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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]

Objective(s): Life and limb threatening vascular emergencies often present to rural hospitals where only general surgery services are available. It is known that Australian rural general surgical centres encounter 10–20 emergency vascular surgery procedures annually. This study aimed to assess rural general surgeons' confidence managing emergent vascular procedures. Setting, Participants and Design: A survey was distributed to Australian rural general surgeons to determine their confidence (Yes/No) in performing emergent vascular procedures including limb revascularisation, revising arterio‐venous (AV) fistulas, open repair of ruptured abdominal aortic aneurysm (AAA), superior mesenteric artery (SMA)/coeliac embolectomy, limb embolectomy, vascular access catheter insertion and limb amputation (digit, forefoot, below knee and above knee). Confidence level was compared with surgeon demographics and training. Variables were compared using univariate logistic regression. Results: Sixteen per cent (67/410) of all Australian rural general surgeons responded to the survey. Increased age, years since fellowship and training prior to 1995 (when separation of Australian vascular and general surgery occurred) were associated with greater confidence in limb revascularisation, revising AV fistulas, open repair of ruptured AAA, SMA/coeliac embolectomy, and limb embolectomy (p < 0.05). Surgeons who completed >6 months of vascular surgery training were more comfortable with SMA/coeliac embolectomy (49% vs. 17%, p = 0.01) and limb embolectomy (59% vs. 28%, p = 0.02). Confidence in performing limb amputation was similar across surgeon demographics and training (p > 0.05). Conclusion: Recently graduated rural general surgeons do not feel confident in managing vascular emergencies. Additional vascular surgery training should be considered as part of general surgical training and rural general surgical fellowships. [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]

Objective: The aims of this study were to test the hypothesis that people with stroke who receive formal powered wheelchair skills training improve their wheelchair skills to a significantly greater extent than participants in a control group who do not and to explore the influence of spatial neglect. Design: Seventeen participants with stroke (including nine with spatial neglect) were randomly allocated to intervention (n = 9) or control (n = 8) groups. Those in the intervention group received up to five 30-min training sessions based on the Wheelchair Skills Training Program 4.1. The powered Wheelchair Skills Test version 4.1 was administered at baseline (T1) and after training (T2). Results: A rank order analysis of covariance on the T2 Wheelchair Skills Test score, having adjusted for the T1 score, showed a significant effect caused by group (P = 0.0001). A secondary analysis showed no significant effect caused by spatial neglect (P = 0.923). Conclusions: People with stroke who receive formal powered wheelchair skills training improve their powered wheelchair skills to a significantly greater extent (30%) than participants who do not (0%). The extent of change was not affected by the presence of spatial neglect. These findings have significance for the wheelchair provision process and the rehabilitation of people with stroke. [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]

Purpose: To determine improvements in goal satisfaction following individualized mobility-related powered wheelchair skills training and whether changes in satisfaction are maintained 3 months post-training. Materials and methods: Seventeen powered wheelchair users, from two centres, who were randomized to the training intervention from a larger multicentre study, were included in this secondary analysis. The intervention consisted of five 30-min individualized Wheelchair Skills Training Program sessions. Participants rated their current satisfaction with each of their goals from 0 to 10 (10 being the highest) prior to training, immediately after the intervention, and approximately 3 months following the intervention. Themes relating to the participants’ goals were also explored. Results: Goal satisfaction scores improved statistically (p < .001) from baseline (4.7 ± 1.9) to immediately following training (8.0 ± 1.0) and were maintained 3 months (8.3 ± 1.2) following the intervention. Participants’ goal satisfaction scores were not significantly correlated with goal attainment scores recorded by the trainer (r = 0.387, n = 17, p = .125). The majority of goals set fell into the broader “manoeuvring” category. Conclusion: Goal satisfaction following the Wheelchair Skills Training Program improved years after initially learning how to operate a powered wheelchair. The five training sessions were effective in improving goal satisfaction. The quantification of goal satisfaction appears to be a sensitive outcome for powered wheelchair users undergoing mobility-related training. Implications for rehabilitation: Goal satisfaction improved following the Wheelchair Skills Training Program. Even with years of powered wheelchair experience, the majority of goals set fell into the broader “manoeuvring” category. An individual’s goal satisfaction may not correlate with whether they have attained their goal as determined by a trainer. [ABSTRACT FROM AUTHOR]

Background: The United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study's purpose was to describe wheelchair users' experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines. Methods: Local researchers in Nairobi and Manila interviewed 48 adult basic wheelchair users, with even distribution of those who had and had not received wheelchair services along with their wheelchair. Recordings were transcribed in the local language and translated into English. The study team coded transcripts for predetermined and emergent themes, using Atlas-ti software. A qualitative content analysis approach was taken with the WHO service delivery process as an organizing framework. Results: Wheelchair users frequently described past experiences with ill-fitting wheelchairs and little formal training to use wheelchairs effectively. Through exposure to multiple wheelchairs and self-advocacy, they learned to select wheelchairs suitable for their needs. Maintenance and repair services were often in short supply. Participants attributed shorter duration of wheelchair use to lack of repair. Peer support networks emerged as an important source of knowledge, resources and emotional support. Most participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for, and despite challenges, they were grateful to have some means of mobility. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support. Conclusions: Interventions are needed to provide wheelchairs services efficiently, at scale, in an environment facilitating physical access and peer support, and reduced social stigma. Trial registration: Not applicable since this was a descriptive study. [ABSTRACT FROM AUTHOR]