A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure

Abstract

Objective: To review, analyse, evaluate and critically appraise available wheelchair skill tests in the international literature and to determine the need for a standardized measurement tool of manual wheeled mobility in those with spinal cord injury.

Data sources: A systematic review of literature (databases PubMed, Web of Science and Cochrane Library (1970-December 2009).

Subjects: Hand rim wheelchair users, mainly those with spinal cord injury.

Review methods: Studies’ content and methodology were analysed qualitatively. Study quality was assessed using the scale of Gardner and Altman.

Results: Thirteen studies fell within the inclusion criteria and were critically reviewed. The 13 studies covered 11 tests, which involved 14 different skills. These 14 skills were categorized into: wheelchair manoeuvring and basic daily living skills; obstacle-negotiating skills; wheelie tasks; and transfers. The Wheelchair Skills Test version 2.4 (WST-2.4) and Wheelchair Circuit tests scored best on the Gardner and Altman scale, the Obstacle Course Assessment of Wheelchair User Performances (OCAWUP) test was found to be the most relevant for daily needs in a wheelchair. The different tests used different measurement scales, varying from binary to ordinal and continuous. Comparison of outcomes between tests was not possible because of differences in skills assessed, measurement scales, environment and equipment selected for each test. A lack of information regarding protocols as well as differences in terminology was also detected.

Conclusion: This systematic review revealed large inconsistencies among the current available wheelchair skill tests. This makes it difficult to compare study results and to create norms and standards for wheelchair skill performance.

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References

Post MWM , Asbeck van FW , Dijk van AJ , Schrijvers AJ Services for spinal cord injured: availability and satisfaction. Spinal Cord 1997; 35: 109-15.

Gouvier WD , Cottam G. , Webster JS , Beissel GF , Wofford JD Behavioral interventions with stroke patients for improving wheelchair navigation . Int J Clin Neuropsychol 1984 ; 6: 186-90.

Kilkens OJ , Post MW , Dallmeijer AJ , van Asbeck FW , Van Der Woude LH Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation. J Rehabil Res Dev 2005; 42(suppl 1): 65-73.

Routhier F. , Vincent C. , Desrosiers J. , Nadeau S. Mobility of wheelchair users: a proposed performance assessment framework . Disabil Rehabil 2003; 25: 19-34.

Kilkens OJ , Post MW , Dallmeijer AJ , Seelen HA , Van Der Woude LH Wheelchair skills tests: a systematic review. Clin Rehabil 2003; 17: 418-30.

Mortenson WB , Miller WC , Auger C. Issues for the selection of wheelchair-specific activity and participation outcome measures: a review . Arch Phys Med Rehabil 2008; 89: 1177-84.

World Health Organization. Towards a common language of function, disability and health: ICF. Geneva: WHO, 2002, 1-23.

World Health Organization. ICF: international classification of functioning, disability and health. Geneva: WHO, 2002.

Washburn RA , Montoye HJ The assessment of physical activity by questionnaire. Am J Epidemiol 1986; 123: 563-76.

10.

van Velzen JM , van Bennekom CA , Polomski W. , Slootman JR , van der Woude LH , Houdijk H. Physical capacity and walking ability after lower limb amputation: a systematic review. Clin Rehabil 2006; 20: 999-1016.

11.

Gardner MJ , Altman DG Statistic with confidence: confidence intervals and statistical guidelines . London: BMJ Books, 1989.

12.

Rudner LM , Shafer WD Reliability. ERIC Digest. College Park, MD: ERIC Clearinghouse on Assessment and Evaluation, 2001.

13.

Middleton JW , Harvey LA , Batty J. , Cameron I. , Quirk R. , Winstanley J. Five additional mobility and locomotor items to improve responsiveness of the FIM in wheelchair-dependent individuals with spinal cord injury. Spinal Cord 2006; 44: 495-504.

14.

Routhier F. , Desrosiers J. , Vincent C. , Nadeau S. Reliability and construct validity of an obstacle course assessment of wheelchair user performance. Int J Rehabil Res 2005; 28: 49-56.

15.

Routhier F. , Vincent C. , Desrosiers J. , Nadeau S. , Guerette C. Development of an obstacle course assessment of wheelchair user performances (OCAWUP): a content validity study. Technol Disabil 2004; 16: 19-31.

16.

Kirby RL , Dupuis DJ , MacPhee AH et al. The Wheelchair Skills Test (version 2.4): measurement properties . Arch Phys Med Rehabil 2004; 85: 794-804.

17.

Kilkens O. , Dallmeijer A. , de Witte L. , van der Woude L. , Post M. The Wheelchair Circuit: construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury . Arch Phys Med Rehabil 2004; 85: 424-31.

18.

Stanley RK , Stafford DJ , Rasch E. , Rodgers MM Development of a functional assessment measure for manual wheelchair users . J Rehabil Res Dev 2003; 40: 301-7.

19.

Kirby RL , Swuste J. , Dupuis DJ , MacLeod DA , Monroe R. The Wheelchair Skills Test: a pilot study of a new outcome measure . Arch Phys Med Rehabil 2002; 83: 10-18.

20.

Kilkens O. , Post M. , van der Woude L. , Dallmeijer A. , van den Hauvel W. The wheelchair circuit: reliability of a test to assess mobility in persons with spinal cord injuries. Arch Phys Med Rehabil 2002; 83: 1783-8.

21.

Cress ME , Kinne S. , Patrick DL , Maher E. Physical functional performance in persons using a manual wheelchair . J Orthop Phys Ther 2002; 32: 104-13.

22.

Taricco M. , Apolone G. , Colombo C. , Filardo G. , Telaro E. , Liberati A. Functional status in patients with spinal cord injury: a new standardized measurement scale. Gruppo Interdisciplinare Valutazione Interventi Riabilitativi . Arch Phys Med Rehabil 2000; 81: 1173-80.

23.

Harvey LA , Batty J. , Fahey A. Reliability of a tool for assessing mobility in wheelchair-dependent paraplegics . Spinal Cord 1998; 36: 427-31.

24.

Gans BM , Haley SM , Hallenborg SC , Mann N. , Inacio CA , Faas RM Description and interobserver reliability of the Tufts Assessment of Motor Performance. Am J Phys Med Rehabil 1988; 67: 202-10.

25.

Jebsen RH , Trieschmann RB , Mikulic MA , Hartley RB , McMillan JA , Snook ME Measurement of time in a standardized test of patient mobility. Arch Phys Med Rehabil 1970; 51: 170-75.

26.

Mills T. , Holm MB , Trefler E. , Schmeler M. , Fitzgerald S. , Boninger M. Development and consumer validation of the functional evaluation in a wheelchair (FEW) instrument. Disabil Rehabil 2002; 24: 38-46.

27.

Mills TL , Holm MB , Schmeler M. Test-retest reliability and cross validation of the functioning everyday with a wheelchair instrument. Assist Technol 2007 ; 19: 61-77.

28.

Webster JS , Cottam G. , Gouvier WD , Blanton P. , Beissel GF , Wofford J. Wheelchair obstacle course performance in right cerebral vascular accident victims. J Clin Exp Neuropsychol 1989; 11: 295-310.

29.

Ditunno JF , Formal CS Chronic spinal cord injury. N Engl J Med 1994 ; 330: 550-6.

30.

Guide for the uniform data set for medical rehabilitation (including the FIM instrument), version 5.1. Buffalo, NY : State University of New York at Buffalo, 1997.