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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 toThe 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.

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 04998539Implications for RehabilitationCaregivers 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. 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.

This study assessed the effectiveness of a learning module we developed for planning students aimed to enhance their understanding for design issues in public spaces faced by wheelchair users. The ...

The aim of this study was to test the hypotheses that, during manual-wheelchair foot propulsion backward on a soft surface, lowering the seat height increases speed, push frequency and push effectiveness, and decreases perceived difficulty.In a repeated-measures crossover study, 50 able-bodied participants used one foot to propel a manual wheelchair 5 m backward on a soft surface at 5 seat heights, ranging from 5.08 cm below to about 5.08 cm above lower-leg length, in random order. We recorded Wheelchair Skills Test (WST) capacity scores and used the Wheelchair Propulsion Test (WPT) to calculate speed (m/s), push frequency (cycles/s) and push effectiveness (m/cycle). We also recorded the participants' perceived difficulty (0-4) and video-recorded each trial.WST capacity scores were reduced at the higher seat heights. Using repeated-measures models (adjusted for age, sex and order), there were negative relationships between seat height and speed (During manual-wheelchair foot propulsion backward on a soft surface, lowering the seat height increases speed and push effectiveness, and decreases perceived difficulty.IMPLICATIONS FOR REHABILITATIONBackward wheelchair foot propulsion on soft surfaces is affected by seat height.Speed (m/s) is improved if the seat height is lowered.Push effectiveness (m/gait cycle) is improved if the seat height is lowered.Perceived difficulty of propulsion is lower if the seat height is lowered.

To test the hypotheses that, during manual wheelchair foot propulsion forward on smooth level surfaces, lowering the seat height increases speed, push frequency and push effectiveness, and decreases perceived difficulty.In a repeated-measures crossover study, 50 able-bodied participants used one foot to propel a manual wheelchair 10 m on a smooth level surface at 5 seat heights in random order, ranging from 5.08 cm below to about 5.08 cm above lower-leg length. We recorded Wheelchair Skills Test (WST) capacity scores and used the Wheelchair Propulsion Test (WPT) to calculate speed (m/s), push frequency (cycles/s) and push effectiveness (m/cycle). We also recorded the participants' perceived difficulty (0-4) and video-recorded each trial.WST capacity scores were reduced at the higher seat heights. Using repeated-measures models (adjusted for age, sex and order), there were negative relationships between seat height and speed (During manual wheelchair foot propulsion forward on smooth level surfaces, lowering the seat height increases speed and push effectiveness, and decreases perceived difficulty.NCT03330912.Implications for RehabilitationGenerally, wheelchairs used for forward foot propulsion should have a seat height that is 2.54-5.08 cm less than the sitting lower-leg length.Clinicians should, however, take into consideration other functions that may be adversely affected by lowering the seat height.

To determine the extent to which wheelchair service providers conduct wheelchair-skills training, the nature of training, and the providers��� perceptions on training. Anonymous global online survey consisting of 29 questions administered via the REDCap electronic data-capture tool to English-speaking wheelchair service providers. We received 309 responses from wheelchair service providers in 35 countries. Of the respondents who responded to the question ������do you typically provide wheelchair-skills training���?��� 227 (81.6%) reported ���yes, always��� or ���yes, usually��� for clients and 213 (81.9%) for caregivers. The median duration of training sessions for clients and caregivers was 45 and 30 min; the median number of sessions was 2 for both. Regarding the importance of training, 251 (94.4%) answered ���very important��� for clients and 201 (78.5%) for caregivers. For clients and caregivers, 182 (68.4%) and 191 (74.3%) of respondents considered themselves adequately prepared for the trainer role. A variety of barriers and facilitators to training were identified. Most wheelchair service providers report that they provide wheelchair-skills training for clients and their caregivers, most consider such training to be important and most consider themselves adequately prepared for the training role. However, the amount of training is generally minimal. Further efforts are needed to address the identified barriers to training.IMPLICATIONS FOR REHABILITATIONMost wheelchair-service providers report that they provide wheelchair-skills training.Most consider such training to be important.Most consider themselves adequately prepared.However, the extent of training is generally minimal.These findings have implications for clinicians, educators, and policymakers. Most wheelchair-service providers report that they provide wheelchair-skills training. Most consider such training to be important. Most consider themselves adequately prepared. However, the extent of training is generally minimal. These findings have implications for clinicians, educators, and policymakers.

Purpose: To determine the extent to which Occupational Therapists (OTs) in Nova Scotia (NS) conduct wheelchair skills training, the nature of training and the OTs’ perceptions on training. Materials and methods: Anonymous online survey. Results: We received 110 responses from OTs living in NS and involved in direct patient care, 96 (93%) of whom reported helping clients obtain manual wheelchairs. Of the OTs who responded to the question “…do you typically provide wheelchair-skills training…?”, 40 (43.5%) answered “Yes, usually” for clients and 40 (46.0%) for caregivers. The median duration of training sessions for clients and caregivers was 30 and 20 min; the median number of sessions was 2 and 1. Regarding the importance of training, 65 (73.9%) OTs answered “Very important” and 22 (25%) “Somewhat important” for clients and 55 (64.0%) answered “Very important” and 29 (33.7%) “Somewhat important” for caregivers. About one-third of OTs considered themselves adequately prepared for the trainer role. A variety of barriers and facilitators to training were identified. Trainers were significantly more likely than non-trainers to consider wheelchair skills training as important (p = .0003 for clients and p = .0039 for caregivers) and to consider themselves adequately prepared for the trainer role (p = .002 for clients and .003 for caregivers). Conclusions: Only a minority of NS OTs usually provide wheelchair-skills training for clients or their caregivers and the training provided is minimal, despite a majority who consider such training to be important. Only about one-third of OTs feel prepared for the training role.Implications for rehabilitationOnly a minority of Occupational Therapists (OTs) in Nova Scotia, Canada usually provide wheelchair-skills training for clients or their caregivers.The training that is provided is minimal.A majority of OTs consider such training to be important.Only about one-third of OTs feel prepared for the training role. Only a minority of Occupational Therapists (OTs) in Nova Scotia, Canada usually provide wheelchair-skills training for clients or their caregivers. The training that is provided is minimal. A majority of OTs consider such training to be important. Only about one-third of OTs feel prepared for the training role.

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.Implications for RehabilitationOnly 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. 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.

Background: Wheeled mobility is critical for individuals with Spinal Cord Injury or Disease (SCI/D) related paralysis. The World Health Organization (WHO) developed guidelines highlighting eight steps in wheelchair service delivery: (1) referral and appointment; (2) assessment; (3) prescription; (4) funding and ordering; (5) product preparation; (6) fitting; (7) user training; and, (8) follow-up maintenance/repairs. This article describes the processes used to develop structure, process and outcome indicators that reflect the WHO guidelines within the Domain of Wheeled Mobility rehabilitation for Canadians. Methods: Wheeled mobility experts within the SCI-High Project Team used the WHO guideline to inform the Construct refinement and development of a Driver diagram. Following seven meetings, the Driver diagram and review of outcome measures and literature synthesis regarding wheelchair service delivery informed indicator selection and group consensus. Results: The structure indicator examines the proportion of SCI/D service providers within a rehabilitation program who have specialized wheelchair training to ensure prescription, preparation, fitting, and maintenance quality. The process indicator evaluates the average number of hours of wheelchair service delivery provided per patient during rehabilitation. The intermediary outcome indicator (rehabilitation discharge), is a target capacity score on the Wheelchair Skills Test Questionnaire (WST-Q). The final outcome indicators (at 18 months post rehabilitation admission) are the Life Space Assessment (LSA) and the Wheelchair Use Confidence Scale (WheelCon) short form mean scores. Conclusion: Routine implementation of the selected Wheeled Mobility structure, process and outcome indicators should measurably advance care within the Wheeled Mobility Domain for Canadians living with SCI/D by 2020.

To evaluate the test-retest reliability, concurrent validity and responsiveness of the Wheelchair Skills Test - Questionnaire (WST-Q) Version 4.1 for powered wheelchair users.A volunteer sample of 72 community-dwelling, experienced powered wheelchair users, ranging in age from 50 to 77 years, participated in this study. Participants completed measures at baseline and 1 month later.Mean ± standard deviation total percentage WST-Q scores at baseline and 1 month were 83.7% ± 10.9 and 86.3% ± 10.0 respectively. Cronbach's alpha was 0.90 and the 1 month test-retest intraclass correlation coefficient (ICC1,1) was 0.78 (confidence interval: 0.68-0.86). There were no floor or ceiling effects. Percentages of agreement between baseline and 1 month for individual skills ranged from 72.2% to 100%. The correlations between the WST-Q and the objective Wheelchair Skills Test (WST), WheelCon and Life Space Assessment were r = 0.65, r = 0.47 and r = 0.47 respectively. The standard error of measurement (SEM) and smallest real difference (SRD) were 5.0 and 6.2 respectively.The WST-Q 4.1 has high internal consistency, strong test-retest reliability and strong support for concurrent validity and responsiveness.There is evidence of reliability, validity and responsiveness of the Wheelchair Skills Test - Questionnaire (WST-Q) among experienced older adult powered wheelchair users. The WST-Q can be used to measure powered wheelchair skills, guide intervention and measure change over time.

To describe the wheelchair skills capacity and performance of experienced manual wheelchair users with spinal cord injury (SCI) and to assess measurement properties of the Wheelchair Skills Test (WST) and Wheelchair Skills Test Questionnaire (WST-Q).Cross-sectional descriptive study involving within-subject comparisons.Four Spinal Cord Injury Model Systems centers.Manual wheelchair users with SCI (N=117).Not applicable.WST and WST-Q version 4.2 as well as measures for Confidence, Basic Mobility, Independence, Ability to Participate, Satisfaction, and Pain Interference.The median (interquartile range) values for WST capacity, WST-Q capacity, and WST-Q performance were 81.0% (69.0%-90.0%), 88.0% (77.0%-97.0%), and 76.0% (66.3%-84.0%). The total WST capacity scores correlated significantly with the total WST-Q capacity scores (r=.76; P.01) and WST-Q performance scores (r=.55; P.01). The total WST-Q capacity and WST-Q performance scores were correlated significantly (r=.63; P.001). Success rates were75% for 10 of the 32 (31%) individual skills on the WST and 6 of the 32 (19%) individual skills on the WST-Q. Regression models for the total WST and WST-Q measures identified statistically significant predictors including age, sex, body mass index, and/or level of injury. The WST and WST-Q measures correlated significantly with the Confidence, Basic Mobility, Independence, or Pain Interference measures.Many people with SCI are unable to or do not perform some of the wheelchair skills that would allow them to participate more fully. More wheelchair skills training may enhance participation and quality of life of adults with SCI. The WST and WST-Q exhibit good content, construct, and concurrent validity.

To test the hypothesis that a multicomponent workshop about wheelchairs, tailored for undergraduate medical students, is effective in improving medical students' wheelchair-related knowledge, skills, and attitudes.A randomized controlled trial of 24 first- and second-year medical students randomly allocated into intervention and control groups was undertaken. The intervention group received a 4-hr workshop that included didactic, practical, community, and reflective elements. The educational objectives were validated by a focus group. The main outcome measures were a written knowledge test, a practical examination, the Scale of Attitudes Toward Disabled Persons, and students' perceptions.The baseline characteristics of the groups were comparable. After the workshop, the mean scores on the written knowledge test and practical examination for the intervention group were higher than for the control group by 23.9% (95% confidence interval, 17.6%-30.3%; P0.0001) and 34.4% (95% confidence interval, 26.3%-42.5%; P0.0001), respectively. The difference (-1.6%) for the Scale of Attitudes Toward Disabled Persons scores was not significant (P = 0.93), but there may have been a ceiling effect (both groups' mean scores were87%). The perceptions of the students who took the workshop were highly positive.A wheelchair workshop designed for medical students was practical, well received by students, and effective at improving students' knowledge and skills. Although students' attitudes were not measurably affected by the intervention, there was qualitative evidence of a positive effect.

Introduction/Background 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 test the hypotheses that many wheelchair users are unaware of the skill and even fewer can perform it. Material and method We conducted a cross-sectional survey following STROBE guidelines on 49 manual wheelchair users with a variety of diagnoses. The main outcome measures were a questionnaire regarding demographic, clinical, wheelchair and tilt-rest data, as well as skill demonstration by those who reported that they were capable of doing so. Results Participants’ mean (SD) age was 55.1 (18.2) years, 38 (77.6%) were male, their mean (SD) duration of wheelchair use was 7.0 (10.4) years and their mean (SD) daily time spent in the wheelchair was 9.5 (4.6) hours. Twenty-seven (55.1%) of participants were aware of the skill, 20 (40.8%) reported being able to perform the skill and 16 (33.3%) could demonstrate it. Conclusion Just over half of manual wheelchair users are aware of the tilt-rest skill and one-third of them can perform it. Older people are less likely to report being able to complete the skill. These findings have implications for wheelchair skills training.

Kirby RL, Heimrath O, Stewart A, Smith C, MacLeod DA. Effect of respiration on the static rear stability of wheelchairs. Objective To test the hypothesis that the static rear stability of an occupied wheelchair is greater during full inspiration than expiration. Design Within-subject comparisons. Setting Rehabilitation center. Participants Able-bodied participants (N=10). Intervention None. Main Outcome Measures We measured the static rear stability (brakes unlocked) of an occupied wheelchair on a test platform according to International Organization for Standardization standards. We also used the Exhalation Threshold Test. The Exhalation Threshold Test was positive if, having been positioned at the maximum degree of platform tilt needed to maintain stability during full inspiration, the wheelchair tipped backward when the participant exhaled. Results The mean static rear stability values at full inspiration and expiration ± SD were 16.5°±2.3° and 16.1°±2.4°, with a mean difference of .46°±.24° (3%; P=.002). The Exhalation Threshold Test was positive in 19 (95%) of 20 trials. Conclusions Respiration has a slight but statistically significant effect on the rear stability of occupied wheelchairs, with greater stability at full inspiration. This has potential clinical implications for stability testing and the training of wheelchair skills, but further study is needed.

Mountain AD, Kirby RL, Eskes GA, Smith C, Duncan H, MacLeod DA, Thompson K. Ability of people with stroke to learn powered wheelchair skills: a pilot study. Objectives Our primary objective was to test the hypothesis that people with stroke can learn to use powered wheelchairs safely and effectively. Our secondary objective was to explore the influence of visuospatial neglect on the ability to learn powered wheelchair skills. Design Prospective, uncontrolled pilot study using within-participant comparisons. Setting Rehabilitation center. Participants Inpatients (N=10; 6 with visuospatial neglect), all with a primary diagnosis of stroke. Interventions Participants received 5 wheelchair skills training sessions of up to 30 minutes each using the Wheelchair Skills Training Program (version 3.2). Main Outcome Measures Powered wheelchair skills were tested before and after training using the Wheelchair Skills Test, Power Mobility version 3.2 (WST-P). Results The group's total mean WST-P scores improved from 25.5% of skills passed at baseline to 71.5% posttraining ( P =.002). The participants with neglect improved their WST-P scores to the same extent as the participants without neglect, although their pretraining and posttraining scores were lower. The training and testing sessions were well tolerated by the participants, and there were no serious adverse events. Conclusions Many people with stroke, with or without visuospatial neglect, can learn to use powered wheelchairs safely and effectively with appropriate training.

To test the hypothesis that, in comparison with a heavier, larger and more expensive manual tilt-in-space wheelchair, a lightweight manual wheelchair equipped with new rear antitip devices provides comparable mean sitting pressures in the tilted position, each of eight able-bodied participants sat for 8 mins in each wheelchair, upright, and tilted back (38-39 degrees). The mean (+/-SD) sitting pressures (of all active sensors in a force-sensing array) at the eighth minute in the upright and tilted positions with the new rear antitip device wheelchair were 58.6 (+/-14.0) and 45.8 (+/-9.3) mm Hg (a 20.7% reduction) (P = 0.005). For the tilt-in-space wheelchair, the mean values were 55.7 (+/-13.9) and 47.2 (+/-10.8) mm Hg (a 26.3% reduction) (P = 0.008). There were no significant differences between the wheelchairs in the upright (P = 0.843) or tilted (P = 0.624) positions. A lightweight manual wheelchair equipped with a new rear antitip device provides equivalent reductions of sitting pressures in the tilted position to a comparably tilted tilt-in-space wheelchair.

Kirby RL, Corkum CG, Smith C, Rushton P, MacLeod DA, Webber A. Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial. Arch Phys Med Rehabil 2008;89: 480-5. Objective: To test the hypotheses that, compared with par- ticipants using manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new RAD design that deploys through an arc (Arc-RAD) perform RAD-relevant wheelchair skills better and as safely. Design: A randomized controlled study. Setting: A rehabilitation center. Participants: Participants (N30) including 16 able-bodied and 14 wheelchair users. Intervention: Participants were provided with wheelchair skills training (up to 2.4h). Main Outcome Measures: Total percentage score on a set of 23 RAD-relevant skills of the Wheelchair Skills Test (WST, version 3.2) administered a minimum of 3 days after training. Results: For the C-RAD and Arc-RAD groups, the mean standard deviation RAD-relevant WST scores were 32.3%8.5% and 85.1%18.9% (Kruskal-Wallis, P.001). Of the 23 RAD- relevant individual skills, the success rates for the Arc-RAD group were at least 20% higher (the criterion we set for clinical signif- icance) in 17 (74%). For the C-RAD group, the success rate was 0% for the 12 wheelie-dependent skills, the 13-cm -high obstacle, and the 15-cm level change ascent. There were no serious adverse effects in either group. Conclusions: The new RAD design allows much better performance on relevant wheelchair skills than the conven- tional design without compromising safety.

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.

To test the hypothesis that able-bodied people simulating hemiplegia (using the hemiplegic-propulsion pattern [1 arm and 1 leg]) have as much difficulty performing wheelchair skills as people with hemiplegia.Single-blind, controlled comparison of 2 groups.Kinesiologic laboratory in a rehabilitation center.Twenty wheelchair users with hemiplegia (HP group) (median age, 68y; 80% men) and 20 able-bodied participants (AB group) (median age, 67y; 75% men).The participants in the AB group simulated hemiplegia and received a brief period of wheelchair skills training. Participants in both groups were asked to attempt the 50 skills of the Wheelchair Skills Test, version 2.4 (WST 2.4).Total and subtotal percentage scores on the WST 2.4 and success rates for the 50 individual skills.The mean percentage WST scores for the AB group were significantly greater than those for the HP group for the total WST scores ( P.001), the indoor skill level ( P.001), and the community skill level ( P.001), but the advanced skill level scores were 0% for both groups. On the individual skills, the AB group had success rates at least 25% higher than the HP group for 13 (26%) of the skills. Both groups were generally successful (/=75% success rate) on 21 skills (42%). Both groups experienced difficulties (/=50% success rate) on 13 skills (26%), notably those in which there was high rolling resistance (eg, incline ascent) or high balance demands (the wheelie skills).Both people with hemiplegia and able-bodied people who are simulating hemiplegia experience similar difficulties when performing some wheelchair skills. This suggests that there are difficulties inherent in these tasks, a finding that holds promise for solutions based on new techniques and technologies.

Kirby RL, Mifflen NJ, Thibault DL, Smith C, Best KL, Thompson KJ, MacLeod DA. The manual wheelchair-handling skills of caregivers and the effect of training. Objective To test the hypothesis that the Wheelchair Skills Training Program (WSTP) is effective in improving the wheelchair-handling skills of untrained caregivers. Design Within-participant comparisons. Setting Rehabilitation center and community. Participants Twenty-four caregivers of manual wheelchair users. Interventions Caregiver participants underwent the WSTP, version 2.4, adapted for caregivers. Training was individualized on the basis of an integrated testing-and-training protocol that took place on a single occasion (total, ≈50min). Main outcome measures Total percentage scores on the objective Wheelchair Skills Test (WST), version 2.4, for the pretraining (N=24), posttraining (N=24), and retention (n=9) evaluations. For the skill-transfer evaluation (n=10), we used the questionnaire version (WST-Q), administered by telephone to participants after return to their communities. Results There were no serious adverse incidents. The mean pretraining total WST score ± standard deviation was 77.8%±12.0%. Posttraining, this increased to 94.7%±7.1% ( P P =.38). At skill-transfer testing, a median latency of 179 days posttraining, the mean value, 92.5%±8.7%, did not decrease significantly from the posttraining level ( P =.73). The greatest improvements were at the advanced skill level. Conclusions The WSTP is a safe, practical, and effective method of improving the wheelchair-handling skills of untrained caregivers. Skill improvements are generally well retained and transfer well to the community. Such training could play an important role in the rehabilitation process.

To test the hypothesis that a brief formalized period of wheelchair skills training, added to the standard curriculum, results in significantly greater overall improvements in wheelchair skills than a standard undergraduate occupational therapy (OT) curriculum alone.Rehabilitation center.Randomized controlled trial.Eighty-two students in a university undergraduate OT program.All students received the standard university curriculum. The 22 second-year students, randomly allocated to the Wheelchair Skills Training Program (WSTP) group, were also trained (on a single occasion each, in groups of 1-3 at a time) on the 50 skills that make up the WSTP. The mean +/- standard deviation (SD) training time was 121.2+/-33.5 minutes per group.Total percentage score on the Wheelchair Skills Test (WST), Version 2.4.From before to after intervention, second-year students in the WSTP group increased their mean percentage WST scores +/- SD from 64.8%+/-9.0% to 81.0%+/-5.2%, a 25% improvement (P.001). Over a comparable period, the 18 students in the second-year control group increased from 66.0%+/-8.0% to 72.4%+/-7.1%, a 9.7% improvement (P=.015). The WSTP group improved to a significantly greater extent (P=.005). For a subset of 8 students in the WSTP group who were retested 9 to 12 months later, the mean WST score was 79.7%+/-4.1%, not significantly less than their WST 2 scores (P=.29). The mean WST score for the 42 students in the fourth-year control group was 73.9%+/-4.1%, significantly lower than the mean postintervention WST score of the second-year students in the WSTP group (P.0001) and not different from the second-year control group (P=.58).The WSTP is an effective way to improve the wheelchair-skills performance of OT students. This has implications for the education of all rehabilitation clinicians.

Kirby RL, Dupuis DJ, MacPhee AH, Coolen AL, Smith C, Best KL, Newton AM, Mountain AD, MacLeod DA, Bonaparte JP. The Wheelchair Skills Test (version 2.4): measurement properties. Arch Phys Med Rehabil 2004;85:794–804. Objective To evaluate the measurement properties of the Wheelchair Skills Test (WST), version 2.4. Design Cohort study. Setting Rehabilitation center. Participants A total of 298 subjects (169 wheelchair users, 129 able-bodied subjects) ranging in age from 17 to 88 years. Intervention We videotaped subjects as they attempted the 50 skills of the WST 2.4. Main outcome measures The test-retest, intrarater, and interrater reliabilities were determined on a subset of 20 wheelchair users. We assessed construct validity by evaluating whether the WST detected expected changes and concurrent validity by seeing how well total WST scores correlated with criterion measures. Results The mean time ± standard deviation taken to administer the WST was 27.0±9.3 minutes. There were no serious adverse incidents, and the test was well tolerated. For the test-retest, intrarater and interrater reliabilities, the intraclass correlation coefficients for the total scores were .904, .959, and .968. For individual skills, the percentage concordance ranged from 73% to 100%. Regarding construct validity, there was a slightly negative Pearson correlation between total WST score and age (–.434). Gender was identified as a significant factor on multiple regression analysis ( P P =.01). Participants with stroke and related disorders had a mean score (55.0%±13.9%) that was significantly lower than those in other diagnostic categories ( P P Conclusions The WST 2.4 is practical and safe, and its measurement properties are very good to excellent. Further study is needed to determine its usefulness in various clinical settings.

Mountain AD, Kirby RL, Smith C. The Wheelchair Skills Test, version 2.4: validity of an algorithm-based questionnaire version. Arch Phys Med Rehabil 2004;85:416–23. Objective To test the hypothesis that an algorithm-based questionnaire version of the Wheelchair Skills Test (WST) would provide a valid assessment of manual wheelchair skills. Design Within-participant comparisons. Setting Rehabilitation center in Nova Scotia, Canada. Participants Twenty wheelchair users, 11 with musculoskeletal and 9 with neurologic disorders, with a wide range of wheelchair experience (1wk–20y). Intervention Each participant completed the questionnaire (WST-Q) and then the objective skills testing (WST, version 2.4). Main outcome measure The WST-Q consisted of 3 components, reported as separate versions: the knowledge version (WST-Q [K]) (structured oral questions only); the visual-aid version (WST-Q [VA]) (visual aids added for 6 of the skills); and the categorical perceived-ability version (WST-Q [PA]). Results The mean total percentage scores for the WST-Q (K), WST-Q (VA), WST-Q (PA), and WST were 60.5%, 62.2%, 64.0%, and 59.8%, respectively. Only the WST-Q (PA) differed significantly from the WST ( P r =.91), WST-Q (VA) ( r =.91), and WST-Q (PA) ( r =.83). The percentage agreement on the individual skill scores ranged from 55% to 100%. Conclusions The algorithm-based WST-Q has excellent concurrent validity in comparison with objective testing, when assessing the overall manual wheelchair skill levels of wheelchair users with a wide range of experience. It may be useful as a screening tool or when objective testing is impractical.

To test the hypothesis that wheelchair users experience more discomfort when holding their necks in extended and/or rotated positions than when in their self-selected most comfortable positions (MCPs).We studied 20 wheelchair users, first determining their MCPs with the eyes closed. Then, subjects assumed and maintained (for 5 min each) four neck positions in random order: level (L) and elevated (E), both straight ahead of the subject (S) and with the neck rotated (R). We measured neck extension angles (from digital photographs) and neck discomfort (using visual analogue scales [VAS], in %).The mean neck-extension angles were MCP - 2.6 degrees, LS 9.5 degrees, LR 8.1 degrees, ES 23.9 degrees and ER 25.4 degrees (ANOVA p0.0001). The mean VAS neck discomfort scores were LS 5.7%, LR 17.4%, ES 24.0% and ER 34.1% (ANOVA p0.0001).Sustained extension and rotation of the neck, alone or in combination, increase the neck discomfort of wheelchair users. The MCP for most wheelchair users is straight ahead with the neck slightly flexed, about 11 degrees and 27 degrees more flexed, respectively, than when looking at an average-height sitting or standing person. These findings have implications for wheelchair design, the behaviour of clinicians and wheelchair users, and the built environment.

MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair Skills Training Program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil 2004;85:41–50. Objective To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program. Design Randomized controlled trial. Setting Rehabilitation center. Participants Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects' mean age ± standard deviation (SD) was 59±18.3 years. Intervention Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5±1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay. Main outcome measures Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined. Results There were no adverse incidents. The control group's mean percentage score ± SD increased from 60.1%±14.4% to 64.9%±13.3%, an 8% improvement of the posttest relative to the pretest ( P =.01). The WSTP group's mean score increased from 64.9%±9.4% to 80.9%±5.6%, a 25% improvement of the posttest relative to the pretest ( P P P Conclusions The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.

Objectives To (1) document the success of learners' attempts to overcome a threshold in a manual wheelchair while using the momentum method; (2) describe the frequency and nature of any errors observed; and (3) compare the characteristics of participants who were or were not successful on their first attempts. Design Cross-sectional, observational study following Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Setting Indoor obstacle course in a rehabilitation center. Participants Able-bodied students (N=214) learning the threshold skill. Intervention Participants attempted to get over the Wheelchair Skills Test (WST) threshold (2cm high, 1.5m wide, and 10cm in the line of progression) in a manual wheelchair. Main Outcome Measures From each participant's video recording of the first attempt, we assigned a WST score for the skill and described any errors noted. Results The WST scores for the first attempts were "pass" for 16 (7.5%), "pass with difficulty" for 100 (46.7%), and "fail" for 98 (45.8%). Eventually, requiring up to 6 attempts, 203 participants (94.9%) were successful (pass or pass with difficulty). Twenty-six different error types were identified. With the use of logistic regression analysis, the odds ratio of failing on the first attempt for women versus men was 2.71 (95% confidence interval, 1.23–6.00) ( P =.0138). Conclusions Only about half of able-bodied people learning the threshold skill using the momentum method are successful on their first attempts, although almost all are successful with further practice and feedback. During the first attempts, there are a wide variety of errors, primarily in the popping phase of the skill. Those who are successful on their first attempts are more likely to be men. These findings have implications for the assessment and training of the threshold skill.

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.

We report the case of a patient who had a transtibial amputation and whose wheelchair had been inadvertently fitted with a push-to-lock brake on one side and a pull-to-lock brake on the other. During a standing-pivot transfer from bed to wheelchair, during which the patient thought that she had applied both brakes, the wheelchair turned away from the patient toward the side of the unlocked brake and the patient fell to the floor. This case report has implications for wheelchair design, wheelchair system management, and for user training.

Smith C, Kirby RL. Manual wheelchair skills capacity and safety of residents of a long-term-care facility. Objectives To evaluate the manual wheelchair skills capacity and safety of residents of a long-term-care (LTC) facility. Our secondary objectives were to describe the wheelchairs that the participants used and to document the participants' perceptions of their assessment experiences. Design A cross-sectional, descriptive, mixed-methods study. Setting One hundred and seventy-five bed LTC veterans' facility. Participants Manual wheelchair users (N=13), a sample of convenience consisting of 10 men and 3 women, with a mean ± SD age of 86.8±6.4 years. Interventions None. Main Outcome Measures Wheelchair Skills Test (WST), version 4.1, the Wheelchair Specification Form, and qualitative observations. Results The mean ± SD total WST scores for capacity and safety were 35.3%±15.4% and 92.5%±6.1%. The mean ± SD number of sessions required was 3.0±1.1 and the mean ± SD total time required was 54.8±20.2 minutes. The analysis of the individual skills and participants provided valuable insights. Only 1 (8%) of the 13 wheelchairs was considered to have proper components and set-up for self-propulsion. Participants generally reported enjoying the wheelchair-skills experience. Conclusions The residents of a LTC veterans' facility whom we studied had significant difficulties when attempting a set of manual wheelchair skills, but they were generally safe. Many of their wheelchairs were less than ideal for self-propulsion. However, these participants enjoyed being challenged to perform wheelchair skills. If these findings are representative, they may have implications for the wheelchair-provision process in the LTC setting.

We present two case reports that shed light on the question of whether routine periodic wheelchair-skills assessment and training are relevant for long-standing wheelchair users. CASE 1: A 60-year-old man with a 15-year history of T12 complete paraplegia sustained an intertrochanteric fracture of his femur due to a tip-over accident that occurred 2 days after a follow-up clinic visit at which no limitations in wheelchair-skill performance were identified. If a procedure had been in place to identify and correct his wheelchair-skill deficiencies, this injury might have been prevented. CASE 2: A 34-year-old woman with spina bifida, whose wheelchair use had gradually increased, came to our attention during the provision of a new wheelchair. She was able to significantly improve her wheelchair abilities through training. The newly learned skills enhanced her community participation.These cases suggest that, even in long-standing wheelchair users, wheelchair skills should be routinely assessed as part of the periodic functional assessment and, when the skill level is determined to be less than appropriate for that person, formal training should be offered.

To review the current understanding of the manual wheelchair wheelie.Review of the literature.A rear wheelchair wheelie occurs when the front wheels, ordinarily in contact with the support surface, are intentionally caused, by means of a transient or sustainable rear pitch, to lift from the surface while the rear wheels remain on the surface. Pitch control (partial or full) is the foundation of many wheelchair skills (e.g., negotiating thresholds, potholes, curbs, steep inclines and gravel). Yet, most wheelchair users never learn to perform this valuable skill. Wheelie capability is affected by the characteristics of the clinician, the wheelchair user, the wheelchair and the environment. Although our understanding of wheelie biomechanics and training methods is evolving, much remains to be learned. Three recent wheelchair developments have wheelie-related implications: a new type of rear anti-tip device (Arc-RAD) that permits wheelie-like function, pushrim-activated power-assisted wheelchairs (PAPAWs) that make wheelie-dependent skills more dangerous and difficult, and a powered wheelchair that has robotic wheelie capabilities (the IBOT).Improvements in our understanding of the nature of wheelies, formalization of training protocols and innovations in wheelchair design hold promise for improved activities and participation by wheelchair users.

Kirby RL, Walker R, Smith C, Best K, MacLeod DA, Thompson K. Manual wheelchair-handling skills by caregivers using new and conventional rear anti-tip devices: a randomized controlled trial.To test the hypothesis that, in comparison with caregivers handling manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new design (Arc-RADs) perform relevant wheelchair skills better and as safely.Randomized controlled trial.Rehabilitation center.Caregivers (n=16) and the wheelchair users (n=16) for whom they cared.Participants were trained in wheelchair-handling skills for an average of 54 minutes each.Total percentage score on a set of 20 rear anti-tip device- and caregiver-relevant skills from the Wheelchair Skills Test, version 3.2, administered a minimum of 3 days after training.For the C-RAD and Arc-RAD groups, the mean +/- SD Wheelchair Skills Test scores were 40%+/-0% and 98.8%+/-3.5%, respectively (P.001). Skills that required the wheelchair to be tipped back extensively (eg, for ascending a 15cm curb) accounted for the differences between the groups. There were no adverse effects in either group.The Arc-RAD design allows significantly better caregiver wheelchair-handling skills than the conventional design, without compromising safety.

Objective: The primary objective of this study was to test the hypotheses that a wheelie training method that begins in a high-rolling-resistance (RR) setting (1) improves the success rate and (2) reduces the training time. Our secondary objectives were to assess the effects of other factors (e.g., age, gender) on training time and to acquire data on the perceptions of the participants that would assist us in refining our training methods. Design: Randomized controlled study including 48 able-bodied participants with no significant wheelchair experience. Each participant was taught the wheelie skill, using up to five training sessions. Participants in the conventional group did all of their training on a smooth, level, tile surface. The RR group began training in a high-RR setting (rear wheels initially prevented from moving at all, progressing to being on 12-cm-thick foam that permitted some movement) before moving to the tile surface. Outcome measures were success rate (%), training time (mins) to achieve wheelie competence (defined as the ability to perform two consecutive 30-sec wheelies within a 1.5-m-diameter circle, assessed at least 2 days after training), and a questionnaire. Results: The success rates for those in the conventional and RR groups were 96% and 100%, respectively (P = 1.000). The mean (±SD) training times for the conventional and RR groups were 55.9 mins (±27.1) and 51.8 mins (±18.7) (P = 0.549). Training time was not significantly affected by trainer or age, but it was affected by sex, with women requiring an average of 21.4 mins more than men (P = 0.002). Perceptions of participants in both groups about the training were positive. Of the participants in the RR group, 14 (74%) perceived the RR technique as very effective, and five (26%) perceived it as moderately effective. Conclusions: Neither success rate nor training time for wheelie skill acquisition by able-bodied learners are improved by a training method using high RR. Women require more time to learn than men. Learners using the RR technique perceive it to be effective. These results have implications for training practices.

Kirby RL, Bennett S, Smith C, Parker K, Thompson K. Wheelchair curb climbing: randomized controlled comparison of highly structured and conventional training methods. Objectives Our primary objective was to test the hypothesis that a highly structured training method for wheelchair curb-climbing requires less training time than conventional training. Our secondary objectives were to test the hypotheses that this training method increases success rate, reduces the need for spotter interventions, and reduces the participants' perceptions of difficulty. Design Randomized controlled trial. Setting Rehabilitation center. Participants Able-bodied participants (N=16), randomly allocated to intervention (n=7) and control (n=9) groups. Interventions Both groups received up to 5 training sessions. Each session included instruction, practice, and feedback. The participants in the intervention and control groups used 18- and 9-step approaches, respectively. Training in the intervention group also included video demonstration, trainer demonstrations, mirror feedback, and standardized feedback phrases. Main Outcome Measures Total training time, success rate at climbing a 15cm-high curb, the number of spotter interventions during training, and a questionnaire. Results The mean ± SD training times for the successful participants in the intervention and control groups were 42.5±24.4 minutes and 87.4±45.3 minutes ( P =.084). The curb-climbing success rates of the intervention and control groups were 86% and 89% ( P =1.000). There were no significant differences between the groups regarding the number of spotter interventions ( P =.203) or for participants' perceptions of difficulty ( P =.050). Conclusions In comparison with a conventional method for curb-climbing, a highly structured method seems to require less than 50% of the training time for able-bodied participants, although this finding is only a trend statistically. This has implications for clinical training.

Kirby RL, MacDonald B, Smith C, MacLeod DA, Webber A. Comparison between a tilt-in-space wheelchair and a manual wheelchair equipped with a new rear anti-tip device from the perspective of the caregiver. Objective To test the hypothesis that, in comparison with a commercially available tilt-in-space wheelchair, a lightweight manual wheelchair equipped with a new, rear anti-tip device (Arc-RAD) provides caregivers with improved wheelchair-handling performance, less exertion, and greater satisfaction. Design Within-participant comparisons. Setting Rehabilitation center. Participants Able-bodied participants (n=19) simulating caregivers and simulating wheelchair users (n=7). Intervention Caregiver participants were trained (50–75min) in wheelchair-handling skills. Main Outcome Measures Each participant was tested in both wheelchairs, in random order. To evaluate wheelchair-handling skills, we used the total percentage score on the Wheelchair Skills Test (WST), version 3.2. For exertion, we used a visual analog scale (in percent). For satisfaction, we used the Quebec Users' Evaluation of Satisfaction with assistive Technology (QUEST; range of values, 8–40), version 2. Results Mean percentage WST scores ± SD for the Arc-RAD and tilt-in-space wheelchairs were 95.9%±4.2%, and 91.9%±4.8%, respectively ( P =.008). The mean perceived exertions during Arc-RAD and tilt-in-space wheelchair use were 26.1%±20.4% and 46.6%±23.2% ( P =.003). The mean total QUEST satisfaction scores for the Arc-RAD and tilt-in-space wheelchairs were 35.1±3.8 and 28.4±4.7 ( P =.002). Conclusions In comparison with the larger and heavier tilt-in-space wheelchair, a lightweight manual wheelchair equipped with a new rear anti-tip design allows 4.4% better wheelchair-handling performance, 44% less exertion, and 23.6% greater wheelchair satisfaction.

A 56-year-old man presented with bilateral transtibial amputations secondary to peripheral vascular disease and diabetes. While using a hospital-owned wheelchair to descend a 27-m-long, 5.6 degrees slope in an underground tunnel connecting the rehabilitation center to a neighboring acute care facility, the patient had difficulty slowing the wheelchair to negotiate a turn. After sustaining burns on the palmar aspects of the thumbs due to friction against the metal handrims, he shifted his thumbs onto the treaded tires. This pulled his right thumb between the wheel lock and the tire of the wheelchair. The resulting laceration and small chip fracture of the dorsal aspect of the thumb metacarpal required immobilization. This injury might have been prevented if the ramp had not violated accessibility guidelines, if the handrims and wheel locks had been different, if brakes had been available, if the patient had been wearing gloves, and/or if the patient had used appropriate procedures for descending long, steep inclines. This case has several implications for the wheelchair-delivery system.

To test the hypothesis that people using a pushrim-activated power-assisted wheelchair (PAPAW) can accomplish a wider range of wheelchair skills than when using a manual wheelchair (MWC).We studied 30 able-bodied participants, using within-participant comparisons. Participants used a manual wheelchair equipped with both PAPAW and regular MWC rear wheels, and rear anti-tip devices (Arc-RADs) that permitted wheelie-like function. We trained participants to perform the wheelchair skills of the Wheelchair Skills Training Program (WSTP, Version 2.4). From the Wheelchair Skills Test (WST, Version 2.4), we calculated pass-fail success rates for the 50 individual skills and a total percentage WST score.The mean (+/-SD) total WST scores were 89.3 (+/-7.0)% for the PAPAW and 88.8 (+/-8.4)% for the MWC, with a mean difference of 0.6 (+/-5.6)% (p = 0.59). Qualitative observations suggested that skills requiring a higher force on the pushrim (e.g., incline ascent) were performed more easily with the PAPAW, whereas skills requiring greater control of the wheelchair (e.g., wheelie-dependent skills) were performed more easily with the MWC.Overall wheelchair skill performance with the PAPAW is not superior to that when using the MWC. The PAPAW may be helpful for specific skills that require more wheel torque, but the additional torque appears to be disadvantageous when performing skills that require greater control.

Best KL, Kirby RL, Smith C, MacLeod DA. Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial. Objective To test the hypotheses that wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. Design Randomized controlled trial. Setting Rehabilitation center and community. Participants Twenty community-based manual wheelchair users (15 men, 5 women; age range, 21–77y), half with musculoskeletal and half with neurologic disorders. Intervention Participants were randomly allocated to the Wheelchair Skills Training Program (WSTP) or control groups. In 1-hour individualized sessions, the WSTP group participants received a mean ± standard deviation of 4.5±0.7 hours of training. Caregivers participated whenever possible. In addition to training at the rehabilitation center, the trainer traveled to administer training in the community. Main Outcome Measures Using the Wheelchair Skills Test (WST, version 3.1), an objective test of 57 skills, we calculated total and subtotal percentage scores (percentage number of skills passed of those possible) and individual skill success rates. Results The WSTP group's improvement in total WST score was significantly greater than the control group's ( P P =.002). The control group increased from a baseline value of 70.8%±14.0% to 74.2%±11.8% at follow-up, a relative improvement of 4.8% ( P =.03). The WSTP group had clinically significant pre- and posttraining improvements (≥20%) in the success rates of 25 of the 57 individual WST skills, compared with only 5 skills for the control group. There were no adverse incidents, and the WSTP participants' comments were all positive. Conclusions Wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. These findings have implications for the standard of rehabilitation care.

To evaluate the measurement properties of the Wheelchair Skills Test (WST), version 2.4.Cohort study.Rehabilitation center.A total of 298 subjects (169 wheelchair users, 129 able-bodied subjects) ranging in age from 17 to 88 years.We videotaped subjects as they attempted the 50 skills of the WST 2.4.The test-retest, intrarater, and interrater reliabilities were determined on a subset of 20 wheelchair users. We assessed construct validity by evaluating whether the WST detected expected changes and concurrent validity by seeing how well total WST scores correlated with criterion measures.The mean time +/- standard deviation taken to administer the WST was 27.0+/-9.3 minutes. There were no serious adverse incidents, and the test was well tolerated. For the test-retest, intrarater and interrater reliabilities, the intraclass correlation coefficients for the total scores were.904,.959, and.968. For individual skills, the percentage concordance ranged from 73% to 100%. Regarding construct validity, there was a slightly negative Pearson correlation between total WST score and age (-.434). Gender was identified as a significant factor on multiple regression analysis (P.001). Wheelchair users with more than 21 days of experience scored higher than those with less experience (65.0% vs 59.6%; P=.01). Participants with stroke and related disorders had a mean score (55.0%+/-13.9%) that was significantly lower than those in other diagnostic categories (P.05). Participants using conventional wheelchairs had lower scores than those in lightweight ones (66.4% vs 75.1%; P.001). Regarding concurrent validity, Spearman rank correlations between total WST scores and the global assessments of the wheelchair users' therapists and admission and discharge FIM instrument scores were.394,.38, and.31.The WST 2.4 is practical and safe, and its measurement properties are very good to excellent. Further study is needed to determine its usefulness in various clinical settings.

To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program.Randomized controlled trial.Rehabilitation center.Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects' mean age +/- standard deviation (SD) was 59+/-18.3 years.Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5+/-1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay.Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined.There were no adverse incidents. The control group's mean percentage score +/- SD increased from 60.1%+/-14.4% to 64.9%+/-13.3%, an 8% improvement of the posttest relative to the pretest (P=.01). The WSTP group's mean score increased from 64.9%+/-9.4% to 80.9%+/-5.6%, a 25% improvement of the posttest relative to the pretest (P.000). The WSTP group showed significantly greater improvements than the control group (P.000). Among the specific skills, significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills (P.001).The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.

Objective: To evaluate the measurement properties of the Wheelchair Skills Test (WST), Version 2.4. Design: Prospective, cohort. Setting: Rehabilitation center. Participants: 298 in all, 169 wheelchair users, and 129 able-bodied subjects, ranging in age from 17 to 88 years. Interventions: Each participant attempted the 50 skills of the WST 2.4. Main Outcome Measures: Reliability was determined on a subset of 20 wheelchair users. We assessed construct validity by evaluating whether the WST detected expected changes and concurrent validity by seeing how well total WST scores correlated with criterion measures. Results: The mean time ± SD taken to administer the WST was 27.0±9.3 minutes. There were no serious adverse incidents. For the test-retest and intra- and interrater reliabilities, the intraclass correlation coefficients for the total scores were .904, .959, and .968. For individual skills, the percentage concordance ranged from 73% to 100%. Regarding construct validity, there was a slight negative correlation between total WST score and age (r=−.434, P 21 days of experience scored higher than those with less experience (65.0% vs 59.6%, P=.01). Participants with stroke and related disorders had a mean score (55.0%±13.9%) that was significantly lower than those in other diagnostic categories (P