Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation

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<.000). The WSTP group showed significantly greater improvements than the control group C, (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). 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.