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To test the hypotheses that, after the delivery of manual wheelchairs following the WHO 8-step service-delivery process, wheelchair-related health and quality of life, wheelchair skills, wheelchair use, and poverty probability would improve; and that the number of wheelchair repairs required, adverse events, caregiver burden, and the level of assistance provided would decrease. This was a longitudinal, prospective within-subject study including 247 manual wheelchair users, and 119 caregivers, in El Salvador who received a wheelchair following the WHO 8-step process as well as maintenance reminders. Outcome measurements were performed via structured questionnaires and dataloggers at the initial assessment, at wheelchair delivery, and at 3- and 6-month follow-up. Significant improvements in wheelchair-related health indicators (all with p < 0.004) and quality of life (p = 0.001), and a significant reduction in national and "extreme" poverty probability (p = 0.004 and p = 0.012) were observed by six months. Wheelchair use significantly decreased (p = 0.011 and p = 0.035) and wheelchair skills increased (p = 0.009). Caregiver burden did not change (p = 0.226) but the number of activities of daily living (ADLs) that required no assistance significantly increased (p = 0.001) by three months and those who required complete assistance decreased (p = 0.001). No changes were observed in wheelchair repairs (p = 0.967) and breakdowns over time with new wheelchairs. Wheelchair service delivery using the WHO 8-step process on manual wheelchair users in El Salvador has positive effects on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. Further research is needed to determine the relative contributions of the intervention components. Providing manual wheelchairs using the 8-step process of the WHO has benefits on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. The WHO 8-steps service delivery process for manual wheelchairs can be used in less-resourced settings. [ABSTRACT FROM AUTHOR]

To test the hypothesis that a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence of wheelchair service providers, and to determine the participants' views on the Course. This was an observational cohort study, with pre-post comparisons. To meet the objectives of the six-week Course, the curriculum included self-study and weekly one-hour remote meetings. Participants submitted their Wheelchair Skills Test Questionnaire (WST-Q) (Version 5.3.1) "performance" and "confidence" scores before and after the Course. Participants also completed a Course Evaluation Form after the Course. The 121 participants were almost all from the rehabilitation professions, with a median of 6 years of experience. The mean (SD) WST-Q performance scores rose from 53.4% (17.8) pre-Course to 69.2% (13.8) post-Course, a 29.6% relative improvement (p < 0.0001). The mean (SD) WST-Q confidence scores rose from 53.5% (17.9) to 69.5% (14.3), a 29.9% relative improvement (p < 0.0001). Correlations between performance and confidence were highly significant (p < 0.0001). The Course Evaluation indicated that most participants found the Course useful, relevant, understandable, enjoyable, "just right" in duration, and most stated that they would recommend the Course to others. Although there is room for improvement, a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence scores of wheelchair service providers by almost 30%, and participants were generally positive about the Course. A Remote-Learning Course improves the subjective wheelchair-skills performance and confidence scores of wheelchair service providers by almost 30%. Participants were generally positive about the Course. [ABSTRACT FROM AUTHOR]

To test the hypotheses that, in comparison with pushing an occupied upright manual wheelchair forward, pulling backward on the push-handles improves the objective and subjective ease with which a caregiver can get the wheelchair across a soft surface (e.g., grass, mud, sand, gravel); and the ease with which a caregiver can get the wheelchair across a soft surface improves if the wheelchair is tipped back into the wheelie position. We used a randomized crossover trial with within-participant comparisons to study 32 able-bodied pairs of simulated caregivers and wheelchair occupants. The caregiving participants moved an occupied manual wheelchair 5 m across a soft surface (7.5-cm-thick gym mats) under four conditions (upright-forward, upright-backward, wheelie-forward and wheelie-backward) in random order. The main outcome measure was time (to the nearest 0.1 s) and the main secondary measure was the ease of performance (5-point Likert scale). The upright-backward condition was the fastest (p < 0.05) and had the highest ease-of-performance scores. In the forward direction, there was no statistically significant difference in the time required between the upright and wheelie positions, but the wheelie position was considered easier. Although further study is needed, our findings suggest that caregivers should pull rather than push occupied wheelchairs across soft surfaces. In the forward direction, caregivers may find the wheelie position easier than the upright condition. These techniques have the potential to both improve the effectiveness of and reduce injuries to caregivers. Clinical Trial Registration Number: NCT 04998539 Caregivers should pull rather than push occupied manual wheelchairs across soft surfaces. In the forward direction, caregivers may find the wheelie position easier than and preferable to the upright condition. These techniques have the potential to both improve the effectiveness of and reduce injuries to caregivers. [ABSTRACT FROM AUTHOR]

We sought to identify opportunities, challenges, contemporary initiatives and strategies for preparing entry-level practitioners who are competent at the basic level of wheelchair service provision across four key international professional rehabilitation organisations as revealed by their educational standards, relevant guidelines and policy statements, and other publicly available information. A rapid review was conducted in 2021 from the International Society of Physical and Rehabilitation Medicine (ISPRM), the International Society for Prosthetics and Orthotics (ISPO), World Physiotherapy, and the World Federation of Occupational Therapists (WFOT). Additional grey-literature and grey-data searches were conducted to identify contemporary initiatives that may support competency development in wheelchair service provision. A total of 17 standards, guidelines, and policy statement documents were selected for detailed review. Each of the four organisations published at least one document containing language relating to wheelchair service provision. Twelve contemporary initiatives relating to wheelchair service provision were identified from the grey literature across the four organisations. Six additional initiatives were identified from the organisations' social media accounts. Themes emerged in the areas of contemporary content, opportunities, and challenges. Global standardisation could help harmonise professional societies' approach to training wheelchair service providers. There is a need to provide more descriptive content on wheelchair service provision in education and service standards and related documents to influence what is taught in professional rehabilitation programs that are accredited or approved by professional rehabilitation organisations. The organisations' networks are vast and may also help to promote additional continuing education in this area. [ABSTRACT FROM AUTHOR]

To describe the subjective reported scooter-skill scores of new mobility scooter users and to identify significant correlations with other characteristics and measures. This was a single-centre study using a cross-sectional design. Participants (N = 22) completed the Wheelchair Skills Test-Questionnaire (WST-Q) Version 4.3 for scooter users. It measures the users' perceived capacity (what the user can do), performance (what the user actually does), and confidence (or self-efficacy). Their scooter skills were also rated objectively with the Wheelchair Skills Test (WST). They completed standardised measures of cognition, hearing, vision, life space mobility, visual attention and task switching, and confidence negotiating the social environment using their scooters. Mean total WST-Q capacity scores were 83% and performance scores were 25%. WST-Q capacity scores had significant positive correlations with WST-Q performance (r = 0.321) and confidence scores (r = 0.787), WST capacity scores (r = 0.488), and confidence negotiating the social environment (WheelCon) (r = 0.463). WST-Q capacity scores were significantly negatively correlated with Trail Making B scores (r = −0.591) and age (r = −0.531). The correlations between WST-Q scores and other variables are similar to those found in other studies among users of scooters and other mobility devices. The gap between capacity and performance scores highlights the needs for additional skills training in this population of novice scooter users. In implementing scooter training for new scooter users, attention should be paid to building community-based skills for navigating both the physical and the social environment. Scooter users' age and their driving capabilities need to be taken into account when developing and delivering the training. [ABSTRACT FROM AUTHOR]

Background: Moving a wheelchair over a low threshold is an entry-level mobility skill. Observation is critical to the assessment and training of this skill. The primary objective of this exploratory pilot study was to determine if a difference between novice and expert visual attention allocation pattern was linked to the accuracy of rating skill performance and decision confidence. Methods: Twelve expert occupational therapists and nine non-expert occupational therapy students observed 30 first-attempt recordings of able-bodied persons learning the low threshold skill. Randomized recordings included 10 recordings from each rating group of "pass," "pass with difficulty" (pwd), and "fail." Skill ratings, confidence ratings, time to decision, and SR Eyelink 1000+ monitored eye movements were recorded. Results: No significant group differences were found in the correct identification skill rating, though significant relationships were found with experts rating higher confidence in their decision-making and generally faster reaction times. While trends of eye movements differences were found between groups, only the number of areas of interest viewed in pwd videos was a potential rating correctness predictor. Conclusion: Improved confidence in decision-making did not mean improved assessment accuracy. The pwd video stimuli created the opportunity for assessing observation patterns differences. Further study is recommended. [ABSTRACT FROM AUTHOR]

Appropriate wheelchair provision is necessary for addressing participation barriers experienced by individuals with mobility impairments. Health care professionals involved in the wheelchair service provision process require a specific set of skills and knowledge to enable wheelchair use that meets individual posture, mobility and daily living requirements. However, inconsistencies exist in academic programmes globally about providing comprehensive education and training programmes. The planned scoping review aims to review and synthesize the global literature on wheelchair service provision education for healthcare professional students, healthcare personnel and educators offered by universities, organizations and industries. This scoping review will be guided by the Joanna Briggs Institute (JBI) methodological framework. Comprehensive literature searches will be conducted on various global electronic databases on health to seek out how wheelchair service provision education is organized, integrated, implemented and evaluated. Two independent reviewers will perform eligibility decisions and key data extractions. Data from selected studies will be extracted and analysed using conventional content analysis. Information related to wheelchair service provision education including curriculum development, content, teaching methods, evaluation and models of integration will be synthesized. The planned scoping review will be the first to examine all aspects of wheelchair service provision education across professionals, settings and countries. We anticipate that results will inform the content of a Wheelchair Educators' Package, and if appropriate, a follow-up systematic review. An article reporting the results of the scoping review will be submitted for publication to a scientific journal. A comprehensive examination of wheelchair service provision education could help develop strategies to address the unmet need for wheelchair services globally. Findings for this review will facilitate the planning and development of an evidence-based education package that could bridge the existing knowledge gaps related to safe and effective wheelchair service provision among health professionals involved. This review will also inform the potential barriers and enablers for effective integration and implementation of wheelchair service provision education worldwide. [ABSTRACT FROM AUTHOR]

To explore the experiences of new motorised mobility scooter users from the perspectives of the assessment and training of scooter skills. Descriptive secondary analysis of qualitative data. Community. 20 New users of motorised mobility scooters. Not applicable. Directed qualitative analysis of up to four semi-structured interviews over the course of the first year of scooter use, to identify themes and sub-themes that could inform recommendations regarding assessment and training protocols. We identified two themes. The first related to potential new content. As one example of the sub-themes, there were many excerpts that dealt with the use of skills in various combinations and permutations that were used to carry out activities during everyday life and participate in society. These excerpts suggested the importance of training skills in combination to facilitate skill transfer (or generalizability). The second theme is related to enhancements of existing content. As one example of the sub-themes, there were several excerpts that dealt with scooter security. These excerpts led to the recommendation that removing and inserting the scooter key should be added to the assessment criteria for the "turns power on and off" skill of the Wheelchair Skills Test (WST) and its questionnaire version (WST-Q). The experiences of scooter users over the first year of receiving a scooter appear to be relevant to the assessment and training of scooter skills and suggest themes for further study. Clinical trial registration number: NCT02696213 The experiences of new scooter users are highly relevant to the assessment and training of scooter skills. These experiences suggest both potential new content and enhancements of existing content to the Wheelchair Skills Program Manual. [ABSTRACT FROM AUTHOR]

This review aimed to collate and summarize available research literature about wheelchair service provision education available to healthcare professional students, healthcare personnel and educators across low- to high-resourced settings. The Joanna Briggs Institute methodological steps for scoping reviews were followed. Included studies were mainly sourced from Medline, Embase, CINAHL, Scopus, Academic Search Complete and ProQuest. Independent title, abstract and full-text screening with defined inclusion and exclusion criteria was performed. All screening and extraction were performed independently by two authors. A thematic approach was used to synthesize results. Data extracted from included studies were charted according to a template that we created. The study quality was also appraised. A total of 25 articles were included (11, 36% from high-income settings) with 12 (48%) observational studies and 13 (52%) experimental studies. The literature addressed three main topics: (1) assessing wheelchair service provision knowledge, (2) implementing training interventions using in-person, online and/or hybrid learning approaches and (3) describing current wheelchair service provision education globally. The most frequently reported training programs used were the Wheelchair Skills Program and the World Health Organization Wheelchair Service Training Package – Basic Level. Limited information has been published about the integration of wheelchair content into the curricula of professional rehabilitation programs. Efforts to build international partnerships, improve the quality and currency of training programs and build resources that can assist educators in the integration of wheelchair-related content into professional rehabilitation programs should be prioritized. This is the first review that examined and synthesized the current state of wheelchair service provision education for rehabilitation students and personnel across low- to high-income countries. Findings from this review indicate that there is limited information about the integration of wheelchair-related content into professional rehabilitation programs. Efforts to build international partnerships, standardize wheelchair service provision content and evaluation and integrate training into professional rehabilitation programs worldwide should be prioritized. [ABSTRACT FROM AUTHOR]

To test the hypothesis that remote learning to teach clinicians manual wheelchair skills is efficacious. 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. 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). 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. NCT01807728. Wheelchair 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. [ABSTRACT FROM AUTHOR]