Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students.

OBJECTIVE 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. SETTING Rehabilitation center. DESIGN Randomized controlled trial. PARTICIPANTS Eighty-two students in a university undergraduate OT program. INTERVENTIONS 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. MAIN OUTCOME MEASURE Total percentage score on the Wheelchair Skills Test (WST), Version 2.4. RESULTS 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). CONCLUSIONS 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.

[1]  R Lee Kirby,et al.  Fatal Wheelchair-related Accidents in the United States , 1990, American journal of physical medicine & rehabilitation.

[2]  Denis Anson,et al.  A Survey of Technology Education in Entry-Level Curricula: Quantity, Quality, and Barriers , 1991 .

[3]  Ross Ihaka,et al.  Gentleman R: R: A language for data analysis and graphics , 1996 .

[4]  R Lee Kirby,et al.  The wheelchair skills test, version 2.4: Validity of an algorithm-based questionnaire version. , 2004, Archives of physical medicine and rehabilitation.

[5]  Alan D. Baddeley,et al.  The influence of length and frequency of training session on the rate of learning to type. , 1978 .

[6]  G. Guyatt,et al.  A comparison of Likert and visual analogue scales for measuring change in function. , 1987, Journal of chronic diseases.

[7]  P. Laud,et al.  Perceived accessibility versus actual physical accessibility of healthcare facilities. , 2000, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[8]  D. Wright,et al.  An Assessment of the Attention Demands during Random- and Blocked-Practice Schedules , 2000, The Quarterly journal of experimental psychology. A, Human experimental psychology.

[9]  S Bullard,et al.  Comparison of Teaching Methods to Learn a Tilt and Balance Wheelchair Skill , 2001, Perceptual and motor skills.

[10]  R Lee Kirby,et al.  Evaluation of manual wheelchair skills: is objective testing necessary or would subjective estimates suffice? , 2002, Archives of physical medicine and rehabilitation.

[11]  James A. Lenker Professional education programs in rehabilitation engineering and assistive technology , 1998 .

[12]  Krista L Best,et al.  The wheelchair skills test (version 2.4): measurement properties. , 2004, Archives of physical medicine and rehabilitation.

[13]  E C Huskisson,et al.  Application of visual-analogue scales to the measurement of functional capacity. , 1976, Rheumatology and rehabilitation.

[14]  L. Napholz,et al.  Using a wheelchair activity as a learning experience for student nurses. , 1995, Rehabilitation Nursing.

[15]  R A Cooper,et al.  Shoulder imaging abnormalities in individuals with paraplegia. , 2001, Journal of rehabilitation research and development.

[16]  R L Kirby,et al.  New wheelie aid for wheelchairs: controlled trial of safety and efficacy. , 2001, Archives of physical medicine and rehabilitation.

[17]  Charles H. Shea,et al.  Enhancing Training Efficiency and Effectiveness Through the Use of Dyad Training. , 1999, Journal of motor behavior.

[18]  J A Sanford,et al.  People with mobility impairments in the United States today and in 2010. , 1996, Assistive technology : the official journal of RESNA.

[19]  R Lee Kirby,et al.  Learning to perform wheelchair wheelies: comparison of 2 training strategies. , 2004, Archives of physical medicine and rehabilitation.

[20]  Anita Perr,et al.  The Manual Wheelchair Training Guide , 1998 .

[21]  R. B. Lazar,et al.  Principles of Neurologic Rehabilitation , 1997 .

[22]  R. L. Kirby,et al.  Proactive balance strategy while maintaining a stationary wheelie. , 2001, Archives of physical medicine and rehabilitation.

[23]  R L Kirby,et al.  Spotter strap for the prevention of wheelchair tipping. , 1999, Archives of physical medicine and rehabilitation.

[24]  R. L. Kirby,et al.  The Wheelchair Skills Test: a pilot study of a new outcome measure. , 2002, Archives of physical medicine and rehabilitation.

[25]  E. Bizzi,et al.  Consolidation in human motor memory , 1996, Nature.

[26]  Linda McClain,et al.  Wheelchair Accessibility—Living the Experience: Function in the Community , 1998 .

[27]  H. J. Arnold Introduction to the Practice of Statistics , 1990 .

[28]  Ida Bromley,et al.  Tetraplegia and Paraplegia: A Guide for Physiotherapists , 1976 .

[29]  David Lindley,et al.  Introduction to the Practice of Statistics , 1990, The Mathematical Gazette.

[30]  G. Vanderheiden Service delivery mechanisms in rehabilitation technology. , 1987, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[31]  Jeffrey A. Jordan,et al.  A Dyadic Protocol for Training Complex Skills , 1992 .

[32]  R L Kirby,et al.  WHEELCHAIR-RELATED ACCIDENTS CAUSED BY TIPS AND FALLS AMONG NONINSTITUTIONALIZED USERS OF MANUALLY PROPELLED WHEELCHAIRS IN NOVA SCOTIA , 1994, American journal of physical medicine & rehabilitation.

[33]  O. Payton Manual of physical therapy , 1944 .

[34]  B J Pollock,et al.  Effects of the model's skill level on observational motor learning. , 1992, Research quarterly for exercise and sport.

[35]  M. Fifield,et al.  Education and training of individuals involved in delivery of assistive technology devices , 1997 .

[36]  R L Kirby,et al.  NONFATAL WHEELCHAIR-RELATED ACCIDENTS REPORTED TO THE NATIONAL ELECTRONIC INJURY SURVEILLANCE SYSTEM , 1994, American journal of physical medicine & rehabilitation.

[37]  J. Russell,et al.  Trends and differential use of assistive technology devices: United States, 1994. , 1997, Advance data.

[38]  Krista L Best,et al.  The manual wheelchair-handling skills of caregivers and the effect of training. , 2004, Archives of physical medicine and rehabilitation.

[39]  D. Anson,et al.  Current trends in assistive technology education in entry-level occupational therapy curricula. , 1998, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[40]  R Lee Kirby,et al.  Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. , 2004, Archives of physical medicine and rehabilitation.

[41]  N. J. Powell Content for educational programs in school-based occupational therapy from a practice perspective. , 1994, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[42]  Barriers Experienced by Nondisabled Wheelchair Users: A University-Based Occupational Therapy Program Educational Exercise , 1999 .

[43]  G. Wulf,et al.  Effects of attentional focus, self-control, and dyad training on motor learning: implications for physical rehabilitation. , 2000, Physical therapy.

[44]  J. Shea,et al.  Contextual interference effects on the acquisition, retention, and transfer of a motor skill. , 1979 .

[45]  J. Mcdonald,et al.  Spinal-cord injury , 2002, The Lancet.