Survey of wheelchair skills tests: making the case for broadening the search and assessment criteria

It was a pleasure to see the excellent recent paper by Fliess-Douer et al. that deals with the important topic of outcome measures for manual wheelchair skills. This survey nicely brings up to date the earlier work of Kilkens et al. However, the authors’ findings need to be interpreted in light of the criteria that they used to guide their search strategy. For instance, they limited their search to articles that included objective observations of wheelchair skills, to those that focused on hand-rim (manual) wheelchairs and to studies that included people with spinal cord injury. Some readers might be equally interested in instruments that are questionnaire-based, that address users of powered wheelchairs and their caregivers, and that are equally relevant to people who use wheelchairs for any reason. In addition, the results of such a survey can be affected by the criteria used to assess the selected articles. Although the criteria used by FliessDouer et al. were all appropriate, there are others that might have been considered. For instance, if low cost had been a criterion, then any test that requires the use of a treadmill might not have scored so highly. A second additional criterion might have been the ease of availability of necessary test materials (i.e. test manuals, forms) to those wishing to use the test. Finally, a useful criterion might have been the extent to which the test had been actually used as an outcome measure in published papers by the test originators and by others. This would have helped to address such issues as replicability, responsiveness and construct validity. As one of the developers of the Wheelchair Skills Test (WST), I was pleased to see that the WST fared reasonably well in the authors’ survey. If the search and assessment criteria had been broadened as noted above, the WST might have done even better. I should also point out that the version of the WST reviewed by the authors (Version 2.4) has since then evolved through two further iterations, based on our experience with it and in response to data on its measurement properties. The latest version (WST 4.1) and a list of related publications are available on our website (www.wheelchairskillsprogram.ca). This is not to say that any single instrument needs to be selected as the only one recommended for the assessment of wheelchair skills. It seems to me to be quite desirable to have a battery of instruments from which to choose for different purposes and settings. The authors have gone a long way toward providing the sort of information that clinicians and researchers need when selecting an instrument that meets their needs.