Development of a new scale for perceived self-efficacy in manual wheeled mobility:a pilot study

Objective: To study the psychometric qualities of a perceived self-efficacy in wheeled mobility scale. Design: Questionnaires. Subjects: Forty-seven wheelchair users with spinal cord injury (elite athletes n= 25, recreational n= 22, from 6 different countries). Method: Based on the literature, and expert's and wheelchair user's comments, a new Self-Efficacy in Wheeled Mobility Scale (SEWM(1)) was developed. Internal consistency (split-half and Cronbach's alpha) and concurrent validity (correlating the Self-Efficacy in Wheeled Mobility Scale with the Generalized Perceived Self-efficacy Scale (GSE) and the spinal cord injury Exercise Self-Efficacy Scale (ESES)) were assessed. To evaluate the construct validity, age, lesion level and completeness and time since injury between groups of participants and their total scores were compared statistically. Results: Cronbach's alpha for the SEWM was 0.91, internal consistency was r=0.90. Significant correlations between pairs of scales of the entire sample (SEWM-ESES: 0.60; SEWM-GSE: 0.50 (p <0.05; n=47, 2-tailed) and of the subgroup comparison (SEWM-ESES recreational r= 0.61; elite r=0.73), demonstrated fair construct and concurrent validity of the SEWM. Conclusion: The SEWM was found to be reliable and valid in active spinal cord injury. A larger more diverse sample is needed to support the psychometric qualities of the SEWM scale

Development of a Test of Wheeled Mobility for Manual Wheelchair Users with Spinal Cord Injury

Manual wheelchair mobility is important for a large number of people, especially for those who will not return to walking again, as individuals with a complete spinal cord injury. To function independently, manual wheelchair users must possess a variety of wheelchair skills, in order to deal with the physical barriers they will encounter in various situations in daily life. Wheelchair skill performance is defined as: The ability to move around and overcome obstacles encountered when carrying out daily activities or social roles in a self-propelled wheelchair" (Routhier et al., 2003). Wheeled mobility (WM) is defined as: Moving around using equipment: moving the whole body from place to place, on any surface or space, by using specific devices designed to facilitate moving or create other ways of moving around, such as moving down the street in a wheelchair or a walker" (ICF WHO 2001). WM skills learned during the rehabilitation period should reflect the daily activities and needs of the specific patient. They should maximize the patient s functional capacity and minimize the dependence on others. Therapists should gain more knowledge and search for ways to improve a person s wheelchair skill performance and by this, to promote participation in community activities and social roles. Furthermore, therapists should have a valid, reliable and sensitive measuring tool in order to objectively and systematically assess their patient's level of WM performances, before, during and after interventions. Functional outcomes after SCI vary from person to person, depending on the level and completeness of the injury, neurologic recovery, associated complications, the amount of rehabilitation training, age, body size, weight, family support and financial status (Haisma et al., 2007). It is assumed that maximizing WM and overall independency is also influenced by attitudinal factors as self-efficacy, rather than just disability-related factors. Therefore, when teaching and assessing wheelchair skills performances, psychological aspects (e.g. anxiety, motivation, etc.), should also be considered. A "WM test" consists of different tasks performed by the candidate under standardized conditions. A validated and reliable wheelchair skills test is necessary as a guiding instrument in the rehabilitation process of people with SCI. Measurement of mobility can assist choice of the appropriate therapy, and evaluation of a patient progress and the effects of treatment (Bussmann et al., 1998). Many tests are applied to measure wheelchair skill performance using different tasks and outcome measures. This makes it difficult to compare study results. Furthermore, a standardized and accepted WM skills test could be used to develop standards of wheelchair skills performance for individuals with different levels of impairment. Such common WM skills test was not available to date (Kilkens et al., 2003. Fliess-Douer et al., 2010).This study aimed to develop a standardized test of wheeled mobility (TOWM) for hand rim wheelchair users with SCI, in order to promote the establishment of norms and standards for WM skill performances. The main research question was: which skills, scale and equipment should comprise a wheelchair skills test that is valid, sensitive and reliable, aimed for fast and easy screening, differentiating between a wide range of performance levels of hand-rim wheelchair users with SCI?In the first study, a systematic literature review was carried out. The main objective of this review was to systematically review, document, analyze and critically appraise the performance-based wheelchair skills tests for manual wheelchair users, especially those with a spinal cord injury, currently available in the international literature. An added value of this study was that it facilitated a selection of the most suitable components from the existing wheelchair skills tests in order to develop a standardized test. To test the preliminary assumption about the level of WM gained during the acute rehabilitation phase, an assessment of differences in WM levels of persons with SCI between discharge from inpatient rehabilitation and 1 year after discharge was conducted. This was based on the Dutch prospective longitudinal study, using an existing data from the "Wheelchair circuit" (Kilkens et al., 2004). An attempt was made also to determine the personal and environmental factors that contribute the most to changes in wheelchair skill performances. Results showed that the scores of the Wheelchair Circuit were stable over the year after discharge from the rehabilitation center. Change in wheelchair skills performance in the year after discharge was not different between groups with different personal or lesion characteristics, while perceived self-efficacy was positively related to the course of wheelchair skill performance over time. The main conclusion of this study was that wheelchair skill performance, measured by means of the Wheelchair Circuit test, stabilizes during the first year after discharge from inpatient rehabilitation and perceived self-efficacy had a positive impact on changes in wheelchair skill performance during that time. The Wheelchair Circuit was found less suitable for testing wheelchair skill performances in the post-acute rehabilitation phase of people with SCI due to a ceiling effect of the ability score (most of the participants already reached the top level at the end of the rehabilitation program and could not further improve).The next study aimed to develop a valid and reliable scale assessing perceived Self-Efficacy in Wheeled Mobility (SEWM). This scale was developed for two main purposes: (a) recruiting the most competent people with SCI (in terms of WM perceptions) in order to create a panel of experts advising and sharing their knowledge with the research team when developing the new test of WM; and (b) to provide evidence for the validity of the test of WM developed in this study, by correlating both tests results. Furthermore, such scale can find wide applicability in clinical and community settings in wheeled mobility focused interventions for people with SCI. No self-efficacy in wheeled mobility scale was found in the international literature. The main results of this study (n=47, only paraplegic) showed high internal consistency of the SEWM but two items showed lower correlations with the total score. The conclusion of this study was that SEWM seems a reliable and valid instrument in manual wheelchair users with SCI, but items 8 and 9 were advised to be rephrased, and a larger sample (including individuals with tetraplegia) was suggested to support the statistical properties of the scale. An opportunity was given during the Beijing Paralympic games 2008, to support the preliminary psychometric findings of the SEWM scale, after rephrasing 2 items. A comparison of self-efficacy perceptions between athletes with SCI competing in dynamic wheelchair sports to athletes who participate in static and non-wheelchair sports was carried out. Results confirmed high internal consistency and construct validity of the SEWM, and athlete's subgroups investigation showed that athletes with tetraplegia perceived significantly lower WM levels than those with paraplegia. Furthermore, athletes who participate in dynamic team wheelchair sports perceived the highest level of WM while athletes competing in static wheelchair sports perceived the lowest WM levels. A survey among elite athletes with SCI was also conducted in Beijing Paralympic games, aiming to sort out the most essential wheeled mobility skills for daily life of manual wheelchair users, in order to incorporate those skills in the newly developed test of wheeled mobility. Aside the sorted list of skills, survey findings demonstrated that nearly half of the participants have learned the most essential WM skills after clinical rehabilitation in a community setting. Having in hands the critical literature review, the SEWM scale and the sorted list of the most essential WM skills for daily life, "an expert team" (including wheelchair users representing all level of SCI as well as physiotherapists and academic professionals) was composed in order to develop the Test of Wheeled Mobility (TOWM). In addition, an idea was raised to develop also a short Wheelie test based on the assumption that mastering wheelie would result in a better wheelchair skill functioning. The process of test development was iterative, with repeated reviews, try-outs and comments by the panel of experts. The TOWM and the short Wheelie test were evaluated for their feasibility, validity and reliability. Both tests were found to be feasible, valid and reliable when assessing wheeled mobility of manual wheelchair users with SCI. In the last part of the dissertation, methodological considerations, practical implications, and recommendations for future research were discussed. The main suggestion was that after refining few quality criteria and considering omitting the Level propulsion task, to use the TOWM in a larger sample, including SCI patients during their rehabilitation phase, as well as assessing the effectiveness of intervention programs by using the TOWM. It was also advised to test if, by teaching, training and assessing wheelchair users to master a wheelie (based on the Wheelie test s protocol), the performance of the TOWM skills will get improved substantially. A positive result, may suggest that the shorter and more economical Wheelie test may serve as an alternative to the TOWM.To conclude, the investigator expressed her hope that the final version of the TOWM and the short Wheelie test will be adopted by the rehabilitation community worldwide, and will be applied regularly, in order to derive norms and standards for wheeled mobility according to lesion level.status: publishe

Relation of functional physical impairment and goal perspectives of wheelchair basketball players

Relation entre le système de classification fonctionnelle selon la sévérité du handicap en basket-ball handisport et le profil de motivation mesuré par le Task and Ego Orientation in Sport Questionnaire (Duda, 1989) chez des joueurs en fauteuil pratiquant en compétition

Test of Wheeled Mobility (TOWM) and a short wheelie test:a feasibility and validity study

<p>Objective: To assess the feasibility and validity of both the Test of Wheeled Mobility (TOWM) and a wheelie test.</p><p>Design: Cross-sectional study.</p><p>Setting: KU Leuven gymnasium.</p><p>Subjects: Thirty male manual wheelchair users (age range 23-53 years) with spinal cord injury.</p><p>Interventions: Participants preformed both tests after completing a personal information form and a 'Perceived self-efficacy in WM' scale. The TOWM consists of 30 tasks reflecting functional wheeled mobility. The wheelie test consists of eight tasks measuring the ability to perform a 'wheelie' in challenging situations.</p><p>Main measure: Ability, performance time, qualitative and anxiety scores were assessed. Convergent validity was tested by correlating the TOWM and the wheelie test scores. Construct validity was assessed by testing whether the four scores of both tests are significantly related to perceived self-efficacy in wheeled mobility, time since injury and sport participation.</p><p>Results: TOWM average total testing time was 24.7 minutes (+/- 5.93) and the wheelie test was 12.62 minutes (+/- 5.08). Convergent validity was confirmed by the positive correlation between the TOWM and wheelie test total ability scores (r = 0.84; P <0.001), quality scores (r = 0.88) and anxiety scores (r = 0.66). Moderate correlations were found between the total time scores of the TOWM and wheelie test (r = 0.47). Construct validity was confirmed by fair to moderate correlations between both test's scores with time since injury, self-efficacy and sport participation after injury.</p><p>Conclusion: The TOWM and the wheelie tests are feasible and valid instruments for assessing manual wheelchair mobility in persons with spinal cord injury.</p>

Reliability of the Test of Wheeled Mobility (TOWM) and the Short Wheelie Test

<p>Objective: To assess the reliability of the Test of Wheeled Mobility (TOWM) and the Wheelie test.</p><p>Design: Cohort study.</p><p>Setting: Gymnasium.</p><p>Participants: Manual wheelchair users (N=30, age 23-53y) with a spinal cord injury.</p><p>Intervention: Participants performed the 30 skills of the TOWM and the 8 skills of the Wheelie test twice. Ability, time, and anxiety scores were assessed on field. Quality scores were assessed by video analysis.</p><p>Main Outcome Measures: Test-retest reliability was evaluated for the ability, time, anxiety, and quality scores of both tests. Intrarater and interrater reliability were determined on the basis of quality scores of 20 participants. Intraclass coefficient and nonparametric statistics were applied, as well as standard error of measurement, method error (ME), coefficient variation of ME, minimal detectable change (95% confidence), and technical error of measurement.</p><p>Results: Test-retest reliability: no significant differences between t1 and t2 in the ability, quality, and time scores, except for anxiety scores. Standard error of measurement, ME, coefficient variation of ME, and minimal detectable change (95% confidence) values were low for the ability and quality total score and higher for the time and anxiety total score. Intrarater and interrater reliability interclass correlation coefficients of both tests ranged between .91 and .99. Interrater relative technical error of measurement for the TOWM and the Wheelie test total quality score was 3.7% and 6.3%, respectively, and intrarater relative technical error of measurement was 4.3% and 6.1%, respectively. Interclass correlation coefficients per individual tasks ranged between .88 and 1.00, except for "level propulsion forward," which showed low interclass correlation coefficient scores (interrater: .49; intrarater: .44; test-retest: .43).</p><p>Conclusions: Based on ability and quality total scores, the TOWM and the Wheelie test are reliable when assessing the wheeled mobility of manual wheelchair users with spinal cord injury. The quality criteria of 1 task from the TOWM and 3 tasks from the Wheelie test need to be refined. Archives of Physical Medicine and Rehabilitation 2013;94:761-70 (C) 2013 by the American Congress of Rehabilitation Medicine</p>

Reliability and validity of perceived self-efficacy in wheeled mobility scale among elite wheelchair-dependent athletes with a spinal cord injury

<p>Purpose: To study the reliability and validity of the perceived self-efficacy in wheeled mobility scale among elite athletes with a spinal cord injury (SCI). Method: During the Beijing Paralympics, 79 participants with SCI completed the SCI Exercise Self-Efficacy Scale (ESES), the revised Self-Efficacy in Wheeled Mobility scale (SEWM) and the perceived wheeled mobility (WM) at present Visual Analog Scale (VAS). Sample included athletes from 18 countries and subcategorized by gender, lesion level/completeness and type of sports. Reliability and concurrent validity were determined. Results: SEWM Cronbach's a was 0.905. High internal consistency was confirmed in Split-half correlation coefficient (r = 0.87). Validity was supported by significant correlations between SWEM and ESES total scores (r = 0.64, p <0.05), and between SEWM and WM VAS scores (r = 0.60; p <0.001). Subgroups analyses showed that athletes with tetraplegia showed significantly lower WM self-efficacy levels than those with paraplegia. There was a significant difference in perceived WM self-efficacy between athletes who participated in dynamic wheelchair sports and those who participated in non-wheelchair sports (p <0.03). Conclusions: The SEWM is a reliable and valid scale among Paralympic athletes with SCI. Findings confirmed a significantly higher perception of self-efficacy in WM among athletes who participated in dynamic wheelchair sports.</p>

Most Essential Wheeled Mobility Skills for Daily Life:An International Survey Among Paralympic Wheelchair Athletes With Spinal Cord Injury

Fliess-Douer O, Vanlandewijck YC, Van Der Woude LHV. Most essential wheeled mobility skills for daily life: an international survey among paralympic wheelchair athletes with spinal cord injury. Arch Phys Med Rehabil 2012;93:629-35. Objectives: To create a hierarchical list of the most essential wheeled mobility (WM) skills for everyday life of wheelchair users with a spinal cord injury (SCI), and to compare perceptions of WM gained during and after clinical rehabilitation. Design: Cross-sectional study using survey questionnaires. Setting: The Beijing Paralympic games, at the international zone of the Olympic village and in different sports venues. Participants: A sample of men (N=49) and women (N=30) elite manual wheelchair user athletes with SCI (paraplegia, n=64; tetraplegia, n=15). Interventions: Not applicable. Main Outcome Measure: A survey with 24 predefined skills was distributed during the Beijing Paralympic games. Respondents were asked to rate the essentiality of each skill (I, not essential; 5, extremely essential); to state where, when, and with whom they have learned to perform each skill; and to mark the level of WM, which they gained during and after clinical rehabilitation, on 3 different WM visual analog scales (scores 1-10). Results: Rated as the most essential skill was transfer into and out of a car (mean +/- SD, 4.7 +/- 0.7). Rated as the least essential skill was the 1-handed wheelie (mean SD, 1.9 +/- 1.3). Of the respondents, 57% have learned the most essential skills in clinical rehabilitation, while 40% claimed to have learned those skills afterward in a community setting. Three percent have never learned to perform the most essential skills. Of the very essential skills, 40% were self-taught. Mean score +/- SD for the extent to which WM skills were gained in rehabilitation was 5.4 +/- 2.5. Conclusions: The main survey outcome is a sorted list of WM skills according to their essentiality for daily life of hand-rim wheelchair users with SCI. It is recommended to incorporate the skills that were graded as very essential and extremely essential during inpatient rehabilitation and in postrehabilitalion WM workshops

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

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

WHEELCHAIR SKILLS PERFORMANCE BETWEEN DISCHARGE AND ONE YEAR AFTER INPATIENT REHABILITATION IN HAND-RIM WHEELCHAIR USERS WITH SPINAL CORD INJURY

<p>Objective: To study possible changes in wheelchair skills in participants with spinal cord injury between discharge and 1 year after rehabilitation, and to determine whether changes in wheelchair skills performance are related to lesion and personal characteristics, self-efficacy, and wheelchair satisfaction.</p><p>Study design: Prospective cohort study.</p><p>Setting: Eight rehabilitation centres with spinal cord injury units in the Netherlands.</p><p>Methods: A total of 111 participants performed the Wheelchair Circuit twice: at discharge (t1) and 1 year after discharge (t2). Personal/lesion characteristics, self-efficacy, and wheelchair satisfaction were measured. Normalized ability score and performance time score were analysed with a linear multilevel regression analysis for possible associations with wheelchair skills.</p><p>Results: No statistically significant changes were found in the ability and performance time scores of the Wheelchair Circuit over the first year after discharge. Younger persons, those with paraplegia, and those with a better self-efficacy score showed higher ability scores and faster performance time scores on both test occasions.</p><p>Conclusion: Wheelchair skills performance, measured with the Wheelchair Circuit, did not change during the first year after discharge from inpatient rehabilitation. Wheelchair skills performance was associated with age, lesion level and self-efficacy perceptions.</p>