faster than they completed the corresponding IMSC tasks. The number of tasks on which participants improved and the amount of improvement varied by difficulty of task and mobility device used.

CONCLUSION. Some mobility device skills used in controlled environments appear to transfer to community settings; others do not. Skills required for community participation may partially depend on mobility device used.

A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure

OBJECTIVE

To review, analyse, evaluate and critically appraise available wheelchair skill tests in the international literature and to determine the need for a standardized measurement tool of manual wheeled mobility in those with spinal cord injury.

DATA SOURCES

A systematic review of literature (databases PubMed, Web of Science and Cochrane Library (1970-December 2009).

SUBJECTS

Hand rim wheelchair users, mainly those with spinal cord injury.

REVIEW METHODS

Studies' content and methodology were analysed qualitatively. Study quality was assessed using the scale of Gardner and Altman.

RESULTS

Thirteen studies fell within the inclusion criteria and were critically reviewed. The 13 studies covered 11 tests, which involved 14 different skills. These 14 skills were categorized into: wheelchair manoeuvring and basic daily living skills; obstacle-negotiating skills; wheelie tasks; and transfers. The Wheelchair Skills Test version 2.4 (WST-2.4) and Wheelchair Circuit tests scored best on the Gardner and Altman scale, the Obstacle Course Assessment of Wheelchair User Performances (OCAWUP) test was found to be the most relevant for daily needs in a wheelchair. The different tests used different measurement scales, varying from binary to ordinal and continuous. Comparison of outcomes between tests was not possible because of differences in skills assessed, measurement scales, environment and equipment selected for each test. A lack of information regarding protocols as well as differences in terminology was also detected.

CONCLUSION

This systematic review revealed large inconsistencies among the current available wheelchair skill tests. This makes it difficult to compare study results and to create norms and standards for wheelchair skill performance.