Manual Wheelchair Skills Capacity Predicts Quality of Life and Community Integration in Persons With Spinal Cord Injury

Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML Manual wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury. Arch Phys Med Rehabil 2012;93: 2237-43. Objectives: To determine wheelchair (WC) skills success rates for manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL). Design: Cross-sectional multisite study. Setting: Six Spinal Cord Injury Model Systems (SC1MS) centers. Participants: Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a manual WC as their primary means of mobility. Intervention: Not applicable. Main Outcome Measures: Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation. Results: Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of <= 75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180 degrees in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation. Conclusions: For people with SCI who use a manual WC as their primary means of mobility, their ability to perform manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed.