Search

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]

Purpose: Although both wheelchair skills and fitness are important and probably inter-related, the extent and nature of the relationship between them are not well understood. The objective of this study was to test the hypothesis that there are significant relationships between wheelchair skills scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. Materials and methods: We studied 26 participants, recording Wheelchair Skills Test Questionnaire scores and peak power output from graded aerobic wheelchair exercise testing on a motorized treadmill. Results: The median Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores were 83.3%, 81.5%, and 76.7% and the median peak power output was 58.2 W. On regression analysis, there were significant relationships between the total Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores and peak power output (R2 0.270–0.709, odds ratios 1.043–1.150, p < 0.05). Conclusions: Significant relationships exist between the wheelchair skills capacity, confidence, and performance scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. These findings suggest that both wheelchair skills training and exercise training may be useful during the rehabilitation of people with spinal cord injury. Moderate positive relationships exist between wheelchair skills capacity and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. Moderate positive relationships exist between wheelchair skills confidence and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. Although further research is needed, these findings suggest that clinicians should address both wheelchair skills training and exercise training during the rehabilitation of people with spinal cord injury and not assume that either alone is sufficient. [ABSTRACT FROM AUTHOR]

Purpose: The tilt-rest skill consists of tipping the wheelchair back and allowing it to rest against a solid object with the wheel locks applied (e.g., for pressure redistribution, neck comfort or hands-free activities). The objective of this study was to determine the proportion of experienced manual wheelchair users who are aware of this skill and who can perform it. Materials and methods: We conducted a cross-sectional survey of 49 manual wheelchair users using a questionnaire developed for the purpose. The tilt-rest skill was attempted by those who reported that they were capable of performing it. Results: Participants' mean (SD) age was 55.1 (18.2) years, 38 (77.6%) were male, their median (IQR) duration of wheelchair use was 2 (7.2) years and their mean (SD) daily time spent in the wheelchair was 9.5 (4.6) hours. Twenty-seven (55.1%) participants were aware of the skill, 19 (38.8%) reported being able to perform the skill and 16 of 47 (34.0%) were able to demonstrate the skill. Multivariate modelling with the question "Can you complete the tilt-rest skill?" as the dependent measure revealed an inverse relationship with age – Odds Ratio (95% Confidence Interval) of 0.476 (0.293, 0.774) (p =.0028) for each 10 year increase in age. Conclusions: Only just over half of manual wheelchair users are aware of the tilt-rest skill and one-third of users can perform it. Older people are less likely to report being able to complete the skill. These findings have implications for wheelchair skills training during the wheelchair-provision process. Only just over half of manual wheelchair users are aware of the tilt-rest skill and only about one-third of users can perform it. Older people are less likely to report being able to complete the skill. These findings have clinical implications for wheelchair skills training during the, specifically that clinicians responsible for manual wheelchair-provision process should ensure that appropriate wheelchair users have the opportunity to learn this skill. [ABSTRACT FROM AUTHOR]

Objectives: To determine the proportion of wheelchair users who receive wheelchair skills training during an inpatient stay at a Canadian rehabilitation center. Methods: Each of 42 wheelchair-using inpatients completed a questionnaire within 72 hours of his or her expected discharge. Results: Twenty-three (54.8%) participants reported having received wheelchair skills training. The median number and duration of training sessions was five 30-minute sessions. None (0%) of the other 19 participants knew of arrangements to receive training after discharge. Conclusion: Only 54.8% of wheelchair-using people nearing discharge from a rehabilitation center reported that they had received wheelchair skills training. [ABSTRACT FROM AUTHOR]