Background
Methods
Phase 1 item identification of WMS
Data sources and searches
Study selection
Assessment of methodological quality
Data extraction and best evidence synthesis
Selection of WMS outcome measure
Phase 2: item selection of WMS for children
Phase 3: Pilot testing of WMS items
Results
Phase 1: item identification of WMS
Search results
Study characteristics
Instrument | Study | Construct | Target population | # WMS items/# total items | Duration | Outcome | ||
---|---|---|---|---|---|---|---|---|
Version | Disease characteristics | Age | Parameters (Scale) | |||||
WPT | Askari (2013) [47] | Manual wheelchair propulsion | Manual wheelchair user | ≥17 years | 1/1 | ≤ 50 s | Propulsion method | |
TOWM & Wheelie test | Manual wheelchair mobility | SCI | 18–65 years | 36/38 | 40 min | Ability (0–1), Quality (0–5), Time (s), Anxiety (0–10) | ||
WC | Manual wheelchair mobility | SCI | 18–65 years | 5/8 | na | Ability (0–1), Performance time (s), Physical strain (max HR) | ||
AM WC | Cowan (2011) [32] | Manual wheelchair mobility | SCI | > 18 years | 12/14 | na | Ability (0–1), Performance time (s) | |
WAIMS | Vereecken (2012) [33] | Manual wheelchair driving | MS | na | 7/8 | 20–30 min | Ability (0–2), Performance time (s), Covered distance (m) | |
Slalom test | Gagnon (2011) [48] | Manual wheelchair propulsion | SCI | ≥ 18 years | 1/1 | 17 min | Time (s) | |
WST | 1.0 | Kirby (2002) [34] | Manual wheelchair user function in daily life | Manual wheelchair user | ≥ 18 years | 14/33 | 29 min | Safety completion (0–2), |
2.4 | Kirby (2004) [20] | Manual wheelchair user function | Manual wheelchair user | ≥ 17 years | 30/50 | 27 min | Ability (pass/fail/NA), GAS | |
4.1 | Lindquist (2010) [35] | Manual wheelchair user function | Manual wheelchair user | > 16 years | 24/30 | 31 min | Ability (pass/fail). Safety (safe/unsafe) | |
HMAT | Harvey (1998) [39] | Manual wheelchair mobility | SCI | na | 3/6 | < 15 min | Level of assistance (1–6) | |
FIM + 5AML | Middleton (2006) [42] | Manual wheelchair user functional independence | SCI | 18–65 years | 3/5 | na | Level of assistance (1–7) | |
OCAWUP | Wheelchair mobility | Manual and power wheelchair user | 18–65 years | 10/10 | 60–90 min | Time (s), Degree of ease (0–3) | ||
TMT | Chafetz (2004) [43] | Manual wheelchair user function | SCI | 8–14 years | 2/6 | 60–90 min | Time (s) | |
WUFA | Stanley (2003) [44] | Manual wheelchair user function | Manual wheelchair user | na | 6/13 | 60–90 min | Level of independence (1–7) | |
WC-PFP | Cress (2002) [45] | Manual wheelchair user function | Manual wheelchair user | 18–67 years | 1/11 | 40 min | Speed (1/time) | |
VFM | Taricco (2000) [46] | Manual wheelchair user function | SCI | All age groups | 9/65 | 30–50 min | Level of independence (1–5) | |
TOMP | Gans (1988) [49] | Physical function and motor performance | All disabilities | > 6 years | 2/32 | < 60 min | Assistance (0–4), Approach (0–1), Pattern (0–1), Proficiency (0–2) | |
TM | Jebsen (1970) [50] | Mobility | Locomotor disorders | > 20 years | 2/31 | 60 min | Time (s) |
Study | Instrument | Participants (N) | Disease characteristics | Mean age (mean years ± SD) | Sex (M/F) |
---|---|---|---|---|---|
Askari et al. 2013 [47] | WPT |
N = 58a
| Amputation, Spinal Cord Injury, Stroke, Traumatic Brain Injury, others | 58 ± 17.9 | 35/13 |
Chafetz et al. 2004 [43] | TMT |
N = 11 | Spinal Cord Injury | 10.5 ± 2.1 | 6/5 |
Cowan et al. 2011 [32] | AM WC |
N = 50 | Spinal Cord Injury | 41.9 ± 13.4 | 42/8 |
Cress et al. 2002 [45] | WC-PFP |
N = 18a
| Multiple Sclerosis, Stroke, Spinal Cord Injury, Polio, Arthritis, Brain injury | 49.4 ± 10.6 | 13/5 |
Fliess-Douer 2012 [37] | TOWM & Wheelie |
N = 126 | Spinal Cord Injury | na | 91/35 |
Fliess-Douer 2013(a) [36] | TOWM & Wheelie |
N = 30a
| Spinal Cord Injury | 38.8 ± 8.0 | na |
Fliess-Douer 2013(b) [38] | TOWM & Wheelie |
N = 30a
| Spinal Cord Injury | 38.8 ± 8.0 | na |
Gagnon et al. 2011 [48] | Slalom test |
N = 15 | Spinal Cord Injury | 40.7 ± 12.6 | na |
Gans 1988 [49] | TOMP |
N = 40 | Neurological disorder, musculoskeletal disorder | 25.6 ± 19.5 | 14/26 |
Harvey et al. 1998 [39] | HMAT |
N = 20 | Spinal Cord Injury | 45.6 ± 16.8 | na |
Jebsen et al. 1970 [50] | TM |
N = 18 | Stroke, Amputation, Peripheral neuropathy, Polio, Spinal Cord Injury, others | 49.7 ± na | na |
Kilkens et al. 2002 [30] | WC |
N = 27 | Spinal Cord Injury | 34.7 ± 12.5 | 18/9 |
Kilkens et al. 2004 [31] | WC |
N = 74 | Spinal Cord Injury | 40.5 ± 14.5 | 51/23 |
Kirby et al. 2002 [34] | WST 1.0 |
N = 24 | Amputation, Stoke, Musculoskeletal disorder, Spinal Cord Injury, Neuromuscular disorder | 59 ± 19 | 16/8 |
Kirby et al. 2004 [20] | WST 2.4 |
N = 298a
| Amputation, Musculoskeletal, Spinal Cord Injury, Stroke, Able bodied | 43.8 ± 22.5 | 158/140 |
Lindquist et al. 2010 [35] | WST 4.1 |
N = 11 | Spinal Cord Injury, Stroke, other | 42.1 ± 16.2 | 9/2 |
Middleton et al. 2006 [42] | FIM +5-AML |
N = 39 | Spinal Cord Injury | 28 ± 6.5 | 32/7 |
Routhier et al. 2004 [40] | OCAWUP |
N = 17 | Spinal Cord Injury, Neuromuscular disorder, Stroke, Amputation | 50.9 ± 12.1 | 10/7 |
Routhier et al. 2005 [41] | OCAWUP | na | na | na | na |
Stanley 2003 [44] | WUFA |
N = 5 | Spinal Cord injury, Cerebral Palsy, Transverse myelitis | 34.2 ± 10.3 | 4/1 |
Taricco 2000 [46] | VFM |
N = 100 | Spinal Cord Injury | 37 ± na | 77/23 |
Vereecken 2012 [33] | WAIMS |
N = 50 | Multiple Sclerosis | 50 ± 12 | 30/20 |
Measurement properties
Instrument | Author | Reliability | ||||||
---|---|---|---|---|---|---|---|---|
Version | Internal consistency | Test-retest | Intra rater | Inter rater | Measurement error | |||
WST | ||||||||
1.0 | Kirby 2002 [34] | |||||||
Substudy 1: total score | . | poor/indeterminate | fair/positive | fair/positivea
| . | |||
Substudy 2: Item score | . | poor/indeterminate | poor/indeterminate | poor/indeterminatea
| . | |||
2.4 | Kirby 2004 [20] | |||||||
Substudy 1: total score | . | good/positive | good/positive | good/positivea
| . | |||
Substudy 2: Item score | . | poor/indeterminate | poor/indeterminate | poor/indeterminatea
| . | |||
Level of evidence | na | moderate positive | moderate positive | moderate positive | na | |||
WPT | ||||||||
Askari 2013 [47] | . | fair/positive | . | good/positivea
| . | |||
Level of evidence | na | limited positive | na | moderate positive | na | |||
WC | ||||||||
Kilkens 2002 [30] | . | good/positive | . | good/positive | . | |||
Kilkens 2004 [31] | . | . | . | . | . | |||
AM-WC | Cowan 2011 [32] | . | good/positive | . | . | good/indeterminate | ||
WAIMS | Vereecken 2012 [33] | . | fair/positive | . | fair/positive | . | ||
Level of evidence | na | strong positive | na | moderate positive | unknown | |||
TOWM Wheelie | . | |||||||
Fliess-Douer 2012 [37] | . | . | . | . | . | |||
Fliess-Douer 2013(a) [36] | ||||||||
Substudy 1: quality item score | . | poor/indeterminate | poor/indeterminate | poor/indeterminatea
| good/indeterminate | |||
Substudy 2: other scores | . | good/positive | . | . | good/indeterminate | |||
Fliess-Douer 2013(b) [38] | . | . | . | . | . | |||
Level of evidence | na | moderate positive | unknown | unknown | unknown | |||
TOMP | ||||||||
Gans 1988 [49] | . | . | . | fair/positivea
| . | |||
Level of evidence | na | na | na | limited positive | na | |||
HMAT | ||||||||
Harvey 1998 [39] | . | . | . | good/positive | . | |||
Level of evidence | na | na | na | moderate positive | na | |||
FIM +5-AML | ||||||||
Middleton 2006 [42] | fair/positive | . | . | . | . | |||
Level of evidence | limited positive | na | na | na | na | |||
VFM | ||||||||
Taricco 2000 [46] | good/positive | . | . | . | . | |||
Level of evidence | moderate positive | na | na | na | na |
Instrument | Author | Validity | Responsiveness | ||||
---|---|---|---|---|---|---|---|
Version | Content validity | Structural validity | Hypothesis testing | ||||
WST | |||||||
1.0 | Kirby 2002 [34] | ||||||
Substudy 1: total score | fair/indeterminate | . | fair/positive | . | |||
Substudy 2: Item score | . | . | . | . | |||
2.4 | Kirby 2004 [20] | ||||||
Substudy 1: total score | . | . | fair/positive | . | |||
Substudy 2: Item score | . | . | . | . | |||
Level of evidence | unknown | na | moderate positive | na | |||
WPT | |||||||
Askari 2013 [47] | good/positive | good/indeterminate | good/positive | . | |||
Level of evidence | moderate positive | unknown | moderate positive | na | |||
WC | |||||||
Kilkens 2002 [30] | . | . | . | . | |||
Kilkens 2004 [31] | . | . | fair/positive | fair/positive | |||
AM-WC | Cowan 2011 [32] | . | . | good/negative | . | ||
WAIMS | Vereecken 2012 [33] | . | . | fair/positive | . | ||
Level of evidence | na | na | conflicting | limited positive | |||
TOWM Wheelie | |||||||
Fliess-Douer 2012 [37] | poor/indeterminate | . | . | . | |||
Fliess-Douer 2013(a) [36] | |||||||
Substudy 1: quality item score | . | . | . | . | |||
Substudy 2: other scores | . | . | . | . | |||
Fliess-Douer 2013(b) [38] | poor/indeterminate | . | poor/indeterminate | . | |||
Level of evidence | unknown | na | unknown | na | |||
TOMP | |||||||
Gans 1988 [49] | . | . | . | . | |||
Level of evidence | na | na | na | na | |||
HMAT | |||||||
Harvey 1998 [39] | . | . | . | . | |||
Level of evidence | na | na | na | na | |||
FIM +5-AML | |||||||
Middleton 2006 [42] | . | fair/positive | fair/positive | fair/positive | |||
Level of evidence | na | limited positive | limited positive | limited positive | |||
VFM | |||||||
Taricco 2000 [46] | . | fair/indeterminate | poor/indeterminate | fair/indeterminate | |||
Level of evidence | na | unknown | unknown | unknown |
Conclusion phase 1: item identification of WMS
Phase 1: wheelchair mobility skill items | Phase 2: selection of relevant items | Phase 3: Pilot testing | |||||||
---|---|---|---|---|---|---|---|---|---|
Health care professional | Children and their parents | Item selected for phase 3 | Opinion of health care professional | ||||||
Relevant items | Relevant items | Activities | |||||||
Cross the road | Maneuver in crowded place | Maneuver in small rooms | Uneven surfaces | ||||||
1. Propulsion forwarda, b, c, d
| 10–50 m | Yes | Yes | x | x | x | x | Yes | Include |
2. Propulsion backwardsa
| 5 m | Yes | x | x | Yes | Include | |||
3. Rolls on soft surfacea, c
| 2 m (gravel, mat, grass) | Yes | Yes | x | Yes | Include mat, exclude gravel and grass | |||
4. Turns 90° while moving forwarda
| Left | Yes | Yes | x | x | Yes | Include | ||
Right | |||||||||
5. Turns 90° while moving backwarda
| Left | Yes | x | x | Yes | Include | |||
Right | |||||||||
6. Turns 180° in placea
| Left | Yes | x | x | Yes | Include | |||
Right | |||||||||
7. Parallel parking/maneuvers sidewaysa
| Left | No | No | - | |||||
Right | |||||||||
8. Avoids moving obstaclea
| Left | Adapted | x | Adapt into sudden stop | Include | ||||
Right | |||||||||
9. Opening/Closing a doora, c
| Open toward | Yes | Yes | Yes | Include | ||||
Open away | |||||||||
10. Figure-of-8-shapec
| Yes | x | x | Yes | Include | ||||
11. Holding a Wheeliea, c
| 0–30 s | No | Yes | Yes | Include | ||||
12. Propelling in a Wheelie forwardc
| 3 m | No | No | - | |||||
13. Turns 180° in place in wheelie positiona
| Left | No | No | - | |||||
Right | - | ||||||||
14. Slope ascenta, c, d
| 3–20% | Yes | Yes | Yes | Include, adapt scoring | ||||
15. Slope descenta, d
| 3–20% | Yes | Yes | Yes | Include, adapt scoring | ||||
16. Side Slopea, c
| Yes | Yes | Yes | Exclude, material too big | |||||
17. Platform ascendinga, c, d
| 2,5–15 cm | Yes | Yese
| x | Yes | Include, adapt scoring | |||
18. Platform descendinga
| 2.5–15 cm | Yes | Yese
| x | Yes | Include, adapt scoring | |||
19. Doorstepa, c
| 1,2–4 cm | Yes | Yese
| Yes | Include, adapt scoring | ||||
20. Gets over potholea
| 15 cm | No | No | - | |||||
21. Ascends stairsa
| No | Yes | No | - | |||||
22. Descends stairsa
| No | No | - | ||||||
New item | Gutter, escalator | sidewalk | No | - |
Results phase 2: item selection of WMS for children
Conclusion phase 2: item selection of WMS for children
Results phase 3: Pilot testing of WMS items
Utrecht Pediatric Wheelchair Mobility Skills Test | Outcome parameter | ||
---|---|---|---|
Ability | Time | ||
1. Propulsion forwarda, b, c, d
| 10 m | Yes/No | Seconds |
2. Propulsion backwardsa
| 5 m | Yes/No | Seconds |
3. Rolls on soft surface (mat)a, c
| 2 m | Yes/No | Seconds |
4. Turns 90° while moving forwarda
| Left | Yes/No | Seconds |
Right | Yes/No | Seconds | |
5. Turns 90° while moving backwarda
| Left | Yes/No | Seconds |
Right | Yes/No | Seconds | |
6. Turns 180° in placea
| Left | Yes/No | Seconds |
Right | Yes/No | Seconds | |
7. Sudden stop | Seconds | ||
8. Opening/Closing a doora, c
| Open toward | Yes/No | Seconds |
Open away | Yes/No | Seconds | |
9. Figure-of-8-shapec
| Yes/No | Seconds | |
10. Holding a Wheeliea, c
| 30 s | Yes/No | Seconds |
11. Slope ascenta, c, d
| 20% | Yes/No | Seconds |
12. Slope descenta, d
| 20% | Yes/No | Seconds |
13. Platform ascendinga, c, d
| 5,10 cm | Yes/No | Seconds |
14. Platform descendinga
| 5,10 cm | Yes/No | Seconds |
15. Doorstepa, c
| 2 cm | Yes/No | Seconds |