Wheelchair skills training for community-based manual wheelchair users: A randomized controlled trial
by Laila AliBiglou
Best, K. L., Kirby, R. L., Smith, C.,
& MacLeod, D. (2005). Wheelchair skills training for community-based
manual wheelchair users: A randomized controlled trial. Arch Phys
Med Rehabil, 86, 2316-23.
One of the most important
rehabilitation interventions for people with disabilities is the wheelchair.
Wheelchair users face many mobility and participation barriers and
are at risk for acute and chronic injuries. To tackle these problems, efforts have been made
to improve accessibility, wheelchair design, and the wheelchair delivery
process. Though wheelchair skills training
has been recognized as an important
component of these efforts, it must compete with other priorities, such
as investigations, bladder and bowel care, conditioning, equipment selection,
counseling, and organizing architectural modifications. The main purpose
of this study was to test the hypothesis that wheelchair skills training
of community-based wheelchair users is efficacious, safe, and practical.
A sample of 20 community-based
manual wheelchair users (15 men, 5 women; age range, 21–77), half
with musculoskeletal conditions and half with neurological conditions,
were recruited from the community through public posters, word of mouth,
and clinicians on the outpatient and inpatient services. Subjects were
randomly placed in two groups: WSPT (Wheelchair Skills Training Program)
group and control group. The inclusion criteria included being 17 years
old or more, being alert and cooperative, being coherent and competent
for giving informed consent, being able to answer questions related
to wheelchair use, being willing to participate, using a manual wheelchair
for a period of at least 6 weeks, using a wheelchair for at least 2
hours a day on average, self-propelling their wheelchairs, and having
written permission from their family doctor or physiatrist to participate.
Exclusion criteria included having unstable medical conditions or emotional
problems that may have made testing or training unsafe or unpleasant.
The experiment protocol
consisted of 3 to 5 1-hour WSTP (Wheelchair Skills Training Program)
for participants in the WSTP group with sessions scheduled at least
5 days apart. The level of training was dependent on participant baseline
skill level, so those with higher skill level at baseline and those
who were not interested in learning some of the more difficult skills
required less training. Each session included 5 to 10 minutes of reviewing
progress, followed by a 10-minute warm-up that consisted of random practice
of previously learned skills, and 20 to 30 minutes of attempting new
skills. The final 15 to 20 minutes of each session consisted of a warm-down,
during which the participants practiced skills in a self-controlled
Participants in the WSTP
group completed a mean of 4.50.7 hours of training (range, 3 to 5 hours).
The investigators found a significant difference between the WSTP group’s
improvement in total WST score (P=.005). The mean total WST score
for the WSTP group increased 24.0% from pre-training to post-training
(P=.002), while the relative improvement of control group was
only 4.8% (P=.03). Interestingly, there were no adverse incidents,
and the WSTP participants’ comments were all positive.
The results indicated that wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. Also, the descriptive data on wheelchair satisfaction (QUEST) and psychosocial impact (PIADS) revealed that community-based wheelchair users were reasonably positive about their wheelchairs and their helpfulness. The authors suggest that a greater focus on training would be useful for improving the safety and effectivness of participation in activities by community-based manual wheelchair users.