Technical report for the Guidelines for the … › __data › assets › pdf_file › ...Technical...

Technical report for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury


2


You may copy, distribute, display and otherwise freely deal with this work for any purpose, provided that you attribute the LTCSA and EnableNSW as the owners. However, you must obtain permission if you wish to (1) charge others for access to the work (other than at cost), (2) include the work in advertising or a product for sale, or (3) modify the work.

ISBN: 978-1-921422-19-5

Suggested citation:

EnableNSW and Lifetime Care & Support Authority, Technical report for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury. EnableNSW and LTCSA Editor, 2011, Sydney.

Author: Sue Lukersmith

For further copies

contact EnableNSW on [email protected] Lifetime Care on [email protected]

download from EnableNSW http://www.enable.health.nsw.gov.au/publications LTCSA http://www.lifetimecare.nsw.gov.au/Resources.aspx

© EnableNSW and Lifetime Care & Support Authority

First edition 2011 A guideline review is scheduled for 2016

Technical report

for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury 3

Contents

Executive summary 4

1. Purpose 5

2. Development process 7

3. Methodology 10

3.1 Clinical questions 10

3.2 Search strategies 10

3.3 Appraising the evidence: guideline and article appraisal 11

3.4 Grading the evidence 11

4. Existing guidelines 14

5. Evidence tables 15

5.1 Assessment and review evidence tables 16

5.1.1 Assessment and review 16

5.1.2 Reasons for non-use 19

5.2 Capacity and performance evidence tables 26

5.2.1 Cognition and perception 26

5.2.2 Upper limb capacity (recommendations and risk factors) 29

5.2.3 Cardiovascular fitness 40

5.3 Wheelchair features evidence tables 45

5.3.1 Ride and comfort 45

5.3.2 Tilt in space 46

5.3.3 Elevating leg rest 50

5.3.4 Elevating seat 51

5.4 Propulsion evidence tables 52

5.4.1 Power assisted 52

5.4.2 Drive wheel position 55

5.5 Training evidence table 56

5.6 Maintenance evidence table 65

5.7 Existing guidelines evidence table 66

6. Working party 67

7. Consumer and public consultation 68

8. Appendices 69

Appendix 1 Clinical questions 69

Appendix 2 Literature searches 71

Appendix 3 Search terms for clinical questions 74

Appendix 4 Abbreviations 83

References 84


4

Executive summary

Providing a wheelchair or scooter is a complex therapy intervention which aims to enhance a person’s functioning. The Guidelines for the prescription of a seated wheelchair or mobility scooter relate to two health conditions—spinal cord injury and traumatic brain injury. The guidelines have been developed using a rigorous methodology of searching for, appraising and grading the research evidence in conjunction with a working party. The topics covered were generated by the concerns and clinical questions raised by the working party. The guidelines are intended to inform and guide the therapist on clinical actions and decisions, but do not replace the need for clinical supervision or clinical judgment.

The guidelines provide recommendations that range from topics on the goals and evaluation, assessment and review, capacity and performance of the client, upper limb capacity and risk of injury, wheelchair features, through to propulsion, training, transport and maintenance. Resources have been developed to support the use of the guidelines and include checklists on key areas such as shoulder injury prevention, long-term needs, training, transport and maintenance.

This technical report provides information on the development process, methodology, tables of evidence and the working party.

Technical report

for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury

1. Purpose

5

Prescribing a wheelchair is a complex therapy intervention. Complex therapy interventions:39, 119

• have a number of inter-dependent and independent components

• are delivered across inpatient, outpatient and community settings

• are influenced by the potential wheelchair user’s context, including environmental and personal factors.

The Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury provide recommendations to assist and guide occupational therapists, physiotherapists and other professionals such as rehabilitation engineers, who are involved in the prescription of a wheelchair. They are not intended to be rigidly prescriptive or to replace clinical judgment, but rather to inform and guide the health professional towards better practice in the prescription of a wheelchair or scooter.

When to consult the guidelines

The guidelines relate to two health conditions: spinal cord injury and traumatic brain injury. Some of the recommendations in the guidelines may be applied to other health conditions. Care should be taken if the graded recommendations are applied to health conditions that are not included in the research study sample on which the recommendations are based.

The population and applicable health conditions

• adults with traumatic brain injury

• adults with spinal cord injury

The definition of adult for these guidelines is 16 years and older.

Spinal cord injury (SCI)

Spinal cord injury is defined as damage to the neural tissues as a result of trauma or a non-progressive disease process, resulting in temporary or permanent sensory deficit, motor deficit, or bladder/bowel dysfunction. Non-progressive diseases include: transverse myelitis, compression by infective process, canal stenosis, haemorrhage or vascular occlusion. Spinal cord injury does not include progressive conditions such as demyelination, genetic disorders, degenerative conditions of the spinal cord and compression by metastatic lesions.

Traumatic brain injury (TBI)

Traumatic brain injury is an insult to the brain following birth, caused by an external force that produces diminished or altered states of consciousness, which can result in a complex range of temporary or permanent neurological impairments in the cognitive, physical, behavioural and emotional domains.

Purpose1


1. Purpose

6

Related publications

The publications in this series include:

• Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury

• Summary of the guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury

• Consumer information for the guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury

• Technical report for the guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury.

The resources developed for the guidelines are also available as separate documents.

Technical report


2. Development process

7

A working party of representatives from key organisations and consumer groups and a part-time project officer developed the guidelines over 2.5 years. Table 1 outlines the development process.

Table 1 Guidelines development process

Phase of guideline development process93 96

Activity

Defining the topics and issues to be included

Lifetime Care & Support Authority (LTCSA) and EnableNSW Department of Health identified the need for evidence-based clinical guidelines on the prescription of wheelchairs for specific populations.

Objective: To devise evidence-based guidelines with best practice recommendations for therapists to identify the individual’s goals and assess their needs, capacity and performance in their own context and prescribe the appropriate wheelchair or scooter.

Preparing the work plan: establishing procedures and time frames; establishing the Guideline multidisciplinary working party

Project brief finalised including: scope of the guidelines, target population, potential users, consultation process, working party membership, trial of the guidelines, methodology, authorship, projected time frames, and initial ideas on dissemination and implementation. The need for two guidelines was considered, but discounted due to content overlap.

Working party established with representation from key stakeholders.

Each working party member signed a conflict of interest declaration.

Working party agreed on the process and meeting dates.

After two meetings, the working party was split between the two health conditions. The rehabilitation engineer, LTCSA and EnableNSW representatives, and the project officer attended both working party meetings.

Scoping and developing the health care questions

The working party identified the key clinical areas and topics within the proposed scope.

Clinical questions on wheelchair prescription were developed and discussed until consensus reached.

Relevant existing Australian and International guidelines identified and reviewed.

These guidelines were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) tool119.

Development process2



8

Developing the guidelines

Key personnel within services specialising in seating were contacted to find potentially relevant publications.

Copies of relevant conference abstracts were sought through personal contacts.

Experts from NSW and interstate were consulted.

Systematic searches of the literature were conducted on multiple databases.

Two working party members appraised the research literature and graded the strength of the evidence.

The evidence and recommendations were discussed with the working party and the evidence graded in accordance with NHMRC grades.95

Where available literature was limited, the working party reached a consensus decision and recommendation.

Consumer opinion was obtained about the patient information sheet via feedback from consumer organisations and working party members.

Validating the guidelines

Consultation and opportunity for feedback on the draft.

Formal endorsement by key stakeholder organisations.

Editing by technical editor.

Implementing the guidelines: strategies include distribution, dissemination, audit and feedback mechanisms, support and guidance to knowledge brokers in units.

LTCSA/Enable NSW publication, distribution and dissemination via email to key stakeholders and other organisations and individuals.

The guidelines, resources, patient information and technical report made available on LTCSA and EnableNSW websites.

The guidelines and resources promoted in various newsletters (consumer, professional association).

Hard copies distributed through LTCSA and Department of Health.

Related professional conference presentations made in NSW and interstate. Workshops to occupational therapy groups and consumer groups.

Workshops and support to key personnel from specialist and general therapy units to adopt a knowledge broker approach and strategy for adaptation and implementation at the local level.

Evaluating the guidelines

To be determined at a future date after implementation.

Technical report



9

Funding

The guidelines were developed as a joint project, with funding provided by the Lifetime Care & Support Authority and EnableNSW. The project officer was contracted to and hosted by LTCSA, but was not an employee. Both organisations were involved and provided support throughout. Printing and distribution of the guidelines was jointly funded.

Framework

The guidelines have been informed by two key documents:

The World Health Organization International Classification of Functioning, Disability and Health (ICF).138 This framework defines a person’s functioning based on the bio-psychosocial model of health.

The United Nations Convention on the Rights of Persons with Disabilities (CRP).122 The CRPD reinforces the principle that the user must be actively involved and thereby placed at the centre of the therapy intervention and specifically refers to supports and assistive devices.

Editorial Independence

The document was written by the project officer. The views and interests of the LTCSA and EnableNSW did not influence the final recommendations.

Conflict of interest

At the beginning of the guidelines development process the working party members were required to declare any real or perceived conflict of interest. One member declared the potential for a perceived conflict of interest because a family member was employed by a supplier. It was anticipated that only wheelchair features would be discussed, not suppliers or brands. Nevertheless, the working party decided and documented that if those topics arose, the party member with the potential conflict of interest would be excluded from the discussion. However, those subjects were not discussed and no conflict of interest occurred.

Guidelines update

A review of the evidence is planned for 2016 when a systematic search for new research published from 2011 to 2016 will be undertaken. A working party will review the recommendations in light of any new research and changes made accordingly. Whether new clinical questions will be explored at this time is not known, but standing wheelchairs may be included in the wheelchair features discussed in Section 8 of the guidelines.


3. Methodology

10

3.1 Clinical questions

The clinical questions were developed by the working party and are listed in Appendix 1. The questions were discussed and refined over a period of four monthly meetings, with email communication and written feedback between working party members throughout this time. None of the existing guidelines precisely answered the clinical questions or provided recommendations that could be adapted. However, some of the existing guidelines’ recommendations and research evidence was used to supplement updated and additional research to formulate a new recommendation.

3.2 Search strategies

Systematic searches for relevant published literature were conducted using key terms and a number of databases. It was anticipated that there would be a paucity of high quality research evidence related to the clinical questions. In order to capture relevant evidence, the working party agreed that the search would be conducted on relevant literature published in the previous twelve years (1998 to May 2011).

Literature searches on clinical questions used key words for search terms to find relevant literature—rather than a participant intervention comparator outcome (PICO) format as for simple interventions—because of the complexity of the clinical questions, many of which would not likely have relevant randomised controlled trials.

National and international guidelines search

Bibliographic databases were systematically searched for existing relevant published guidelines. Only guidelines published since 1999 were included. Manual searches were also performed to identify relevant guidelines. Details of the search terms are provided in Table 3 in Appendix 2. The websites are also listed in Appendix 2.

Systematic reviews

A search for systematic reviews on the Cochrane and DARE databases was conducted in 2009.

Clinical questions and published studies

Appendix 3 lists the search terms used for each clinical question. The databases systematically searched for research studies for all clinical questions were:

CINAHLEMBASEMEDLINEPsychINFO

Inclusion criteria

• Studies in English• Adults• Humans• Papers published between 1998 and May 2011

Methodology 3

Technical report


3. Methodology

11

Methodological filters such as ‘clinical trial’ or ‘randomised controlled trial (RCT)’ were not used. The reference lists of key papers were searched manually. Some of the experts contacted also identified relevant research papers.

Exclusion criteria

• Studies involving children (with the exception of training)

• Papers or guidelines in foreign languages

• Papers published before 1998

Articles that were considered of limited relevance or poor quality have not been cited in the evidence tables.

3.3 Appraising the evidence: guideline and article appraisal

The research was assessed for relevance and critically appraised by two reviewers. Research study appraisal was based on the National Health and Medical Research Council (NHMRC) levels for the strength of evidence (levels I–IV) and grading system for guideline recommendations.57, 58, 95 The literature included reviews and studies of wheelchair user’s experiences and perspectives. Qualitative and single case studies were also considered in order to strengthen the body of evidence. The research evidence was presented to the working party.

Clinical Guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II)119.

Research articles were appraised according to study design:

• Quantitative studies were assessed using an expanded version of the (NHMRC) appraising the evidence checklists94 for prognostic and prediction studies, and intervention studies. The partitioned PEDro scale was also used for intervention studies.104

• Qualitative studies were evaluated with the McMaster’s University qualitative appraisal checklist, Letts et al (2007).75

• Single case studies were reviewed using the Single Case Experimental Design (SCED) scale.117

• Systematic reviews were not appraised.

3.4 Grading the evidence

The strength of the body of evidence for each recommendation was determined using the NHMRC grades for recommendations95 with adaptations. The NHMRC grades use a hierarchical model of quantitative research methods. Systematic reviews or meta-analysis of randomised controlled trials are considered to be the most robust evidence.

The NHMRC grading does not incorporate good qualitative research or single case studies, but these methodologies may be relevant to a number of questions raised by therapists for these guidelines. Given the complexity of the intervention, the clinical questions and the context variables posed by the working party, it was important to include qualitative research in grading recommendations.132 The qualitative research was appraised and included in the determination of the grade for each recommendation. The way in which qualitative research was incorporated within the NHMRC recommendations is outlined in Table 2. Single case studies were not included in grading the recommendations although they are included in the tables of evidence where relevant.

The views or interests of EnableNSW and the Lifetime Care and Support Authority did not influence the final recommendations. All the research on which the recommendations are based is included in the evidence tables in this report.


3. Methodology

12

Table 2 Grade of recommendation

Grade of recommendation

Description

A Body of evidence can be trusted to guide practice.

• One or more level I or several level II studies with low risk of bias and all studies consistent, or inconsistency can be explained.

• The clinical impact is very large.

• The population(s) studied in the body of evidence are the same as the target population for the guidelines.

• Directly applicable to the Australian healthcare context.

B Body of evidence can be trusted to guide practice in most situations.

• One or two level II studies with a low risk of bias or a systematic review/several level III studies with a low risk of bias with most studies consistent or inconsistencies can be explained.

• Clinical impact is substantial.

• Population studied in the body of evidence is similar to the guideline population.

• Applicable to Australian healthcare context with few caveats.

BQ Body of evidence can be trusted to guide practice.

• As above for quantitative studies.

• Qualitative studies have been included in the body of evidence so there is one or more qualitative studies of high quality and rigour58 (credibility, transferability, dependability, confirmability).

C Body of evidence provides some support for recommendation but care should be taken in its application to individual clinical and organisational circumstances.

• One or two level III studies with low risk of bias or level I or II studies with a moderate risk of bias.

• Some inconsistency reflecting some uncertainty.

• Clinical impact is moderate.

• Population studied in the body of evidence differs from the guideline population but it is sensible to apply it to target population.

• Applicable to Australian health care context with some caveats.

CQ Body of evidence provides some support for recommendation(s) but care should be taken in its application to individual clinical and organisational circumstances.

• As above for quantitative studies.

• Qualitative studies have been included in the body of evidence so there is one or more qualitative studies of reasonable rigour (credibility, transferability, dependability, confirmability).

Technical report


3. Methodology

13

D Body of evidence is weak and recommendation must be applied with caution.

• Level IV studies or level I to II studies/systematic reviews with a high risk of bias.

• Evidence is inconsistent.

• The clinical impact is slight.

• Population studies in the body of evidence differ to target population and hard to judge whether it is sensible to apply it to the target population.

Consensus Consensus based recommendation.

A systematic review of the evidence was conducted as part of the guideline research strategy. In the absence of high quality evidence, the working party utilised the literature available in combination with the best available clinical expertise and practices to reach a consensus on the recommendation. Consensus recommendations may be context sensitive in some cases.

Some recommendations are not based on evidence or expert opinion. They involve compliance with professional ethics, standards or statutory requirements. These recommendations are referred to as principles (professional best practice) or requirements (regulatory or statutory requirements).

P (Principle) A principle provides the standard required for a best practice therapy intervention. The working party reached agreement on the wording of the principle.

R (Requirement) This recommendation is guided by a legal requirement, regulation or rule established by a statutory authority (e.g. Roads and Traffic Authority).


4. Existing guidelines

14

A systematic search for clinical guidelines found few that were relevant to wheelchair or scooter prescription (refer to Table 3 in Appendix 2). Those that were used in the development of the guidelines are listed in the table of evidence in Section 5.7.

The Spinal Cord Injury Rehabilitation Evidence (SCIRE)113 is not a clinical guideline. Although it does provide evidence on key topics and makes key points arising from the research, these are not framed as recommendations. The WHO Guidelines on provision of wheelchairs in low resource settings (2008)139 is also not a clinical guideline, although it has elements relevant to prescribing wheelchairs in certain settings. The document focuses on design and production, service delivery and training. Neither SCIRE113 nor WHO (2008)139 could be appropriately assessed using the AGREE tool.39

Existing guidelines 4

Technical report


5. Evidence tables

15

All research studies used in the development of the guidelines were appraised for quality. The evidence tables only include the results of research studies used for recommendations graded A through D (including qualitative studies). They exclude appraisal information for studies that were only used in the commentary for each section (e.g. upper limb injury and pain prevalence studies). Recommendations graded as a Principle, Requirement or Consensus used other sources of information and thus were not appraised.

The evidence tables include the following information:

• Author and year

• Level of evidence95

• Study description and type of study, e.g. RCT, case control

• Study objective or question

• Population or study sample, e.g. participants, method, length of follow up

• Study results or findings, size of summary measure, confidence interval or P value

• Comments, e.g. importance, quality, relevance, generalisability, applicability.

Evidence tables 5


5. Evidence tables

16

5.1

Ass

essm

ent

and

rev

iew

evi

den

ce t

able

s

5.1.

1 A

sses

smen

t an

d r

evie

w

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Kitt

el e

t al

(200

2)68

n/a

Qua

litat

ive

stud

y,

phen

omen

olog

ical

an

d th

emat

ic

anal

ysis

Iden

tify

fact

ors

whi

ch in

fluen

ce

indi

vidu

als

with

a

SC

I to

aban

don

thei

r fir

st w

c be

fore

5 y

ears

of

use

Adu

lts w

ith S

CI

n=3

The

lack

of e

xper

ienc

e in

wc

use

and

sele

ctio

n,

the

func

tiona

l lim

itatio

ns

enco

unte

red

with

the

desi

gn o

f the

wc,

the

man

ner

and

timin

g of

the

pres

crip

tion

proc

ess

com

bine

d le

d to

dis

satis

fact

ion

and

aban

donm

ent.

Theo

retic

al p

ersp

ectiv

e lin

ked

to

adul

t lea

rnin

g. S

emi-s

truc

ture

d in

terv

iew

. Sm

all s

ampl

e,

sam

plin

g de

scrib

ed, r

ole

of

rese

arch

er a

nd re

latio

nshi

p w

ith p

artic

ipan

t not

iden

tified

, tr

iang

ulat

ed d

ata,

hig

h rig

our

with

cre

dibi

lity,

tran

sfer

abilit

y,

depe

ndab

ility,

con

firm

abilit

y.

Exp

erie

nce

in h

ome

envi

ronm

ent

high

light

ed. C

onta

ct w

ith

peer

s w

ho u

se a

wc

enha

nced

kn

owle

dge.

Mor

e tim

e to

pr

actic

e he

lped

.

Technical report


5. Evidence tables

17

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Mor

tens

en

& M

iller

(200

8)87

n/a

Qua

litat

ive

stud

y,

grou

nded

theo

ry

Exp

lore

the

intr

icac

ies

of th

e pr

ocur

emen

t pr

oces

s fro

m

the

pers

pect

ives

of

clie

nts

and

ther

apis

ts.

Inve

stig

ate

the

pers

pect

ives

of

pre

scrib

ers,

in

divi

dual

s w

ho

use

wc

and

thei

r as

soci

ates

on

the

proc

urem

ent

proc

ess;

how

the

desi

red

outc

omes

ar

e ne

gotia

ted;

an

d th

e fa

ctor

s th

at fa

cilit

ate

or h

inde

r th

e pr

oces

s.

Two

sem

i-str

uctu

red

inte

rvie

ws,

with

feed

back

on

pre

viou

s in

terv

iew

(s

umm

ary

and

them

es

iden

tified

acr

oss

all

part

icip

ants

) req

uest

ed

in s

econ

d in

terv

iew

n=

13 w

c pr

escr

iber

s n=

14 w

c us

ers

n=7

care

give

rs o

r fa

mily

WC

pro

cure

men

t is

a co

mpl

ex n

egot

iate

d an

d ite

rativ

e pr

oces

s.

Five

them

es id

entifi

ed:

who

dec

ides

, exp

ert

know

ledg

e, fo

rm v

ersu

s fu

nctio

n, fi

ttin

g in

, and

(re

)sol

utio

ns. G

oals

and

en

viro

nmen

tal f

acto

rs

play

a c

ritic

al ro

le

thro

ugho

ut p

roce

ss.

Lim

itatio

ns: i

n-de

pth

inte

rvie

ws

wer

e th

e on

ly s

ourc

e of

dat

a.

Sta

ndpo

int t

heor

y id

entifi

ed

dive

rse

sam

plin

g, in

dep

th

inte

rvie

ws

plus

re-in

terv

iew

. Dat

a an

d an

alys

is c

lear

ly d

escr

ibed

, us

e of

refle

ctiv

e jo

urna

ls,

good

rig

our

with

cre

dibi

lity,

tr

ansf

erab

ility,

dep

enda

bilit

y,

confi

rmab

ility.

Sam

uels

son

& W

ress

le

(200

8)10

9

IVC

ase

serie

s, p

ost-

test

D

eter

min

e an

y di

ffere

nce

in

satis

fact

ion

betw

een

user

s of

two

diffe

rent

ty

pes

of m

obilit

y pr

oduc

ts

Que

stio

nnai

re s

ent t

o a

rand

om s

ampl

e on

the

data

base

(n=

510)

n=

262

resp

onde

nts

incl

uded

in d

ata

anal

ysis

A s

tand

ardi

sed

follo

w-

up w

ill gi

ve re

habi

litat

ion

prof

essi

onal

s co

ntin

uous

an

d va

luab

le in

form

atio

n ab

out t

he e

ffect

of

and

satis

fact

ion

with

as

sist

ive

devi

ces.

Cro

ss-s

ectio

nal f

ollo

w u

p,

resp

onde

nts

alre

ady

grou

ped

from

allo

catio

n eq

uipm

ent t

ype.


5. Evidence tables

18

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Verz

a et

al

(200

6)13

0

III-3

His

toric

al c

ontr

ol

stud

y D

emon

stra

te

whe

ther

an

inte

r-di

scip

linar

y ap

proa

ch to

ev

alua

ting

and

pres

crib

ing

AT re

duce

d eq

uipm

ent

aban

donm

ent

Per

sons

with

MS

. Fi

rst t

wo

year

s AT

pr

escr

iptio

n by

ph

ysic

ian

base

d on

ph

ysic

al th

erap

ist

reco

mm

enda

tion.

Th

e in

terv

entio

n ov

er

next

2 y

ears

invo

lved

st

anda

rdis

ed p

roto

col

impl

emen

ted

by a

n in

terd

isci

plin

ary

team

. P

roto

col a

imed

to e

nsur

e th

at e

quip

men

t tru

ly

need

ed a

nd m

et n

eeds

, by

invo

lvin

g th

em a

nd

thei

r fa

milie

s in

pro

cess

. n=

54 s

ubje

cts

n=15

1 AT

dev

ices

(67

durin

g pr

e-in

terv

entio

n,

84 w

ith th

e in

terv

entio

n)

A c

ompa

rison

of

the

num

ber

of

devi

ces

obta

ined

pr

e-in

terv

entio

n w

ith th

ose

obta

ined

du

ring

inte

rven

tion

show

ed e

quip

men

t ab

ando

nmen

t rat

e de

crea

se fr

om 3

7.3

to

9.5%

.

Gro

ups

sim

ilar

at b

asel

ine,

all

aids

for

all s

ubje

cts

repo

rted

, all

rece

ived

eith

er p

re-

inte

rven

tion

or in

terv

entio

n.

Wie

land

t &

Str

ong

(200

0)13

7

n/a

Lite

ratu

re re

view

E

xam

ine

the

post

-dis

char

ge

com

plia

nce

of in

divi

dual

s w

ith p

resc

ribed

ad

aptiv

e eq

uipm

ent

Dat

abas

es C

INA

HL

and

Med

line;

31

artic

les

incl

uded

Five

cat

egor

ies

of

fact

ors

that

affe

ct

com

plia

nce:

med

ical

-re

late

d, c

lient

-rel

ated

, eq

uipm

ent-

rela

ted,

as

sess

men

t-re

late

d an

d tr

aini

ng-r

elat

ed.

Ass

essm

ent-

rela

ted

fact

ors

incl

uded

ev

alua

tion

of c

lient

’s

envi

ronm

ent a

nd

pers

onal

nee

ds, n

ot ju

st

diag

nosi

s.

No

stud

y ap

prai

sal c

ondu

cted

, st

udie

s w

ere

surv

eys

of

com

plia

nce.

Out

com

e of

stu

dies

co

nsid

ered

incl

uded

nat

ure

of

‘use

’, th

e tim

e of

follo

w-u

p an

d sa

mpl

e si

zes.

Abb

revi

atio

ns: w

c –

whe

elch

air;

SC

I – s

pina

l cor

d in

jury

; AT

– as

sist

ive

tech

nolo

gy; M

S –

mul

tiple

scl

eros

is

Technical report


5. Evidence tables

19

5.1.

2 R

easo

ns f

or

non-

use

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

leS

tud

y re

sult

s an

d

find

ing

sC

om

men

ts

Cow

an e

t al

(200

9)19

III

-1C

ross

ove

r tr

ial a

ppra

ised

as

pse

udo-

rand

omis

ed

Exa

min

e th

e im

pact

of s

urfa

ce

type

, whe

elch

air

wei

ght a

nd re

ar

axle

pos

ition

on

old

er a

dult

prop

ulsi

on

biom

echa

nics

Con

veni

ence

sa

mpl

e, o

lder

adu

lts

with

min

imal

wc

expe

rienc

e n=

53

Ther

e is

dec

reas

ed s

elf-

sele

cted

vel

ocity

and

in

crea

sed

peak

forc

e w

hen

surfa

ce re

sist

ance

in

crea

ses.

Ant

erio

r ax

le

posi

tions

dec

reas

e fo

rces

par

ticul

arly

on

high

car

pet.

Effe

cts

of

wei

ght a

nd a

xle

posi

tion

inde

pend

ent,

with

gr

eate

st re

duct

ions

in

peak

forc

es w

ith li

ghte

r w

c an

d an

terio

r ax

le

posi

tion.

Tria

l inv

olve

d ra

ndom

isat

ion

of

diffe

rent

sur

face

s an

d w

c so

ap

prai

sed

as R

CT,

alth

ough

no

con

trol

s. C

once

alm

ent

of a

lloca

tion

or b

lindi

ng to

co

nditi

ons

not p

ossi

ble.

O

utco

mes

mea

sure

d fo

r al

l su

bjec

ts.

Di M

arco

(2

005)

31

III-3

C

ompa

rativ

e st

udy

Inve

stig

ate

the

fact

ors

that

in

fluen

ce w

c us

ers’

sitt

ing

post

ure,

com

fort

, w

c sk

ills,

mai

nten

ance

kn

owle

dge,

sa

tisfa

ctio

n w

ith

and

aban

donm

ent

of th

eir

pres

crib

ed

wc

over

a 5

yea

r pe

riod

Adu

lts w

ith S

CI

n=12

0 Th

e st

udy

iden

tified

co

mpl

ex a

nd in

terr

elat

ed

fact

ors

influ

enci

ng

the

outc

omes

of w

c pr

escr

iptio

n am

ong

peop

le w

ith S

CI o

ver

time.

Inte

rrup

ted

time

serie

s, n

o co

ntro

l. E

ligib

ility

crite

ria n

ot

desc

ribed

, but

pos

t des

crip

tion

of s

ubje

cts.

One

gro

up o

nly,

ou

tcom

e m

easu

res

varie

d fro

m

78%

to 9

0% fo

r pa

rtic

ipan

ts,

ratin

gs o

f sat

isfa

ctio

n by

sub

ject

s w

as li

mite

d to

78%

of t

otal

. Th

ere

was

repo

rtin

g of

gro

up

com

paris

ons

for

satis

fact

ion

and

com

fort

. Mea

sure

s on

ly

frequ

ency

, no

poin

t mea

sure

s an

d m

easu

res

of v

aria

bilit

y.


5. Evidence tables

20

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

leS

tud

y re

sult

s an

d

find

ing

sC

om

men

ts

Edw

ards

&

McC

lusk

ey

(201

0)37

IV

Coh

ort s

tudy

In

vest

igat

e th

e ch

arac

teris

tics

of

adul

ts w

ho u

se

pow

er w

c an

d sc

oote

rs, e

xplo

re

the

proc

ess

of

pow

er-m

obilit

y pr

ovis

ion

and

exam

ine

the

bene

fits

and

chal

leng

es o

f use

Con

veni

ence

sam

ple,

su

rvey

sn=

202

Pow

er-m

obilit

y de

vice

s ha

ve m

any

bene

fits

for

user

s, b

ut c

an h

ave

nega

tive

outc

omes

like

ac

cide

nts,

resu

lting

in

inju

ries.

Fur

ther

rese

arch

is

nee

ded.

Cro

ss-s

ectio

nal s

urve

y.

App

roxi

mat

ely

650

surv

eys

dist

ribut

ed th

roug

h co

unci

ls,

pers

onal

con

tact

s an

d di

sabi

lity

orga

nisa

tions

. No

conf

ound

ers

iden

tified

, com

paris

ons

mad

e be

twee

n w

c an

d sc

oote

r us

ers

on o

utco

me

mea

sure

s, g

roup

si

mila

rity

n/a.

Eva

ns e

t al

(200

7)38

n/a

Qua

litat

ive

stud

y,

phen

omen

olog

ical

an

alys

is

Stu

dy o

lder

in

door

/out

door

wc

user

s’ s

atis

fact

ion

with

the

chai

r an

d se

rvic

e pr

ovid

ers

Men

and

wom

en

betw

een

60-8

1 ye

ars

n=17

The

wc

serv

ice

was

us

eful

to o

lder

peo

ple

with

dis

abilit

ies,

al

thou

gh th

ose

with

wc

only

use

d it

mod

erat

ely.

Li

mite

d us

e re

late

d to

an

infre

quen

t nee

d fo

r ou

tings

, fee

lings

of

inse

curit

y, a

nd le

ngth

y w

aitin

g tim

es fo

r ch

air

deliv

ery

and

requ

ired

mod

ifica

tions

.

Par

ticip

ants

des

crib

ed. S

ite

and

part

icip

ants

, res

earc

her

assu

mpt

ions

, and

role

and

re

latio

nshi

p to

rese

arch

er c

lear

ly

desc

ribed

. Min

imal

info

rmat

ion

on p

roce

dure

s fo

r tr

ansl

atio

n an

d a

prio

ri de

velo

pmen

t of t

he

topi

cs.

Technical report


5. Evidence tables

21

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

leS

tud

y re

sult

s an

d

find

ing

sC

om

men

ts

Gar

ber

& B

unze

l (2

002)

46

IV

Cas

e se

ries,

pos

t-te

st

Det

erm

ine

the

exte

nt to

whi

ch w

c pr

escr

ibed

dur

ing

reha

bilit

atio

n ar

e us

ed a

nd

perc

eive

d as

sa

tisfa

ctor

ily

mee

ting

indi

vidu

al

mob

ility,

fu

nctio

nal,

psyc

holo

gica

l and

so

cial

nee

ds o

f ve

tera

ns w

ho h

ave

had

a st

roke

Vete

rans

with

str

oke

n=49

C

ontin

ued

use

was

as

soci

ated

with

im

prov

ed p

hysi

cal

func

tion

and

use

of

alte

rnat

ive

mob

ility

aids

, med

ical

and

ps

ycho

-soc

ial p

robl

ems

unre

late

d to

nee

d fo

r w

c w

ere

com

mon

, e.

g. s

ocia

lisat

ion,

oc

cupa

tion,

dep

ress

ion.

Th

ere

is a

nee

d fo

r re

-ev

alua

tion

of m

obilit

y an

d ps

ycho

soci

al

need

s du

ring

the

year

s fo

llow

ing

reha

bilit

atio

n.

Cro

ss-s

ectio

nal d

escr

iptiv

e st

udy,

par

ticip

ants

des

crib

ed.

Onl

y on

e gr

oup,

onl

y 54

% o

f pa

rtic

ipan

ts p

rovi

ded

outc

ome

data

. Sta

tistic

al re

port

ing

of

com

paris

ons

n/a

only

one

gro

up.

Poi

nts

mea

sure

s an

d m

easu

re o

f va

riabi

lity

prov

ided

.

Kitt

el e

t al

(200

2)68

n/

a Q

ualit

ativ

e st

udy,

ph

enom

enol

ogic

al

and

them

atic

an

alys

is

Iden

tify

fact

ors

whi

ch in

fluen

ce

indi

vidu

als

with

a

SC

I to

aban

don

thei

r fir

st w

c be

fore

5 y

ears

of

use

Adu

lts w

ith S

CI

n=3

The

lack

of e

xper

ienc

e in

wc

use

and

sele

ctio

n,

the

func

tiona

l lim

itatio

ns

enco

unte

red

with

th

e de

sign

, and

the

man

ner

and

timin

g of

the

pres

crip

tion

proc

ess

com

bine

d le

ad

to d

issa

tisfa

ctio

n an

d ab

ando

nmen

t.

Theo

retic

al p

ersp

ectiv

e lin

ked

to

adul

t lea

rnin

g. S

emi-s

truc

ture

d in

terv

iew

. Sm

all s

ampl

e, s

ampl

ing

desc

ribed

, rol

e of

rese

arch

er

and

rela

tions

hip

with

par

ticip

ant

not i

dent

ified

, tria

ngul

ated

da

ta, h

igh

rigou

r w

ith c

redi

bilit

y,

tran

sfer

abilit

y, d

epen

dabi

lity,

co

nfirm

abilit

y. E

xper

ienc

e in

ho

me

envi

ronm

ent h

ighl

ight

ed.

Con

tact

with

pee

rs w

ho u

se a

wc

enha

nced

kno

wle

dge.

Mor

e tim

e to

pra

ctic

e he

lped

.


5. Evidence tables

22

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

leS

tud

y re

sult

s an

d

find

ing

sC

om

men

ts

Mor

tens

on &

M

iller

(200

8)87

n/a

Qua

litat

ive

stud

y,

grou

nded

theo

ryE

xplo

re th

e in

tric

acie

s of

the

proc

urem

ent

proc

ess

from

th

e pe

rspe

ctiv

es

of c

lient

s an

d th

erap

ists

. In

vest

igat

e th

e pe

rspe

ctiv

es

of p

resc

riber

s,

indi

vidu

als

who

us

e w

c an

d th

eir

asso

ciat

es o

n th

e pr

ocur

emen

t pr

oces

s; h

ow th

e de

sire

d ou

tcom

es

are

nego

tiate

d;

and

the

fact

ors

that

faci

litat

e or

hin

der

the

proc

ess.

Two

sem

i-str

uctu

red

inte

rvie

ws,

with

fe

edba

ck o

n pr

evio

us

inte

rvie

w (s

umm

ary

and

them

es

iden

tified

acr

oss

all p

artic

ipan

ts)

requ

este

d in

sec

ond

inte

rvie

w

n=13

wc

pres

crib

ers

n=14

wc

user

s n=

7 ca

regi

vers

or

fam

ily

WC

pro

cure

men

t is

a co

mpl

ex n

egot

iate

d an

d ite

rativ

e pr

oces

s.

Five

them

es id

entifi

ed:

who

dec

ides

, exp

ert

know

ledg

e, fo

rm v

ersu

s fu

nctio

n, fi

ttin

g in

, and

(re

)sol

utio

ns. G

oals

and

en

viro

nmen

tal f

acto

rs

play

a c

ritic

al ro

le

thro

ugho

ut p

roce

ss.

Lim

itatio

ns: i

n-de

pth

inte

rvie

ws

wer

e th

e on

ly s

ourc

e of

dat

a.

Sta

ndpo

int t

heor

y id

entifi

ed

dive

rse

sam

plin

g, in

dep

th

inte

rvie

ws

plus

re-in

terv

iew

. Dat

a an

d an

alys

is c

lear

ly d

escr

ibed

, us

e of

refle

ctiv

e jo

urna

ls,

good

rig

our

with

cre

dibi

lity,

tr

ansf

erab

ility,

dep

enda

bilit

y,

confi

rmab

ility.

Technical report


5. Evidence tables

23

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

leS

tud

y re

sult

s an

d

find

ing

sC

om

men

ts

Muk

herje

e &

Sam

anta

(2

005)

89

IV

Cas

e se

ries

Sur

vey

the

fate

of

the

dona

ted

wc

and

the

diffi

culti

es

enco

unte

red

by th

e us

ers

by id

entif

ying

th

e ca

use

of

reje

ctio

ns, a

nd

to e

valu

ate

the

perfo

rman

ce

by a

sses

sing

ph

ysio

logi

cal s

trai

n on

the

reci

pien

ts

durin

g th

eir

rout

ine

ambu

latio

n us

ing

card

io-r

espi

rato

ry

para

met

ers

Don

ated

wc

reci

pien

ts in

Indi

an=

162

(159

mal

e)

Han

d rim

pro

pelle

d m

anua

l wc

are

unsu

itabl

e fo

r ou

tdoo

r am

bula

tion

due

to

low

spe

ed a

nd h

igh

phys

iolo

gica

l dem

ands

, th

ey a

re a

lso

of li

ttle

us

e in

door

s –

diffi

cult

to m

anoe

uvre

giv

en

envi

ronm

enta

l con

ditio

ns

& a

rchi

tect

ural

rest

rain

ts.

WC

sho

uld

not b

e re

com

men

ded

with

out

prop

er a

sses

smen

t of

the

user

’s a

ctiv

ity le

vel &

re

quire

men

ts.

Sub

ject

s in

terv

iew

ed a

nd s

impl

e fie

ld te

st. G

roup

ed to

occ

asio

nal

user

s an

d re

gula

r us

ers

(som

e co

mpa

rison

s be

twee

n gr

oups

) be

twee

n gr

oup

com

paris

ons

mad

e in

clud

ing

poin

ts m

easu

res

and

mea

sure

s of

var

iabi

lity

(SD

an

d P

val

ues)

.

Pap

adim

itrio

u (2

008)

100

n/a

Qua

litat

ive

stud

y,

phen

omen

olog

ical

an

alys

is

Doc

umen

t the

pr

oces

s of

le

arni

ng to

use

a

wc

and

mak

ing

it a

part

of

one’

s em

bodi

ed

exis

tenc

e

Con

veni

ence

sam

ple

n=30

Th

e pr

oces

s in

volv

es

the

nego

tiatio

n of

pas

t an

d ne

w h

abits

, abi

litie

s an

d w

ays

of d

oing

, th

e co

mpe

tenc

e an

d ab

ilitie

s re

quire

d to

ac

hiev

e em

bodi

men

t is

a s

ituat

ed

acco

mpl

ishm

ent w

ith

soci

al a

nd p

oliti

cal

cons

eque

nces

.

Inte

rvie

ws

and

ethn

ogra

phic

de

scrip

tions

use

d. L

inke

d to

bi

o-ps

ycho

soci

al m

odel

(bod

y as

a s

ocio

-cul

tura

l and

bio

logi

cal

entit

y). S

ubje

cts

desc

ribed

in

deta

il. R

esul

ts p

rese

nted

as

a liv

ed e

xper

ienc

e or

a li

fe s

tory

, ra

ther

than

in a

redu

ctio

nist

or

mec

hani

stic

way

. Rig

our:

go

od c

redi

bilit

y, tr

ansf

erab

ility,

le

ss d

epen

dabi

lity

and

poor

co

nfirm

abilit

y.


5. Evidence tables

24

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

leS

tud

y re

sult

s an

d

find

ing

sC

om

men

ts

Pap

e et

al

(200

2)10

1 n/

a Li

tera

ture

revi

ew

Exa

min

e th

e de

velo

pmen

t of

indi

vidu

alis

ed

mea

ning

s as

sign

ed

to a

ssis

tive

tech

nolo

gy

and

how

thes

e in

fluen

ce th

e in

tegr

atio

n of

ass

istiv

e te

chno

logy

into

da

ily a

ctiv

ities

81 p

ublic

atio

ns u

sed

Suc

cess

ful i

nteg

ratio

n of

ass

istiv

e te

chno

logy

in

to d

aily

live

s re

quire

s po

tent

ial d

evic

e us

ers

to e

xplo

re

the

mea

ning

s th

ey

assi

gn to

the

devi

ces,

th

eir

expe

ctat

ions

, an

ticip

ated

soc

ial c

osts

an

d w

ays

to u

nder

stan

d th

at d

isab

ility

is n

ot th

e on

ly fe

atur

e to

defi

ne

iden

tity.

Sam

uels

son

& W

ress

le

(200

8)10

9

IVC

ase

serie

s, p

ost-

test

D

eter

min

e an

y di

ffere

nce

in

satis

fact

ion

betw

een

user

s of

two

diffe

rent

ty

pes

of m

obilit

y pr

oduc

ts

Que

stio

nnai

re s

ent t

o a

rand

om s

ampl

e on

th

e da

taba

se (n

=51

0)n=

262

resp

onde

nts

incl

uded

in d

ata

anal

ysis

A s

tand

ardi

sed

follo

w-

up w

ill gi

ve re

habi

litat

ion

prof

essi

onal

s co

ntin

uous

an

d va

luab

le in

form

atio

n ab

out t

he e

ffect

of

and

satis

fact

ion

with

as

sist

ive

devi

ces.

Cro

ss-s

ectio

nal f

ollo

w u

p,

resp

onde

nts

alre

ady

grou

ped

from

allo

catio

n eq

uipm

ent t

ype.

Sam

uels

son

et

al (1

999)

110

n/a

Cas

e st

udy

and

desc

riptio

n of

m

etho

d

Pre

sent

a m

etho

d ap

plyi

ng p

ract

ical

kn

owle

dge

to

the

pres

crip

tion,

ad

just

men

t and

ad

apta

tion

of w

c

Cas

e st

udy

n=1

Ass

ists

with

dec

isio

n m

akin

g an

d ev

alua

tion

in

the

indi

vidu

al c

ases

.

Tran

SP

OT

(201

0)12

1

n/a

Gui

delin

es

Tran

spor

t saf

ety

guid

elin

es fo

r pe

ople

with

a

disa

bilit

y

n/a

Pro

cedu

ral g

uide

lines

and

in

form

atio

n fo

r be

st p

ract

ice

on

safe

ty.

Technical report


5. Evidence tables

25

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

leS

tud

y re

sult

s an

d

find

ing

sC

om

men

ts

Wei

ss-

Lam

brou

et a

l (1

999)

135

IV

Cas

e se

ries

Eva

luat

e us

er

satis

fact

ion

with

w

c se

atin

g ai

ds

n=24

Th

e re

sults

sup

port

th

e va

lue

of c

onsu

mer

op

inio

n an

d ch

alle

nge

the

assu

mpt

ions

of

assi

stiv

e te

chno

logy

pr

ofes

sion

als,

un

ders

core

the

appr

opria

tene

ss o

f as

sess

ing

cons

umer

sa

tisfa

ctio

n.

Pos

t-te

st o

nly.

Fre

nch

vers

ion

of Q

UE

ST

outc

ome

mea

sure

. E

valu

atio

ns to

ok p

lace

in

subj

ects

’ nat

ural

set

ting,

e.g

. ho

me

or in

stitu

tion.

Des

crip

tive

anal

ysis

.

Wes

sels

et a

l (2

003)

136

n/a

Lite

ratu

re re

view

D

iscu

ss th

e de

term

inan

ts th

at

affe

ct th

e de

gree

of

non

-use

of

prov

ided

ass

istiv

e te

chno

logy

n/a

Dis

cuss

ion

and

grou

ping

of

fact

ors.

Wie

land

t &

Str

ong

(200

0)13

7

n/a

Lite

ratu

re re

view

E

xam

ine

the

post

-dis

char

ge

com

plia

nce

of in

divi

dual

s w

ith p

resc

ribed

ad

aptiv

e eq

uipm

ent

Dat

abas

es C

INA

HL

and

Med

line;

31

stud

ies

incl

uded

Five

cat

egor

ies

of

fact

ors

that

affe

ct

com

plia

nce:

med

ical

-re

late

d, c

lient

-rel

ated

, eq

uipm

ent-

rela

ted,

as

sess

men

t-re

late

d an

d tr

aini

ng-r

elat

ed.

Ass

essm

ent-

rela

ted

fact

ors

incl

uded

ev

alua

tion

of c

lient

’s

envi

ronm

ent a

nd

pers

onal

nee

ds, n

ot ju

st

diag

nosi

s.

No

stud

y ap

prai

sal c

ondu

cted

, st

udie

s w

ere

surv

eys

of

com

plia

nce.

O

utco

me

of s

tudi

es c

onsi

dere

d in

clud

ed n

atur

e of

‘use

’, th

e tim

e of

follo

w-u

p an

d sa

mpl

e si

zes.

Abb

revi

atio

ns: w

c –

whe

elch

air;

RC

T –

rand

omis

ed c

ontr

olle

d tr

ial;

SD

– s

tand

ard

devi

atio

n


5. Evidence tables

26

5.2

Cap

acit

y an

d p

erfo

rman

ce e

vid

ence

tab

les

5.2.

1 C

og

niti

on

and

per

cep

tio

n

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

nS

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Cul

len

(200

8)21

IIP

rosp

ectiv

e co

hort

stu

dy

Inve

stig

ate

the

rate

s of

pow

ered

w

c us

e an

d le

vel o

f use

r-ra

ted

func

tiona

l pe

rform

ance

at

1 m

onth

follo

w

up a

nd w

heth

er

psyc

holo

gica

l va

riabl

es w

ere

pros

pect

ivel

y pr

edic

tive

of

outc

ome

Adu

lts w

ith im

paire

d m

obilit

y re

crui

ted

from

po

wer

wc

clin

ics

n=10

3

Thos

e w

ith in

door

cha

irs w

ere

less

freq

uent

use

rs. T

hose

w

ith in

door

/out

door

cha

irs

72%

. Rat

es o

f ind

oor

use

wer

e pr

edic

ted

by m

easu

res

of v

erba

l re

call,

figu

re c

opyi

ng, a

nd g

loba

l co

gniti

on. P

ower

ed w

c us

e pr

edic

ted

by c

ogni

tive

mea

sure

s.

P v

alue

s pr

ovid

ed. F

orw

ard

regr

essi

on m

odel

. Exe

cutiv

e fu

nctio

n m

easu

res

take

n di

d no

t pre

dict

func

tiona

l pow

er w

c us

e, b

ut th

e m

easu

res

may

hav

e la

cked

sen

sitiv

ity.

Follo

w u

p 79

%. S

ome

conf

ound

ers

repo

rted

su

ch a

s co

nfide

nce,

ed

ucat

iona

l lev

el.

Daw

son

&

Thor

nton

(2

003)

23

n/a

Sin

gle

case

st

udy

Eva

luat

e th

e po

tent

ial u

se

of a

n in

door

el

ectr

ical

ly

pow

ered

wc

with

two

peop

le

with

uni

late

ral

negl

ect,

whe

ther

tr

aini

ng im

prov

ed

accu

racy

to d

rive

Sin

gle

inci

dent

rig

ht

hem

isph

ere

lesi

on

follo

win

g st

roke

. Stu

dy

over

8 w

eeks

, AB

A

sing

le s

ubje

ct d

esig

n,

driv

ing

accu

racy

m

easu

red

each

w

eekd

ay. T

wo

wee

ks

of tr

aini

ng, 3

0 m

inut

es

each

wee

kday

. n=

2

Par

ticip

ants

lean

ed to

driv

e th

e po

wer

ed w

c de

spite

per

sist

ing

negl

ect.

Task

spe

cific

trai

ning

sh

ould

be

used

. Uni

late

ral

negl

ect s

houl

d no

t rul

e ou

t pa

tient

s be

ing

cons

ider

ed fo

r po

wer

wc.

Fur

ther

rese

arch

is

need

ed.

Technical report


5. Evidence tables

27

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

nS

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Hig

uchi

et a

l (2

009)

56

III-2

Cas

e co

ntro

l st

udy

Det

erm

ine

whe

ther

wc

user

s sh

owed

en

hanc

ed a

bilit

y to

est

imat

e th

e sp

ace

requ

ired

for

loco

mot

ion

with

fam

iliar

and

unfa

milia

r w

c

Par

ticip

ants

had

to

mak

e a

dete

rmin

atio

n at

a d

ista

nce

from

2.8

m

as

to w

heth

er a

doo

r op

enin

g w

as p

assa

ble

or im

pass

able

n=7

part

icip

ants

with

te

trap

legi

an=

7 m

atch

ed a

ble-

bodi

ed c

ontr

ols

Ada

ptat

ion

to a

ltere

d bo

dy

dim

ensi

ons

occu

rs in

a s

hort

tim

e on

ly u

nder

a w

ell-l

earn

ed, f

amilia

r fo

rm o

f loc

omot

ion.

The

find

ings

su

gges

ted

indi

vidu

als

are

likel

y to

rely

mor

e on

vis

ual m

emor

y of

a

pass

able

spa

ce th

an s

omat

o-se

nsor

y in

form

atio

n on

the

whe

elch

air

dim

ensi

ons.

Elig

ibilit

y cr

iteria

no

t spe

cifie

d, n

o ra

ndom

isat

ion

or

blin

ding

of a

sses

sors

, or

sub

ject

s. A

ll su

bjec

ts

used

in a

naly

sis,

sta

tistic

al

com

paris

ons

betw

een

grou

ps m

ade.

Poi

nt

mea

sure

s an

d m

easu

res

of v

aria

bilit

y pr

ovid

ed.

Lett

s et

al

(200

7)76

IVC

ase

serie

sD

eter

min

e re

liabi

lity

and

valid

ity o

f po

wer

mob

ility

com

mun

ity

driv

ing

asse

ssm

ent

(PC

DA

)

Pha

se I:

Occ

upat

iona

l th

erap

ists

who

pi

lot t

este

d P

CD

A

cont

acte

d (n

=11

0), l

ow

resp

onse

rat

e of

n=

7.

Met

hod:

ther

apis

ts u

se

PC

DA

, and

pro

vide

fe

edba

ck.

Pha

se II

: Adu

lt dr

iver

s of

pow

er

mob

ility

(n=

38).

Met

hod:

trea

ting

ther

apis

ts r

ated

driv

ing

perfo

rman

ce, r

esea

rch

asse

ssor

s as

sess

ed

clie

nt u

sing

PC

DA

and

ot

her

test

s.

PC

DA

has

goo

d co

nten

t val

idity

, re

ason

able

relia

bilit

y, b

ut n

ot

cons

truc

t val

idity

for

visu

al

perc

eptu

al a

nd c

ogni

tive

skills

of

the

driv

er. T

hera

pist

s ne

ed

to a

sses

s dr

ivin

g pe

rform

ance

ra

ther

than

rely

on

test

s of

pe

rcep

tion,

cog

nitio

n or

en

viro

nmen

tal a

cces

sibi

lity

to

pre-

dete

rmin

e w

heth

er s

omeo

ne

will

rece

ive

pow

er m

obilit

y.

Som

e bl

indi

ng:

ther

apis

t sco

red

driv

ing

perfo

rman

ce w

ithou

t kn

owin

g re

sults

of a

ny

othe

r st

udy

asse

ssm

ents

.


5. Evidence tables

28

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

nS

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Mas

seng

ale

et

al (2

005)

79

IVC

ohor

t stu

dy

Det

erm

ine

to

wha

t ext

ent

visu

al p

erce

ptio

n,

visu

al fu

nctio

n,

cogn

ition

and

pe

rson

ality

trai

ts

affe

ct p

ower

wc

use

in a

dults

Sta

ndar

dise

d in

stru

men

ts

used

, par

ticip

ants

un

dert

ook

a po

wer

w

c pe

rform

ance

test

(d

evel

oped

by

auth

ors

– po

wer

mob

ility

road

te

st).

Adu

lt po

wer

w

heel

chai

r us

ers

(min

imum

3 m

onth

s dr

ivin

g ex

perie

nce)

.n=

62

Vis

ual p

erce

ptio

n, v

isua

l fun

ctio

n,

and

cogn

itive

ski

lls a

re im

port

ant

skills

for

pow

er w

c dr

iver

s an

d im

pact

on

perfo

rman

ce. T

he d

ata

assi

st c

linic

ians

iden

tify

fact

ors

to c

onsi

der

whe

n ev

alua

ting

and

trai

ning

for

pow

er w

c us

e.

No

conf

ound

ers

repo

rted

, no

grou

p to

co

mpa

re, h

igh

follo

w

up, n

o as

sess

or b

lindi

ng

repo

rted

.

Nils

son

&

Ekl

und

(200

6)98

n/

a Q

ualit

ativ

e st

udy,

gr

ound

ed

theo

ry

Inve

stig

ate

the

rela

tions

hip

betw

een

char

acte

ristic

s co

nnec

ted

to

pow

er w

c us

e an

d tr

aine

es’

succ

ess

or fa

ilure

in

dev

elop

ing

cons

ciou

s jo

ystic

k us

e

Adu

lts a

nd c

hild

ren

with

pro

foun

d co

gniti

ve

disa

bilit

ies

and

mul

tivar

iate

add

ition

al

disa

bilit

y or

at r

isk

of d

evel

opin

g th

e co

nditi

on.

n=45

Find

ings

sho

wed

hig

h pr

edic

tabi

lity

and

usab

ility

of

pow

ered

wc

use

faci

litat

ed

succ

essf

ul a

chie

vem

ents

in

the

earli

er id

entifi

ed p

roce

ss

of g

row

ing

cons

ciou

snes

s of

jo

ystic

k us

e. T

he im

plic

atio

ns a

re

that

it is

mea

ning

ful t

o en

gage

pe

ople

with

pro

foun

d co

gniti

ve

disa

bilit

ies

in tr

aini

ng o

f joy

stic

k us

e in

a p

ower

ed w

c, b

ut

the

wc

need

s to

pro

vide

hig

h pr

edic

tabi

lity

and

usab

ility

of

func

tions

.

Aim

s an

d re

sults

cle

arly

re

port

ed. M

ultip

le

sour

ces

of d

ata:

vid

eo-

reco

rdin

gs, fi

eld

note

s,

open

inte

rvie

ws

with

co

ncom

itant

ana

lysi

s.

Theo

retic

al s

ampl

ing

with

su

bjec

ts re

crui

ted

over

12

year

s. O

vera

ll rig

our

with

cr

edib

ility,

dep

enda

bilit

y,

deci

sion

trai

l not

as

wel

l re

port

ed, d

ifficu

lties

as

stu

dy e

volv

ed o

ver

prot

ract

ed p

erio

d of

tim

e.

Technical report


5. Evidence tables

29

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

nS

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Tefft

et a

l (1

999)

118

IVC

ase

serie

s Id

entif

y an

d do

cum

ent t

he

skills

nec

essa

ry

to o

pera

te a

po

wer

ed w

c fu

nctio

nally

, w

hich

cog

nitiv

e sk

ills c

orre

late

w

ith p

ower

ed

mob

ility

driv

ing

skills

, ide

ntify

w

hen

a ch

ild h

as

the

cogn

itive

sk

ills n

eces

sary

to

ope

rate

a

pow

ered

wc

safe

ly

Chi

ldre

n ag

ed 2

0-36

mon

ths

with

ph

ysic

al d

isab

ilitie

s,

cogn

itive

ly a

sses

sed,

an

d pa

rtic

ipat

ed in

wc

mob

ility

trai

ning

and

as

sess

men

t pro

gram

. C

hild

ren

with

dia

gnos

is

typi

cally

ass

ocia

ted

with

sev

ere

cogn

itive

an

d/or

sen

sory

mot

or

impa

irmen

ts e

xclu

ded.

n=26

Cog

nitiv

e do

mai

ns o

f spa

tial

rela

tions

and

pro

blem

sol

ving

w

ere

sign

ifica

nt a

nd a

ccou

nted

fo

r 57

% o

f the

var

ianc

e in

wc

skills

.

Diff

eren

t dia

gnos

is

and

diffe

rent

sta

ges.

S

ensi

tivity

and

spe

cific

ity

chos

en w

ith h

ighe

r cu

t off

poin

t on

sens

itivi

ty, l

ower

sp

ecifi

city

– to

det

erm

ine

degr

ee o

f mas

tery

that

a

child

nee

ded

for

spat

ial

rela

tions

and

pro

blem

so

lvin

g do

mai

ns. S

mal

l sa

mpl

e si

ze, c

onsi

dere

d pr

elim

inar

y re

sults

.

Abb

revi

atio

ns: w

c –

whe

elch

air;

AB

A –

(thr

ee p

hase

s: A

=ba

selin

e co

nditi

ons,

B=

inte

rven

tion,

A=

retu

rn to

bas

elin

e co

nditi

ons)

5.2.

2 U

pp

er li

mb

cap

acit

y (r

eco

mm

end

atio

ns a

nd r

isk

fact

ors

)

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Akb

ar e

t al

(201

0)3

III-3

Ret

rosp

ectiv

e co

hort

stu

dyE

valu

ate

the

prev

alen

ce a

nd r

isk

of

path

olog

ical

cha

nges

in

the

wei

ght-

bear

ing

shou

lder

gird

le o

f pa

rapl

egic

pat

ient

s w

ho h

ave

been

wc

depe

nden

t for

mor

e th

an 3

0 ye

ars

in

com

paris

on w

ith a

ble-

bodi

ed

n=10

0 pe

ople

w

ith p

arap

legi

an=

100

mat

ched

ab

le-b

odie

d vo

lunt

eers

Str

uctu

ral a

nd fu

nctio

nal

chan

ges

of th

e sh

ould

er jo

int

are

mor

e se

vere

and

the

risk

of

deve

lopm

ent o

f sho

ulde

r gi

rdle

da

mag

e is

sig

nific

antly

hig

her

in in

divi

dual

s w

ith lo

ng-t

erm

pa

rapl

egia

than

in a

ge-m

atch

ed

cont

rols

.

Bot

h sh

ould

ers

of e

ach

subj

ect m

easu

red.

Elig

ibilit

y cr

iteria

repo

rted

. Gro

ups

sim

ilarit

y re

port

ed a

nd r

isk

fact

ors

for

shou

lder

tear

id

entifi

ed, c

onfo

unde

rs n

ot

linke

d to

cau

sal o

r ris

k. G

roup

co

mpa

rison

. Odd

s ra

tio a

nd P

va

lues

pro

vide

d. R

adio

logi

sts

(ass

esso

rs) b

linde

d to

gro

up.

Out

com

e da

ta fo

r al

l sub

ject

s.


5. Evidence tables

30

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Bee

kman

et

al (1

999)

6

IIR

ando

mis

ed

tria

l C

ompa

re w

c pr

opul

sion

in li

ght a

nd

ultr

a-lig

ht w

c in

peo

ple

with

diff

eren

t lev

els

of

SC

I

Peo

ple

with

SC

I, m

ost s

ubje

cts

mal

e, 5

fem

ale

n=74

(44

para

pleg

ia, 3

0 te

trap

legi

a)

The

ultr

a-lig

ht w

c im

prov

ed th

e ef

ficie

ncy

of p

ropu

lsio

n in

the

subj

ects

.

Com

paris

on o

f tw

o w

c ra

ndom

ised

but

met

hod

of

rand

omis

atio

n no

t doc

umen

ted.

U

nlik

ely

any

blin

ding

. All

subj

ects

had

all

outc

ome

mea

sure

s.

Bon

inge

r et

al

(199

9)9

IV

Cas

e se

ries

Gai

n a

bett

er

unde

rsta

ndin

g of

th

e m

echa

nism

s be

hind

car

pal t

unne

l sy

ndro

me

in m

anua

l w

c us

ers

Peo

ple

with

pa

rapl

egia

w

ho u

sed

wc

for

mob

ility,

all

had

para

pleg

ia

belo

w T

3n=

34

Sub

ject

wei

ght (

but n

ot b

ody

mas

s in

dex)

rela

ted

to p

ush

rim fo

rces

and

med

ian

nerv

e fu

nctio

n. In

depe

nden

t of w

eigh

t, pu

sh r

im b

iom

echa

nics

wer

e al

so re

late

d to

med

ian

nerv

e fu

nctio

n.

Sub

ject

s re

crui

ted

from

wc

vend

ors,

and

dis

char

ge re

cord

s of

inpa

tient

reha

bilit

atio

n pr

ogra

ms.

97%

of s

ubje

cts

with

ou

tcom

e m

easu

rem

ents

.

Bon

inge

r et

al

(200

3)10

IV

Long

itudi

nal

coho

rt s

tudy

In

vest

igat

e th

e re

latio

nshi

p be

twee

n pu

sh r

im fo

rces

and

th

e pr

ogre

ssio

n of

sh

ould

er in

jurie

s in

m

anua

l wc

user

s

Sub

ject

s w

ith

SC

In=

14 (8

men

, 6

wom

en)

Pus

hing

with

gre

ater

per

cent

age

of fo

rce

dire

cted

tow

ards

the

axle

was

at i

ncre

ased

ris

k of

fin

ding

s on

MR

I. C

linic

ians

sh

ould

inst

ruct

wc

user

s in

ef

fect

ive

prop

ulsi

on te

chni

ques

, in

par

ticul

ar w

omen

, red

ucin

g fo

rces

dur

ing

wc

prop

ulsi

on m

ay

redu

ce li

kelih

ood

of in

jury

.

Sub

ject

s no

t at s

ame

stag

e th

eref

ore

not a

ppra

ised

as

pros

pect

ive.

Sm

all s

ampl

e. M

RI

chan

ges

wer

e id

entifi

ed a

nd

then

sam

ple

dich

otom

ised

. C

onfo

unde

rs n

ot re

port

ed.

Rad

iolo

gist

(ass

esso

r) w

as

blin

ded,

all

subj

ects

wer

e m

easu

red.

Col

linge

r et

al

(200

8)11

IV

C

ase

serie

s D

escr

iptiv

e an

alys

is

and

com

paris

on o

f sh

ould

er k

inet

ics

and

kine

mat

ics

durin

g w

c pr

opul

sion

at

mul

tiple

spe

eds

and

inve

stig

atin

g th

e ef

fect

of

pai

n

Man

ual w

c us

ers

with

pa

rapl

egia

n=61

Bod

y w

eigh

t mai

nten

ance

and

ot

her

inte

rven

tions

sho

uld

be

desi

gned

to re

duce

the

forc

e re

quire

d to

pro

pel a

wc,

sho

uld

be im

plem

ente

d to

redu

ce th

e pr

eval

ence

of s

houl

der

pain

and

in

jury

am

ong

man

ual w

c us

ers.

Rec

ruitm

ent a

nd e

xclu

sion

cr

iteria

pro

vide

d, n

o gr

oup

allo

catio

n, g

roup

sim

ilar

info

rmat

ion,

som

e su

bjec

ts’

outc

ome

mea

sure

men

t not

re

port

ed (8

2% lo

ss).

Technical report


5. Evidence tables

31

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Con

sort

ium

fo

r S

pina

l C

ord

Med

icin

e (2

005)

13

n/a

Gui

delin

e P

rese

rvat

ion

of u

pper

lim

b fu

nctio

n fo

llow

ing

spin

al c

ord

inju

ry

n/a

n/a

Ref

er to

Sec

tion

5.7

for

AG

RE

E

ratin

g.

Cow

an e

t al

(200

9)19

III-1

Cro

ss o

ver

tria

l app

rais

ed

as p

seud

o-ra

ndom

ised

Exa

min

e th

e im

pact

of

sur

face

type

, w

heel

chai

r w

eigh

t and

re

ar a

xle

posi

tion

on

olde

r ad

ult p

ropu

lsio

n bi

omec

hani

cs

Con

veni

ence

sa

mpl

e, o

lder

ad

ults

with

m

inim

al w

c ex

perie

nce

n=53

Ther

e is

dec

reas

ed s

elf-

sele

cted

ve

loci

ty a

nd in

crea

sed

peak

fo

rce

whe

n su

rface

resi

stan

ce

incr

ease

s. A

nter

ior

axle

pos

ition

s de

crea

se fo

rces

par

ticul

arly

on

high

car

pet.

Effe

cts

of w

eigh

t an

d ax

le p

ositi

on in

depe

nden

t, w

ith g

reat

est r

educ

tions

in

peak

forc

es w

ith li

ghte

r w

c an

d an

terio

r ax

le p

ositi

on.

Tria

l inv

olve

d ra

ndom

isat

ion

of

diffe

rent

sur

face

s an

d w

c so

ap

prai

sed

as R

CT,

alth

ough

no

con

trol

s. C

once

alm

ent

of a

lloca

tion

or b

lindi

ng to

co

nditi

ons

not p

ossi

ble.

O

utco

mes

mea

sure

d fo

r al

l su

bjec

ts.

Dal

lMei

jer

et

al (1

998)

22

IVC

ohor

t stu

dy

Inve

stig

ate

the

effe

ctiv

enes

s of

forc

e ap

plic

atio

n, p

ower

ou

tput

and

ene

rgy

expe

nditu

re, a

nd

timin

g pa

ram

eter

s of

w

c pr

opul

sion

Adu

lts w

ith S

CI

n=29

Tetr

aple

gia

show

ed a

si

gnifi

cant

ly lo

wer

effe

ctiv

enes

s of

forc

e ap

plic

atio

n in

the

front

al

plan

e. P

ower

out

put/

ener

gy

expe

nditu

re a

s an

indi

catio

n of

mec

hani

cal e

ffici

ency

was

lo

wer

in te

trap

legi

c su

bjec

ts a

nd

asso

ciat

ed w

ith e

ffect

iven

ess

of

forc

e ap

plic

atio

n.

Incl

usio

n/ex

clus

ion

crite

ria

repo

rted

, mal

es a

nd fe

mal

es,

age

rang

e, m

inim

um 1

ye

ar s

ince

inju

ry, p

re-t

est

on te

chni

que

perfo

rmed

fo

r an

alys

is o

f tec

hniq

ue

para

met

ers.


5. Evidence tables

32

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Des

roch

es e

t al

(200

6)28

IVC

ase

serie

s D

eter

min

e th

e ef

fect

of

syst

em ti

lt an

gle

(STA

) an

d se

at-t

o-ba

ck re

st

angl

e (S

BA

) cha

nges

on

the

load

sus

tain

ed

by th

e sh

ould

er d

urin

g m

anua

l wc

prop

ulsi

on

Adu

lts, m

ixed

di

agno

sis,

mea

n ag

e 68

yea

rsn=

14

No

sign

ifica

nt d

iffer

ence

s be

twee

n sh

ould

er jo

int m

omen

ts

for

the

vario

us c

ombi

natio

ns.

Sho

ulde

r lo

ad w

as m

aint

aine

d at

th

e sa

me

leve

l whe

n ch

angi

ng

seat

ang

le b

ut k

eepi

ng w

heel

-ax

le p

ositi

on. T

hus

seat

ang

le

can

be d

eter

min

ed w

ith u

ser

com

fort

and

goa

ls, a

nd p

ress

ure

mod

ulat

ion

at s

eat i

nter

face

fo

r al

levi

atin

g pr

essu

re w

ithou

t in

crea

sing

ris

k of

ove

ruse

sh

ould

er in

jurie

s.

Sub

ject

s ra

ndom

ly a

lloca

ted

orde

r of

test

s. N

o bl

indi

ng o

f su

bjec

ts o

r th

erap

ists

.

Des

roch

es e

t al

(201

0)27

IVD

iagn

ostic

D

escr

ibe

uppe

r lim

b jo

ints

dyn

amic

s du

ring

man

ual w

c pr

opul

sion

us

ing

join

t coo

rdin

ate

syst

ems

Peo

ple

with

SC

I, le

sion

bel

ow C

7 an

d m

anua

l wc

for

> 1

yea

r, no

pr

evio

us u

pper

ex

trem

ity p

ain

past

6 m

onth

sn=

9

Sta

bilis

atio

n co

nfigu

ratio

n at

the

uppe

r lim

b jo

ints

cou

ple

part

ly

expl

ains

the

low

er m

echa

nica

l ef

ficie

ncy

of m

anua

l wc

prop

ulsi

on a

nd c

ould

giv

e in

sigh

t ab

out i

njur

y ris

k at

the

wris

t, el

bow

and

sho

ulde

r jo

ints

.

Dia

gnos

is o

r sc

reen

ing

used

as

mos

t app

ropr

iate

– p

urpo

se w

as

to in

vest

igat

e jo

int d

ynam

ics

for

man

ual w

c pr

opul

sion

but

not

va

lidat

e m

etho

d. N

o re

fere

nce

stan

dard

alth

ough

val

idity

of

met

hod,

tool

s an

d pr

oced

ure

linke

d to

pre

viou

s re

sear

ch in

th

e lit

erat

ure.

Sub

ject

s no

t in

own

wc.

Dub

owsk

y et

al

(200

8)36

III-2

Va

lidat

ion

stud

yP

rese

nt a

nd

valid

ate

a rig

id-b

ody

mus

culo

skel

etal

m

odel

of t

he u

pper

lim

b fo

r ca

lcul

atio

n of

sho

ulde

r jo

int

forc

es th

roug

hout

wc

prop

ulsi

on

n=2

subj

ects

w

ith p

arap

legi

an=

1 ab

le-b

odie

d

The

mea

sure

d fo

rces

at t

he

push

rim

and

3-D

pro

puls

ion

kine

mat

ics

drov

e th

e m

odel

an

d co

mpu

tatio

nally

cal

cula

ted

mus

cle

activ

ities

wer

e co

mpa

red

with

exp

erim

enta

l mus

cle

activ

ities

. Pre

sent

wor

k va

lidat

es

met

hod.

Dia

gnos

is o

r sc

reen

ing

appr

aisa

l use

d as

mos

t ap

prop

riate

met

hod

to a

ppra

ise.

C

ompa

rison

with

refe

renc

e st

anda

rd (A

nyB

ody

Mod

elin

g sy

stem

), no

t blin

ded.

Technical report


5. Evidence tables

33

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Fors

lund

et a

l (2

007)

40

IVC

ohor

t stu

dy

Inve

stig

ate

how

men

an

d w

omen

with

SC

I pe

rform

tran

sfer

s fro

m ta

ble

to w

c w

ith re

gard

to ti

min

g an

d m

agni

tude

of

forc

e ge

nera

tion

bene

ath

the

hand

s an

d as

soci

ated

bod

y m

ovem

ents

Sub

ject

s w

ith

thor

acic

SC

I n=

13 (7

men

, 6

wom

en)

The

forc

es b

enea

th th

e tr

ailin

g ha

nd w

ere

larg

er th

an th

ose

in

the

lead

ing,

if th

ere

is w

eakn

ess

or p

ain

in o

ne a

rm, t

his

arm

sh

ould

be

sele

cted

as

the

lead

ing.

To

avoi

d ex

cess

ive

load

on

the

arm

s, te

chni

cal a

ids

and

envi

ronm

enta

l fac

tors

sho

uld

be

very

wel

l ada

pted

.

Sub

ject

s at

diff

eren

t sta

ges

of d

isea

se, g

roup

ed b

y se

x.

No

conf

ound

ers

iden

tified

, si

mila

ritie

s no

t exa

min

ed, g

roup

co

mpa

rison

s no

t rep

orte

d,

all o

utco

me

mea

sure

s fo

r al

l su

bjec

ts re

port

ed.

Gag

non

(200

8)42

IV

Coh

ort s

tudy

Q

uant

ify a

nd c

ompa

re

the

tria

xial

net

sh

ould

er a

nd e

lbow

jo

int f

orce

s an

d sh

ould

er fl

exor

and

ad

duct

or m

omen

ts,

elbo

w m

omen

ts

whe

n th

e do

min

ant

uppe

r lim

b is

in th

ree

diffe

rent

role

s: le

ad,

trai

led

or li

fted

durin

g tr

ansf

ers

Con

veni

ence

sa

mpl

e of

SC

In=

13

Sitt

ing

pivo

t tra

nsfe

rs a

re

amon

g th

e m

ost m

echa

nica

lly

chal

leng

ing

wc

rela

ted

activ

ities

in

sho

ulde

r an

d el

bow

join

t fo

rces

, mom

ents

rout

inel

y pe

rform

ed. T

he tr

ansf

ers

and

wei

ght-

relie

ving

lifts

wer

e fo

und

to e

xpos

e th

e sh

ould

er jo

ints

to

sub

stan

tial p

oste

riorly

and

su

perio

rly d

irect

ed fo

rces

.

Sub

ject

s at

diff

eren

t sta

ges

of

dise

ase.

All

subj

ects

com

plet

ed

both

type

s of

tran

sfer

s,

cond

ition

s no

t ran

dom

ly

pres

ente

d. N

eith

er s

ubje

ct

com

paris

ons

nor

blin

ding

re

port

ed.

Gag

non

et a

l (2

008)

43

IV

Cas

e se

ries,

po

st-t

est

Exa

min

e th

e ki

nem

atic

re

quire

men

ts o

f sitt

ing

pivo

t tra

nsfe

r

Adu

lt m

ales

with

S

CI

n=10

Sitt

ing

pivo

t tra

nsfe

rs a

re

char

acte

rised

by

subs

tant

ial

angu

lar

disp

lace

men

ts a

nd

velo

citie

s at

the

trun

k an

d up

per

extr

emiti

es.

Elig

ibilit

y cr

iteria

doc

umen

ted.

O

rder

of t

rans

fers

rem

aine

d sa

me,

alth

ough

not

repo

rted

, it

is a

ssum

ed th

at a

ll su

bjec

ts

com

plet

ed a

ll tr

ansf

ers

and

all

data

obt

aine

d.


5. Evidence tables

34

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Gag

non

et a

l (2

009)

44

IV

Coh

ort s

tudy

D

eter

min

e if

uppe

r lim

b m

uscu

lar

dem

and

is re

duce

d w

hen

indi

vidu

als

with

S

CI p

erfo

rm a

sitt

ing

pivo

t tra

nsfe

r in

the

pref

erre

d di

rect

ion

com

pare

d w

ith n

on-

pref

erre

d

Adu

lts w

ith S

CI,

leve

ls fr

om C

6 to

S1

n=14

Dire

ctio

n pr

efer

ence

exp

ress

ed

by in

divi

dual

s w

ith S

CI w

hen

tran

sfer

ring

betw

een

seat

s of

ev

en h

eigh

t is

not e

xpla

ined

by

rela

tive

mus

cula

r de

man

d di

ffere

nces

.

Sub

ject

s at

diff

eren

t sta

ges

of d

isea

se, e

ligib

ility

crite

ria

deta

iled,

ord

er o

f dire

ctio

n of

tran

sfer

s no

t ran

dom

ised

, al

way

s pr

efer

red

first

, som

e co

nfou

nder

s id

entifi

ed, g

roup

al

loca

tion

not r

elev

ant,

appe

ars

all o

utco

me

data

for

all s

ubje

cts.

Gag

non

et a

l (2

009)

45

IV

Cas

e se

ries,

po

st-t

est

Exa

min

e th

e E

MG

ac

tivat

ion

patt

erns

of

upp

er e

xtre

mity

m

uscl

es in

mal

es

with

SC

I and

to

com

pare

them

acr

oss

sitt

ing

pivo

t tra

nsfe

rs

perfo

rmed

tow

ard

seat

s of

diff

eren

t he

ight

s

Mal

es w

ith S

CI

n=10

C

oord

inat

ed a

nd h

ighe

r m

uscu

lar

effo

rts

wer

e ge

nera

ted

at th

e tr

ailin

g de

ltoid

, pec

tora

lis

maj

or w

hen

tran

sfer

ring

to a

hi

gh ta

rget

sea

t com

pare

d to

on

e of

sim

ilar

heig

ht, a

nd in

the

lead

ing

bice

ps w

hen

tran

sfer

ring

to a

hig

h se

at c

ompa

red

to a

le

vel o

ne. L

ower

ing

targ

et s

eat

with

resp

ect t

o th

e in

itial

sea

t ha

d no

favo

urab

le e

ffect

on

mus

cula

r de

man

d.

Elig

ibilit

y cr

iteria

repo

rted

. A

lloca

tion

of s

eat h

eigh

t not

ra

ndom

ised

(sam

e or

der),

no

blin

ding

repo

rted

, ass

umed

al

l out

com

e m

easu

res

for

all

subj

ects

, and

3 tr

ansf

er le

vels

. B

etw

een

grou

p st

atis

tical

co

mpa

rison

s re

port

ed.

Grie

ve &

D

icke

rson

(2

008)

49

n/a

Lite

ratu

re

revi

ew,

com

men

tary

Iden

tify

evid

ence

on

the

mec

hani

sm

of fa

tigue

and

inju

ry

asso

ciat

ed w

ith

over

head

wor

k in

the

cont

ext o

f erg

onom

ic

desi

gn

n/a

Rep

orts

on

the

mec

hani

sms

of

expo

sure

to o

verh

ead

wor

k an

d th

eir

asso

ciat

ed n

egat

ive

heal

th

and

perfo

rman

ce o

utco

mes

.

Met

hods

not

des

crib

ed.

Sum

mar

ises

kno

wle

dge

rega

rdin

g ov

erhe

ad w

ork,

pr

opos

es e

vide

nce-

base

d co

nsid

erat

ions

for

eval

uatio

n of

ta

sks,

and

iden

tifies

rese

arch

ar

eas

that

lack

gui

delin

es.

Gut

ierr

ez e

t al

(200

5)50

IVC

ase

serie

s Q

uant

ify th

e ef

fect

of

sea

t for

e-af

t on

shou

lder

mus

cle

activ

ity d

urin

g w

c pr

opul

sion

Mal

es w

ith S

CI

n=13

R

educ

tion

in th

e in

tens

ity o

f the

pr

imar

y pu

sh p

hase

mus

cles

du

ring

high

-dem

and

activ

ities

of

fast

and

gra

ded

prop

ulsi

on m

ay

redu

ce th

e po

tent

ial f

or s

houl

der

mus

cle

fatig

ue a

nd in

jurie

s.

Ord

er o

f con

ditio

ns c

onsi

sten

t.

Technical report


5. Evidence tables

35

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Hat

chet

et a

l (2

009)

55

III-3

Com

para

tive

stud

y D

eter

min

e th

e im

pact

of

gen

der

on s

houl

der

mus

cle

stre

ngth

and

co

mm

unity

wc

usag

e in

indi

vidu

als

with

pa

rapl

egia

Men

and

w

omen

re

crui

ted

from

ou

tpat

ient

cl

inic

sn=

67

Com

mun

ity w

c pr

opul

sion

sp

eed

was

sim

ilar

betw

een

men

and

wom

en, b

ut m

en

wer

e st

rong

er, t

hus

daily

m

obilit

y re

quire

s hi

gher

rela

tive

effo

rt fo

r w

omen

’s s

houl

der

mus

cles

, whi

ch m

ay in

crea

se

susc

eptib

ility

to fa

tigue

and

de

velo

pmen

t of s

houl

der

pain

.

Exc

lude

d th

ose

with

sho

ulde

r pa

in, b

lindi

ng n

ot p

ossi

ble,

al

loca

tion

by s

ex, a

ll su

bjec

ts

had

outc

ome

mea

sure

men

ts.

Koo

ntz

et a

l (2

002)

69

IV

Cas

e se

ries

Exa

min

e th

e ki

nem

atic

s an

d ki

netic

s of

the

shou

lder

dur

ing

wc

prop

ulsi

on a

t a s

low

an

d m

oder

ate

spee

d

Spi

nal c

ord

inju

ry s

ubje

cts

with

par

aple

gia

n=27

(10

wom

en, 1

7 m

en)

Pea

k fo

rces

occ

urre

d at

the

near

en

d of

the

prop

ulsi

on p

hase

at

sam

e tim

e sh

ould

er w

as

max

imal

ly fl

exed

and

min

imal

ly

abdu

cted

. Sho

ulde

r po

sitio

ning

an

d as

soci

ated

pea

k sh

ould

er

load

s du

ring

prop

ulsi

on m

ay

be im

port

ant i

ndic

ator

s fo

r id

entif

ying

wc

user

s at

ris

k of

de

velo

ping

sho

ulde

r pa

in a

nd

inju

ry.

Sub

ject

s un

derw

ent a

ll co

nditi

ons,

som

e su

bjec

ts

had

diffi

culty

with

spe

ed 2

, bu

t out

com

e m

easu

res

for

all.

Bet

wee

n gr

oups

sta

tistic

al

repo

rtin

g (P

val

ues

and

SD

).

Kot

ajar

vi e

t al

(200

4)71

II

Ran

dom

ised

tr

ial

Exa

min

e th

e ef

fect

of

a s

eat p

ositi

on

on h

and

rim

biom

echa

nics

Exp

erie

nced

m

anua

l wc

user

s (>

6

mon

ths)

, SC

I in

jury

leve

l be

twee

n T5

and

L3

, mal

es a

nd

fem

ales

n=13

A s

hort

er d

ista

nce

betw

een

the

axle

and

sho

ulde

r (lo

w

seat

hei

ght)

impr

oved

pus

h tim

e an

d pu

sh a

ngle

. Axi

al a

nd

radi

al fo

rces

wer

e hi

ghes

t in

the

low

est s

eat p

ositi

on, w

here

as

prop

ulsi

on e

ffici

ency

did

not

ch

ange

with

sea

t pos

ition

.

Ran

dom

isat

ion

of o

rder

of

diff

eren

t axl

e po

sitio

ns

per

subj

ect,

appr

aise

d as

ra

ndom

ised

tria

l, no

blin

ding

re

port

ed, e

xclu

sion

crit

eria

lis

ted,

dat

a co

llect

ed fo

r al

l sea

t co

nditi

ons

for

all s

ubje

cts.


5. Evidence tables

36

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Kul

ig e

t al

(200

1)72

IVC

ase

serie

sS

tudy

the

effe

cts

of

SC

I lev

el o

n sh

ould

er

kine

tics

durin

g m

anua

l w

c pr

opul

sion

Peo

ple

with

SC

In=

69

The

supe

rior

push

forc

e in

th

e te

trap

legi

c gr

oup

coup

led

with

wea

knes

s of

thor

aco-

hum

eral

dep

ress

ors

incr

ease

s su

scep

tibilit

y of

the

sub-

acro

mia

l st

ruct

ures

to c

ompr

essi

on.

Elig

ibilit

y cr

iteria

pro

vide

d.

Con

foun

ders

not

iden

tified

ca

usal

or

risk

(e.g

. lev

el o

f SC

I),

grou

p si

mila

rity

and

stat

istic

al

diffe

renc

es b

etw

een

grou

ps

prov

ided

. Sub

ject

s at

diff

eren

t st

ages

of d

isea

se. A

lloca

ted

acco

rdin

g to

leve

l of S

CI (

4 gr

oups

). M

etho

d of

recr

uitm

ent

not c

ited.

Lal (

1998

)74II

Pro

spec

tive

coho

rt s

tudy

A

ssis

t to

iden

tify

high

ris

k S

CI i

ndiv

idua

ls

and

ultim

atel

y de

velo

p pr

even

tive

stra

tegi

es

Peo

ple

with

SC

I (1

8 fe

mal

e)n=

53 (3

3 te

trap

legi

a, 2

0 pa

rapl

egia

)

The

stud

y de

mon

stra

ted

a co

rrel

atio

n be

twee

n in

divi

dual

s w

ith h

ighe

r le

vel o

f wc

activ

ity,

high

er a

ge, f

emal

e ge

nder

, an

d m

ore

pron

e to

dev

elop

de

gene

rativ

e ch

ange

s in

the

shou

lder

s pa

rtic

ular

ly a

ffect

ing

the

acro

mio

-cla

vicu

lar

join

t.

Pro

spec

tivel

y fo

llow

ed d

urin

g ou

tpat

ient

s, a

ll at

sam

e st

age

of d

isea

se. G

roup

ing

base

d on

leve

l of S

CI,

subj

ects

ha

d be

en o

utpa

tient

s to

re

habi

litat

ion

faci

lity.

Fol

low

up

was

for

a m

inim

um o

f 5

and

max

imum

of 1

5 ye

ars.

B

asel

ine

char

acte

ristic

s no

t re

port

ed, c

onfo

unde

rs, g

roup

co

mpa

rison

s no

t app

licab

le.

X-ra

ys a

t fol

low

up

for

60%

of

case

s.

Mer

cer

et a

l (2

006)

82

IV

Coh

ort s

tudy

E

xam

ine

the

rela

tions

hip

betw

een

shou

lder

forc

es a

nd

mom

ents

exp

erie

nced

du

ring

wc

prop

ulsi

on

and

shou

lder

pa

thol

ogy

Sub

ject

s re

crui

ted

from

w

c ve

ndor

s an

d di

scha

rge

reco

rds

inpa

tient

SC

I re

habi

litat

ion

unit,

inju

ry

belo

w T

1n=

33 (2

3 m

ales

, 10

fem

ales

)

Spe

cific

join

t for

ces

and

mom

ents

wer

e re

late

d to

m

easu

res

of s

houl

der

path

olog

y an

d m

ay in

dica

te th

e ne

ed to

re

duce

the

over

all f

orce

requ

ired

to p

rope

l a w

c to

pre

serv

e up

per

limb

inte

grity

.

Exc

lusi

on c

riter

ia li

sted

. C

onfo

unde

rs id

entifi

ed a

s m

arke

r of

ris

k (in

jury

and

de

gene

rativ

e ch

ange

s, k

inet

ic

data

from

Sm

artw

heel

and

su

rface

EM

G),

all 3

3 su

bjec

ts

with

out

com

e m

easu

res,

te

stin

g di

d no

t app

ear

to b

e in

depe

nden

t.

Technical report


5. Evidence tables

37

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Mor

row

et a

l (2

010)

86

IVC

ase

serie

s In

vest

igat

e th

e sh

ould

er jo

int k

inet

ics

over

a r

ange

of d

aily

liv

ing

and

mob

ility

task

s as

soci

ated

with

m

anua

l wc

prop

ulsi

on

to c

hara

cter

ise

dem

ands

pla

ced

on

the

shou

lder

dur

ing

the

daily

act

ivity

of

man

ual w

c us

ers

Man

ual w

c us

ers

n=12

(11

SC

I, 1

spin

a bi

fida)

Act

iviti

es id

entifi

ed th

at re

sult

in

high

er s

houl

der

kine

tics

whe

n co

mpa

red

to s

tand

ard

leve

l pr

opul

sion

. Wei

ght r

elie

f req

uire

d hi

gh fo

rces

, and

larg

e m

omen

ts

durin

g ra

mp

prop

ulsi

on.

Sta

tistic

al re

port

ing

of g

roup

co

mpa

rison

s –

diffe

renc

es P

va

lue

prov

ided

, blin

ding

not

re

port

ed, s

ome

data

onl

y 85

%

of s

ubje

cts,

oth

ers

less

than

th

is.

Mul

roy

(200

4)90

IV

C

ase

serie

s D

eter

min

e th

e in

fluen

ce o

f SC

I lev

el

on th

e tim

ing

and

rela

tive

inte

nsity

of

shou

lder

mus

cle

activ

ity a

nd th

eref

ore

dem

ands

on

uppe

r ex

trem

ity, d

urin

g w

c pr

opul

sion

Con

veni

ence

sa

mpl

e,

outp

atie

nts

clin

ics,

mix

of

tetr

aple

gia

and

para

pleg

ia

n=69

The

leve

l of S

CI s

igni

fican

tly

affe

cted

the

shou

lder

mus

cle

recr

uitm

ent p

atte

rns

durin

g w

c pr

opul

sion

. Des

pite

sl

ower

pro

puls

ion,

thos

e w

ith

tetr

aple

gia

has

sim

ilar

or h

ighe

r el

ectr

omyo

grap

hic

inte

nsity

and

du

ratio

n fo

r m

ost m

uscl

es.

Mea

n tim

e in

wc

sinc

e in

jury

6

to 1

0.5

year

s. E

xclu

ded

if pr

evio

us s

houl

der

pain

, non

e pa

rtic

ipat

ed in

com

petit

ive

wc

spor

ts.

Mul

roy

et a

l (2

005)

91

IVC

ase

serie

sD

ocum

ent t

he e

ffect

of

fore

-aft

seat

po

sitio

n on

sho

ulde

r jo

int k

inet

ics

Mal

es w

ith

para

pleg

ia

n=13

A p

oste

rior

seat

pos

ition

re

duce

d th

e su

perio

r co

mpo

nent

of t

he s

houl

der

join

t re

sulta

nt fo

rce,

this

inte

rven

tion

pote

ntia

lly d

imin

ishe

s th

e ris

k fo

r im

ping

emen

t of s

ub-a

crom

ial

stru

ctur

es.

Elig

ibilit

y cr

iteria

repo

rted

. Tes

t w

c bu

t use

d ow

n cu

shio

n. P

re-

and

post

-dat

a co

llect

ed. N

o gr

oup

com

paris

on o

r bl

indi

ng

repo

rted

.

New

sam

et a

l (1

999)

97

IV

Cas

e se

ries

A c

ompa

rison

of

uppe

r ex

trem

ity

mot

ion

durin

g w

c pr

opul

sion

at 4

leve

ls

of S

CI u

sing

thre

e di

men

sion

s

Sub

ject

s w

ith

SC

In=

69 (1

7 lo

w

para

pleg

ia, 1

9 hi

gh p

arap

legi

a,

16 C

7 te

trap

legi

a, 1

7 C

6 te

trap

legi

a)

Com

pare

d w

ith p

arap

legi

c su

bjec

ts, t

hose

with

tetr

aple

gia

diffe

red

prim

arily

in th

e st

rate

gy

to c

onta

ct th

e w

heel

, with

gr

eate

r w

rist e

xten

sion

and

less

fo

rear

m p

rona

tion.

Sub

ject

s ha

d m

inim

um 1

yea

r of

wc

use.

Sub

ject

s us

ed s

ame

wc,

with

som

e m

odifi

catio

ns to

be

con

sist

ent w

ith th

eir

own

wc,

br

ief p

ract

ice

in te

st w

c. G

roup

si

mila

rity

repo

rted

, num

ber

of s

ubje

cts

with

out

com

e m

easu

res

not r

epor

ted.


5. Evidence tables

38

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Pric

e et

al

(200

7)10

5

IV

Cro

ss-

sect

iona

l bi

o-m

echa

nic

stud

y

Com

pare

upp

er li

mb

join

t pow

er m

agni

tude

an

d di

strib

utio

n be

twee

n sh

ould

er,

elbo

w a

nd w

rist d

urin

g m

axim

al a

ccel

erat

ion

vers

us s

tead

y-st

ate,

se

lf-se

lect

ed s

peed

m

anua

l wc

prop

ulsi

on

Adu

lts w

ith S

CI,

mor

e th

an 1

ye

ar p

ost-

inju

ry,

man

ual w

c us

ers

with

inju

ry

belo

w T

1 n=

13

Pow

er a

t the

sho

ulde

r w

as

larg

er th

an a

t oth

er jo

ints

. Pea

k sh

ould

er jo

int p

ower

larg

er

durin

g m

axim

al a

ccel

erat

ion

vers

us s

elf-

sele

cted

spe

ed,

whe

reas

elb

ow a

nd w

rist

pow

er fr

actio

ns w

ere

smal

ler

for

max

imum

spe

ed a

nd s

elf-

sele

cted

spe

ed p

ropu

lsio

n.

Hig

her

join

t pow

er p

rese

nt

unde

r m

axim

al a

ccel

erat

ion

may

pr

edis

pose

wc

user

s to

inju

ry a

t th

e sh

ould

er.

No

allo

catio

n w

ith o

rder

of

cond

ition

s as

sess

ed, b

lindi

ng

not p

ossi

ble,

out

com

es fo

r al

l sub

ject

s an

d al

l sub

ject

s un

derw

ent b

oth

cond

ition

s.

Gro

up s

tatis

tical

com

paris

ons

prov

ided

P v

alue

s. F

ores

t plo

t pr

ovid

ed.

Sab

ick

et a

l (2

004)

108

IVC

ase

serie

s U

se a

n er

gono

mic

s-ba

sed

ratin

g th

at

char

acte

rises

bot

h de

man

d on

and

ca

paci

ty o

f upp

er

extr

emity

mus

cle

grou

ps m

ost a

t ris

k fo

r pa

in o

r ov

erus

e in

jury

in a

rela

tivel

y de

man

ding

wc

prop

ulsi

on ta

sk

Adu

lt m

anua

l w

c us

ers

with

co

mpl

ete

T6-L

2 pa

rapl

egia

n=

16

A re

lativ

ely

beni

gn r

amp

(2.9

de

gree

s) p

lace

s a

larg

e de

man

d on

the

mus

cula

ture

of t

he u

pper

ex

trem

ity.

All

part

icip

ants

had

bee

n us

ing

wc

for

prim

ary

mob

ility

for

four

ye

ars.

Con

side

red

conf

ound

ers,

us

ed o

wn

wc

to m

inim

ise

chan

ges

to p

ropu

lsio

n, n

o co

mpa

rison

gro

up, a

ll da

ta fo

r al

l sub

ject

s.

Saw

atzk

y et

al

(200

5)11

2 IV

C

ross

-se

ctio

nal

coho

rt s

tudy

Com

pare

the

prev

alen

ce o

f sho

ulde

r pa

in in

adu

lt w

c us

ers

who

beg

an

usin

g th

eir

wc

durin

g ch

ildho

od (i

mm

atur

e sk

elet

on) w

ith th

ose

who

beg

an u

sing

thei

r w

c as

adu

lts (m

atur

e sk

elet

on)

Sub

ject

s’

cond

ition

s S

CI

and

spin

a bi

fida.

n=53

(22

adul

t on

set,

31 c

hild

on

set)

Hig

her

prev

alen

ce o

f ove

rall

pain

an

d sh

ould

er p

ain

in a

dult

onse

t gr

oup.

The

imm

atur

e sk

elet

on

can

poss

ibly

resp

ond

to th

e re

petit

ive

forc

es o

f whe

elin

g be

tter

than

that

of t

hose

who

be

gin

usin

g a

wc

afte

r th

eir

skel

etal

str

uctu

re is

com

plet

ely

deve

lope

d.

Gro

up c

ompa

rison

s m

ade.

Co-

varia

bles

iden

tified

, con

foun

ders

lin

ked

to c

ause

s, g

roup

co

mpa

rison

s re

port

ed a

nd

stat

istic

al d

iffer

ence

s, m

easu

res

pres

umed

to b

e ta

ken

for

all

subj

ects

(not

repo

rted

).

Technical report


5. Evidence tables

39

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Van

der

Wou

de e

t al

(200

9)12

4

IIR

ando

mis

ed

tria

l E

valu

ate

the

effe

cts

of w

c se

at h

eigh

t on

whe

elin

g ef

ficie

ncy

and

tech

niqu

e du

ring

reha

bilit

atio

n

Sub

ject

s w

ith

rece

nt S

CI

(stu

dy o

ccur

red

durin

g th

eir

reha

bilit

atio

n)n=

12

Opt

imis

atio

n of

sea

t hei

ght

durin

g sp

inal

cor

d in

jury

re

habi

litat

ion

may

lead

to m

ore

effic

ient

and

less

str

aini

ng

cond

ition

s fo

r m

anua

l whe

elin

g.

Ran

dom

isat

ion

of o

rder

of s

eat

heig

ht p

er s

ubje

ct, a

ppra

ised

as

rand

omis

ed tr

ial.

Van

Dro

ngel

en e

t al

(200

5)12

5

III-2

Cas

e co

ntro

l st

udy

Est

imat

e th

e di

ffere

nces

in g

leno

-hu

mer

al c

onta

ct

forc

es a

nd s

houl

der

mus

cle

forc

es

betw

een

able

-bod

ied

subj

ects

and

thos

e w

ith p

arap

legi

a an

d te

trap

legi

a du

ring

wc

rela

ted

activ

ities

of

daily

livi

ng

Mal

e su

bjec

tsn=

17 (5

abl

e-bo

died

, 8

para

pleg

ia, 4

te

trap

legi

a)

Gle

no-h

umer

al c

onta

ct fo

rces

w

ere

sign

ifica

ntly

hig

her

for

wei

ght-

relie

f lift

ing

and

high

est o

ver

the

3 ta

sks

for

the

tetr

aple

gia

grou

p. M

ore

mus

cle

forc

e w

as e

stim

ated

for

tetr

aple

gic

subj

ects

.

Allo

catio

n by

dia

gnos

is,

stat

istic

al re

port

ing

betw

een

grou

ps. G

roup

s di

ffere

nt –

pa

rapl

egia

gro

up o

lder

than

ab

le-b

odie

d an

d te

trap

legi

a gr

oup.

Out

com

es fo

r al

l su

bjec

ts o

btai

ned.

Gro

up

com

paris

ons

not u

sed

to e

xplo

re c

onfo

unde

rs.

Inte

rven

tion

stud

y ap

prai

sal

used

as

best

fit b

ecau

se o

f co

ntro

l gro

up. I

nclu

sion

crit

eria

re

port

ed.

Veeg

er e

t al

(199

8)12

8

IVC

ase

serie

s S

tudy

wris

t joi

nt

angl

es a

nd th

eir

rela

tions

hip

with

wris

t an

d fin

ger

activ

ity

durin

g th

e pu

sh p

hase

of

wc

prop

ulsi

on

n=5

non-

impa

ired

cont

rols

n=4

wc

user

s

Larg

e de

viat

ion

and

exte

nsio

n an

gles

, and

esp

ecia

lly th

ose

occu

rrin

g si

mul

tane

ousl

y w

ith

wris

t flex

or a

ctiv

ity a

re s

erio

us

risk

fact

ors

for

carp

al tu

nnel

sy

ndro

me.

Sm

all s

ampl

e, n

o ba

selin

e co

mpa

rison

s re

port

ed, n

or

conf

ound

ing

fact

ors.

Som

e of

th

e no

n-im

paire

d co

ntro

ls h

ad

prio

r w

c pr

opul

sion

exp

erie

nce.

M

ost s

ubje

cts

used

a d

iffer

ent

wc

but o

ne h

ad to

use

his

ow

n w

c. A

ll su

bjec

ts’ o

utco

me

mea

sure

s re

port

ed.


5. Evidence tables

40

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Veeg

er e

t al

(200

2)12

9

IV

Cas

e se

ries

Ass

ess

the

mec

hani

cal l

oad

on

the

glen

o-hu

mer

al

join

t and

on

shou

lder

m

uscl

es d

urin

g w

c pr

opul

sion

at e

very

day

inte

nsiti

es

Mal

e w

c us

ers,

al

l par

ticip

ated

in

wc

spor

ts

wee

kly

n=3

Low

inte

nsity

wc

prop

ulsi

on

does

not

app

ear

to le

ad to

hig

h co

ntac

t for

ces,

the

mus

cles

fo

rces

in th

e ro

tato

r cu

ff ar

e hi

gh, w

hich

mig

ht in

dica

te a

ris

k fo

r m

uscl

e da

mag

e an

d de

velo

pmen

t of s

ubse

quen

t sh

ould

er in

jurie

s.

Sm

all s

ampl

e si

ze, S

D p

rovi

ded.

O

utco

me

mea

sure

s fo

r al

l su

bjec

ts ta

ken.

Wei

(200

3)13

4IV

C

ase

serie

s In

vest

igat

e w

rist k

inem

atic

ch

arac

teris

atio

n at

var

ious

wc

seat

po

sitio

ns

Peo

ple

with

di

sabi

litie

s, w

c us

ers

n=11

Sea

t was

foun

d to

be

a cr

itica

l fa

ctor

affe

ctin

g th

e te

mpo

ral

para

met

ers

of m

ovem

ent a

nd

wris

t kin

emat

ic p

rope

rtie

s, w

rist

join

t ang

les

and

wris

t flex

ion-

exte

nsio

n ra

nge

of m

otio

n va

ried

acco

rdin

g to

sea

t hei

ght,

idea

l se

at h

eigh

t not

indi

cate

d.

Com

bina

tions

of h

oriz

onta

l po

sitio

ns a

nd v

ertic

al s

eat

heig

ht. S

ubje

cts

poor

ly d

efine

d,

sequ

ence

of t

estin

g ra

ndom

ised

bu

t no

deta

ils o

f met

hod,

no

blin

ding

repo

rted

, not

all

subj

ects

’ out

com

e m

easu

res

repo

rted

but

ass

umed

all

wer

e m

easu

red.

Abb

revi

atio

ns: w

c –

whe

elch

air,

SC

I – s

pina

l cor

d in

jury

; SD

– s

tand

ard

devi

atio

n; M

RI –

mag

netic

reso

nanc

e im

agin

g; R

CT

– ra

ndom

ised

con

trol

led

tria

l; E

MG

– e

lect

rom

yogr

am

5.2.

3 C

ard

iova

scul

ar fi

tnes

s

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

le

Stu

dy

resu

lts

and

find

ing

s C

om

men

ts

Abe

l et a

l (2

008)

1

III-2

Non

-ra

ndom

ised

tr

ial

Eva

luat

e th

e en

ergy

ex

pend

iture

of

whe

elch

air

depe

nden

t in

divi

dual

s

End

uran

ce te

st in

volv

ing

basa

l met

abol

ism

ev

alua

tion,

incr

emen

tal

exer

cise

test

unt

il ex

haus

tion

and

an

endu

ranc

e te

st

n=10

wc

race

rsn=

17 h

and

bike

rs(tw

o at

hlet

es w

ith b

ilate

ral

leg

ampu

tatio

ns)

Ene

rgy

expe

nditu

re o

f han

d bi

king

and

wc

raci

ng is

hig

h en

ough

to m

aint

ain

fitne

ss

and

prob

ably

hel

p to

pre

vent

ca

rdio

vasc

ular

dis

ease

eve

n at

a

mod

erat

e in

tens

ity.

Sub

ject

s w

ere

com

petit

ive

athl

etes

. Con

foun

ders

re

cogn

ised

(age

, bod

y m

ass,

spo

rt a

ctiv

ity).

Technical report


5. Evidence tables

41

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

le

Stu

dy

resu

lts

and

find

ing

s C

om

men

ts

Cow

an &

N

ash

(201

0)20

n/a

Mon

ogra

ph

and

liter

atur

e re

view

Sum

mar

ise

the

SC

I sp

ecifi

c pr

ofile

of

3 ca

rdio

vasc

ular

di

seas

e ris

k fa

ctor

s: fa

stin

g dy

slip

idea

mei

a, p

ost

pran

dial

lipi

daem

ia

and

vasc

ular

in

flam

mat

ion;

how

ex

erci

se m

ight

be

bene

ficia

l

n/a

No

anal

ysis

, alth

ough

st

udie

s w

ere

grou

ped

by

card

iova

scul

ar r

isk

fact

ors

and

type

s of

exe

rcis

e.

Des

crip

tive,

sea

rch

stra

tegy

not

pro

vide

d,

no q

ualit

y ap

prai

sal o

f lit

erat

ure

used

, not

abl

e to

de

term

ine

hom

ogen

eity

/he

tero

gene

ity o

f stu

dies

.

Dev

illard

et a

l (2

007)

29

n/a

Lite

ratu

re

revi

ew

Rev

iew

the

liter

atur

e on

the

effic

ienc

y of

tr

aini

ng p

rogr

ams

for

SC

I

n/a,

sea

rche

d M

ED

line

only

R

econ

ditio

ning

trai

ning

pr

ogra

ms

afte

r S

CI h

ave

a di

rect

impa

ct o

n fu

nctio

n an

d qu

ality

of l

ife, p

erm

ittin

g pa

rtic

ipat

ion

in p

hysi

cal

activ

ities

in a

dditi

on to

dai

ly

livin

g ac

tiviti

es.

Lim

ited

to o

ne d

atab

ase,

se

arch

str

ateg

y id

entifi

ed.

Met

hodo

logi

cal q

ualit

y re

view

ed b

ut c

riter

ia

for

this

not

spe

cifie

d.

Des

crip

tive

pres

enta

tion

of re

sults

, no

anal

ysis

ot

her

than

gro

upin

g by

in

tend

ed e

ffect

of t

rain

ing.

N

o te

sts

of s

imila

rity

appl

ied.

Fuku

oka

et a

l (2

006)

41

IVP

re-

and

post

-tes

t ca

se s

erie

s

Ass

ess

the

effe

cts

of

trai

ning

on

pulm

onar

y ox

ygen

upt

ake

for

peop

le w

ith S

CI

SC

I par

ticip

ants

, non

e ha

d pe

rform

ed e

xerc

ise

in

the

past

3 m

onth

s

n=8

In S

CI p

artic

ipan

ts th

ere

was

an

acc

eler

atio

n of

VO

2 ki

netic

s at

the

onse

t of e

xerc

ise

obse

rved

ove

r a

shor

t ter

m.

Sm

all s

ampl

e si

ze, n

o gr

oup

allo

catio

n, a

ll re

ceiv

ed s

ame

trea

tmen

t, no

dro

p ou

ts. B

etw

een

time

poin

ts a

naly

sis

prov

ided

.


5. Evidence tables

42

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

le

Stu

dy

resu

lts

and

find

ing

s C

om

men

ts

Jae

et a

l (2

008)

60

IV

Cro

ss-

sect

iona

l ca

se c

ontr

ol

Test

hyp

othe

sis

that

phy

sica

lly

activ

e pe

ople

with

S

CI d

o no

t hav

e in

crea

sed

sub-

clin

ical

at

hero

scle

rosi

s co

mpa

red

with

an

age-

mat

ched

abl

e-bo

died

gro

up

n=28

wc

athl

etes

with

S

CI

n=24

recr

eatio

nally

act

ive

age

mat

ched

abl

e-bo

died

co

ntro

l gro

up

Par

ticip

atio

n in

regu

lar

exer

cise

m

ay p

rese

rve

arte

rial f

unct

ion

in in

divi

dual

s w

ith S

CI w

hen

com

pare

d w

ith a

ge-m

atch

ed

able

-bod

ied

part

icip

ants

.

Par

ticip

ants

with

SC

I al

l at d

iffer

ent s

tage

s,

grou

p si

mila

rity

on s

ever

al

fact

ors.

Jans

sen

et a

l (2

001)

63

IVC

ase

serie

s E

xam

ine

the

phys

ical

cap

acity

, gr

oss

effic

ienc

y an

d ph

ysic

al s

trai

n of

ha

nd c

ycle

use

rs in

a

race

(on

a tr

eadm

ill)

Mal

e su

bjec

ts, s

ome

with

up

per

limb

impa

irmen

ts,

SC

I, tw

o w

ith s

pina

bifi

da,

one

with

am

puta

tion,

on

e w

ith lo

wer

lim

b am

puta

tion

and

join

t pr

oble

ms.

The

rac

e w

as

10 k

ilom

etre

s, a

ll su

bjec

ts

used

a h

and

cycl

e sy

stem

at

tach

ed to

thei

r w

c.

n=16

Res

ults

sug

gest

that

han

d cy

clin

g is

wel

l sui

ted

for

aero

bic

trai

ning

for

mos

t gr

oups

of w

c us

ers.

Gro

up s

imila

ritie

s m

ade,

si

mila

r at

bas

elin

e, a

ll su

bjec

ts c

ompl

eted

rac

e.

Allo

catio

n an

d bl

indi

ng

n/a,

min

imal

loss

to f/

up, s

tatis

tical

ana

lysi

s an

d co

mpa

rison

s w

ith

stan

dard

dev

iatio

ns

prov

ided

.

Jans

sen

et a

l (2

002)

62

IV

Cas

e se

ries

Dev

elop

nor

mat

ive

data

and

de

term

inan

ts o

f ph

ysic

al c

apac

ity

in in

divi

dual

s w

ith

tetr

aple

gia

and

para

pleg

ia

Dat

a fro

m 5

pre

viou

s st

udie

s re

-ana

lyse

d

n=16

6 ad

ults

Valu

es a

nd p

erce

ntile

s fo

r ph

ysic

al c

apac

ity m

easu

res

deve

lope

d.

App

roxi

mat

ely

40%

of

subj

ects

wer

e at

hlet

es,

whi

ch w

ould

influ

ence

the

valu

es. A

lso

som

e ov

er 7

0 ye

ars

and

som

e le

ss th

an

18 y

ears

, or

unab

le to

pr

opel

man

ual w

c.

Technical report


5. Evidence tables

43

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

le

Stu

dy

resu

lts

and

find

ing

s C

om

men

ts

Muk

herje

e et

al

(200

1)88

IVC

ase

serie

s,

pre-

and

po

st-t

est

outc

omes

Obs

erve

the

effe

ct o

f en

dura

nce

trai

ning

on

nov

ice

user

s of

arm

-pro

pelle

d th

ree-

whe

eled

ch

air,

pow

ered

by

asyn

chro

nous

arm

cr

ank

prop

ulsi

on, i

n ac

tual

loco

mot

ive

cond

ition

s

Stu

dy c

ondu

cted

in a

n ou

tdoo

r se

ttin

g, w

ith a

co

ntin

uous

end

uran

ce

trai

ning

pro

gram

, sub

ject

s pr

opel

them

selv

es a

t a

free

chos

en s

peed

for

15 m

inut

es d

aily.

Dat

a co

llect

ed a

t tw

o-w

eek

inte

rval

s, m

easu

res

incl

uded

pro

puls

ion

spee

d, p

eak

hear

t rat

e,

oxyg

en u

ptak

e.

n=12

mal

e pa

rapl

egic

s

Sel

f-am

bula

tion

at fr

ee c

hose

n sp

eed

regu

larly

for

10-1

2 w

eeks

pro

vide

s ef

ficie

ncy

and

impr

oves

fitn

ess

stat

us

requ

ired

for

whe

elch

airs

driv

en

by a

n as

ynch

rono

us a

rm c

rank

pr

opul

sion

tech

niqu

e an

d no

spe

cial

exe

rcis

e pr

ogra

m

is re

quire

d. M

ay b

e du

e to

di

ffere

nt p

ropu

lsio

n te

chni

que

com

pare

d to

sta

ndar

d w

c pr

opul

sion

.

No

loss

to fo

llow

up,

ex

clus

ion

crite

ria li

sted

. R

ando

mis

atio

n an

d bl

indi

ng n

/a, n

o ad

vers

e in

cide

nts,

P v

alue

ove

r tim

e, p

oint

mea

sure

s,

stan

dard

dev

iatio

ns.

Tord

i et a

l (2

001)

120

IVC

ase

serie

s,

pre-

and

post

-tes

t ou

tcom

es

Inve

stig

ate

the

effe

cts

of a

sho

rt in

terv

al

trai

ning

pro

gram

sp

ecifi

cally

des

igne

d fo

r pa

tient

s w

ith S

CI

Two

type

s of

max

imal

te

sts

perfo

rmed

bef

ore

and

afte

r tr

aini

ng:

prog

ress

ive

test

and

co

nsta

nt lo

ad te

st.

Trai

ning

and

test

use

d a

wc

ergo

met

er. F

our

wee

k tr

aini

ng (u

pper

bod

y)

prog

ram

. n=

5

Ther

e w

as a

sig

nific

ant

impr

ovem

ent i

n th

e fit

ness

leve

l an

d en

dura

nce

capa

city

of

para

pleg

ic p

atie

nts

with

sho

rt

trai

ning

per

iod,

app

ropr

iate

co

mbi

natio

n of

diff

eren

t typ

es

of tr

aini

ng, d

urat

ion,

inte

nsity

an

d fre

quen

cy e

xerc

ise.

Tr

aini

ng s

low

ed d

own

the

deve

lopm

ent o

f fat

igue

; re

spira

tory

acc

esso

ry m

uscl

es

play

a ro

le.

One

trea

tmen

t gro

up

only

(thu

s no

blin

ding

of

subj

ects

or

ther

apis

ts),

poin

t mea

sure

s an

d m

easu

res

of v

aria

bilit

y pr

ovid

ed.


5. Evidence tables

44

Aut

hor

and

ye

arLe

vel o

f ev

iden

ceS

tud

y d

escr

ipti

on

Stu

dy

ob

ject

ive

or

que

stio

nP

op

ulat

ion

or

stud

y sa

mp

le

Stu

dy

resu

lts

and

find

ing

s C

om

men

ts

Vale

nt e

t al

(200

8)12

3

II P

rosp

ectiv

e lo

ngitu

dina

l co

hort

stu

dy

Inve

stig

ate

the

influ

ence

of h

and

cycl

ing

on o

utco

me

mea

sure

s of

phy

sica

l ca

paci

ty d

urin

g an

d af

ter

reha

bilit

atio

n in

pe

rson

s w

ith S

CI (

C5

or lo

wer

)

Stu

dy a

cros

s th

ree

reha

bilit

atio

n ce

ntre

s in

the

Net

herla

nds.

O

utco

me

mea

sure

s in

clud

ed p

eak

oxyg

en

upta

ke a

nd p

ower

ou

tput

dur

ing

a pe

ak

exer

cise

test

, pea

k m

uscl

e st

reng

th o

f the

up

per

extr

emiti

es a

nd

pulm

onar

y fu

nctio

n.

Mea

sure

s ta

ken

at th

e st

art a

nd e

nd o

f clin

ical

re

habi

litat

ion

and

1 ye

ar

afte

r di

scha

rge.

Han

d cy

cle

use

was

mon

itore

d re

tros

pect

ivel

y vi

a qu

estio

nnai

re.

n=16

2 po

pula

tion

with

a

rece

nt S

CI

Reg

ular

han

d cy

clin

g (o

nce

per

wee

k or

mor

e) a

ppea

red

to b

e be

nefic

ial f

or im

prov

ing

aero

bic

phys

ical

cap

acity

for t

hose

with

pa

rapl

egia

.

Con

side

red

conf

ound

ers

(leve

l/fre

quen

cy o

f han

d cy

clin

g, m

uscl

e st

reng

th.

No

diffe

renc

e fo

und

in

hand

cyc

ling

grou

p an

d th

e no

n-ha

nd c

yclin

g gr

oup

durin

g an

d af

ter

clin

ical

reha

bilit

atio

n,

exce

pt fo

r ag

e of

thos

e w

ith te

trap

legi

a. 2

0% lo

ss

to f/

up. S

tand

ardi

sed

outc

ome

mea

sure

s.

Abb

revi

atio

ns: w

c –

whe

elch

air;

SC

I – s

pina

l cor

d in

jury

; f/u

p –

follo

w u

p

Technical report


5. Evidence tables

45

5.3

Whe

elch

air

feat

ures

evi

den

ce t

able

s

5.3.

1 R

ide

and

co

mfo

rt

Aut

hor

and

yea

rLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Hug

hes

et a

l (2

005)

59

III-3

C

ross

ove

r tr

ial,

com

para

tive

stud

y

Com

pare

the

ener

gy

effic

ienc

y of

str

aigh

t lin

e w

heel

ing

usin

g S

pine

rgy

whe

els

com

pare

d w

ith

stan

dard

ste

el-s

poke

whe

els,

an

d co

mpa

rison

of c

omfo

rt,

whe

elin

g pr

efer

ence

dur

ing

turn

s an

d su

rface

s

Peo

ple

with

pa

rapl

egia

n=

20

Spi

nerg

y w

heel

s pr

ovid

e a

mor

e co

mfo

rtab

le r

ide,

bu

t did

not

diff

er.

Com

fort

may

ha

ve im

port

ant

impl

icat

ions

in

patie

nt m

anag

emen

t of

pai

n an

d sp

astic

ity.

Non

-blin

ded

part

icip

ants

but

blin

ded

asse

ssor

s, r

ando

mis

ed. S

mal

l sam

ple

size

. Inc

lusi

on/e

xclu

sion

crit

eria

sp

ecifi

ed, a

ll su

bjec

ts m

easu

red

on a

ll ou

tcom

es.

No

para

llel c

ontr

ol g

roup

. Stu

dy

mea

sure

d ou

tcom

es p

re-

and

post

-in

terv

entio

n.

Saw

atsk

y et

al

(200

4)11

1

II R

ando

mis

ed

tria

l E

stab

lish

the

rollin

g re

sist

ance

cha

ract

eris

tics

of

pneu

mat

ic a

nd s

olid

tyre

s an

d al

so id

entif

y th

e en

ergy

ex

pend

iture

rela

ted

to ro

lling

resi

stan

ce a

t var

ious

tyre

pr

essu

res,

to e

stab

lish

the

link

betw

een

mai

nten

ance

of

tyre

pre

ssur

e an

d fa

tigue

ex

perie

nced

by

wc

user

s an

d as

soci

ated

upp

er e

xtre

mity

re

petit

ive

stra

in in

jurie

s

Adu

lt su

bjec

ts

with

par

aple

gia

(T5-

T12)

n=

15

The

stud

y sh

ows

the

bene

fits

to

clie

nts

and

staf

f us

ing

pneu

mat

ic

tyre

s fa

r ou

twei

ghs

the

min

imal

cos

t in

tim

e to

mai

ntai

n ad

equa

te ty

re

infla

tion.

PE

Dro

sco

re 4

/8.

Con

ditio

ns r

ando

mis

ed, i

nter

vent

ions

ap

prai

sal c

onsi

dere

d m

ost a

ppro

pria

te.

Aut

hor

stat

es b

linde

d st

udy

–

pres

umed

this

refe

rs to

sub

ject

s an

d as

sess

ors.

Rol

ling

resi

stan

ce te

stin

g w

ithou

t hum

an s

ubje

cts,

new

wc

tyre

s. N

o gr

oup

allo

catio

n. A

ll su

bjec

ts

com

plet

ed te

sts

with

mea

sure

s.

VanS

ickl

e et

al

(200

1)12

7

IV

Coh

ort s

tudy

A

pply

cur

rent

vib

ratio

n st

anda

rds

to w

c us

ers

for

the

deve

lopm

ent

of in

stru

men

tatio

n an

d te

chni

ques

to m

easu

re

dyna

mic

acc

eler

atio

n an

d to

de

term

ine

pote

ntia

l hea

lth

prob

lem

s fo

r w

c us

ers

Peo

ple

with

ph

ysic

al

disa

bilit

ies

with

mob

ility

impa

irmen

tn=

16

Vib

ratio

n m

ay b

e a

cont

ribut

ing

fact

or

to fa

tigue

am

ong

man

ual w

c us

ers,

w

hich

cou

ld le

ad to

in

jury

.

Incl

usio

n cr

iteria

spe

cifie

d. S

ubje

ct

char

acte

ristic

s sp

ecifi

ed. T

wo

cond

ition

s: fi

eld

test

with

usu

al

activ

ities

and

a s

imul

ated

road

cou

rse.

N

o co

mpa

rison

bet

wee

n m

obilit

y co

nditi

ons.

No

cont

rol o

f pot

entia

l co

nfou

ndin

g fa

ctor

s (s

ize,

ath

letic

ism

).


5. Evidence tables

46

Aut

hor

and

yea

rLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Vorr

ink

et a

l (2

008)

131

IV

Coh

ort s

tudy

To in

vest

igat

e w

heth

er

Spi

nerg

y w

heel

s w

ould

ab

sorb

vib

ratio

n, re

duce

pe

rcei

ved

spas

ticity

in p

eopl

e w

ith S

CI

Sta

ge 1

: no

n-di

sabl

ed

subj

ects

n=

22 (m

en a

nd

wom

en)

Sta

ge 2

: su

bjec

ts w

ith

SC

I n=

13 (1

0 m

en)

In th

e cu

rren

t ex

perim

enta

l se

tup

the

Spi

nerg

y w

heel

s ne

ither

re

duce

d vi

brat

ion

or

perc

eive

d sp

astic

ity

nor

impr

oved

co

mfo

rt in

peo

ple

with

SC

I mor

e th

an

the

conv

entio

nal

stee

l-spo

ked

whe

els.

Two

stag

es, t

he fi

rst r

egar

ding

spi

nerg

y w

heel

s, th

e se

cond

whe

ther

spa

stic

ity

trig

gere

d by

roug

h te

rrai

n w

as re

duce

d.

Firs

t sta

ge: l

imite

d in

form

atio

n on

su

bjec

ts, n

o gr

oup

com

paris

ons

e.g.

w

eigh

t. S

econ

d st

age:

dat

a fro

m o

ne

part

icip

ant a

bsen

t. S

ubje

cts

with

SC

I us

ed o

wn

wc.

Abb

revi

atio

ns: w

c –

whe

elch

air;

SC

I – s

pina

l cor

d in

jury

5.3.

2 T

ilt in

sp

ace

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Con

sort

ium

fo

r S

pina

l C

ord

Med

icin

e (2

000)

12

n/a

Gui

delin

e n/

a n/

a n/

a R

efer

to S

ectio

n 5.

7 fo

r A

GR

EE

rat

ing

Des

roch

es e

t al

(200

6)28

IVC

ase

serie

s D

eter

min

e th

e ef

fect

of

syst

em ti

lt an

gle

(STA

) an

d se

at-t

o-ba

ck re

st

angl

e (S

BA

) cha

nges

on

the

load

sus

tain

ed b

y th

e sh

ould

er d

urin

g m

anua

l w

c pr

opul

sion

Adu

lts, m

ixed

di

agno

sis,

mea

n ag

e 68

yea

rsn=

14

No

sign

ifica

nt d

iffer

ence

s be

twee

n sh

ould

er jo

int m

omen

ts fo

r th

e va

rious

com

bina

tions

. Sho

ulde

r lo

ad w

as m

aint

aine

d at

the

sam

e le

vel w

hen

chan

ging

sea

t an

gle

but k

eepi

ng w

heel

-axl

e po

sitio

n. T

hus

seat

ang

le c

an b

e de

term

ined

with

use

r co

mfo

rt a

nd

goal

s, a

nd p

ress

ure

mod

ulat

ion

at s

eat i

nter

face

for

alle

viat

ing

pres

sure

with

out i

ncre

asin

g ris

k of

ov

erus

e sh

ould

er in

jurie

s.

Sub

ject

s ra

ndom

ly

allo

cate

d or

der

of te

sts.

N

o bl

indi

ng o

f sub

ject

s or

ther

apis

ts.

Technical report


5. Evidence tables

47

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Dew

ey e

t al

(200

4)30

n/

aQ

ualit

ativ

e st

udy

Exp

lore

and

com

pare

th

e ex

perie

nces

of t

ilt

in s

pace

wc

use

and

conv

entio

nal w

c us

e in

se

vere

ly d

isab

led

clie

nts

with

mul

tiple

scl

eros

is

and

sign

ifica

nt s

past

icity

n=23

(7 ti

lt in

sp

ace

and

16

conv

entio

nal w

c us

ers)

The

maj

ority

of t

ilt in

spa

ce u

sers

w

ere

satis

fied

wer

e sa

tisfie

d w

ith

thei

r w

c, p

artic

ular

ly in

term

s of

co

mfo

rt.

Des

crip

tive

phen

omen

olog

ical

(q

ualit

ativ

e) a

ppro

ach,

us

ed in

terv

iew

s ap

prop

riate

to li

ved

expe

rienc

e qu

estio

ns,

incl

usio

n cr

iteria

re

port

ed. T

heor

etic

al

pers

pect

ive

not

repo

rted

, res

earc

hers

’ bi

ases

and

as

sum

ptio

ns n

ot m

ade

expl

icit.

App

ropr

iate

rig

our

for

cred

ibilit

y,

tran

sfer

abilit

y,

depe

ndab

ility

and

confi

rmab

ility.

Dic

iann

o et

al

(200

9)32

n/a

Pos

ition

st

atem

ent

and

liter

atur

e re

view

Des

crib

e th

e ty

pica

l cl

inic

al a

pplic

atio

ns a

nd

prov

ide

evid

ence

from

the

liter

atur

e su

ppor

ting

the

appl

icat

ion

of ti

lt, re

clin

e an

d el

evat

ing

leg

rest

s

n/a

n/a

No

qual

ity a

ppra

isal

of

stud

ies.

Din

g (2

008)

33

IV

Coh

ort s

tudy

E

xam

ine

the

usag

e of

pow

ered

sea

ting

func

tions

am

ong

a gr

oup

of w

c us

ers

durin

g th

eir

typi

cal d

aily

act

iviti

es

Adu

lt po

wer

wc

user

s n=

12

Sub

ject

s co

nsis

tent

ly a

cces

sed

the

seat

ing

func

tions

thro

ugho

ut

the

day

and

spen

t mos

t of t

heir

time

in a

tilte

d an

d/or

recl

ined

po

sitio

n, b

ut d

id n

ot re

-pos

ition

th

emse

lves

as

frequ

ently

as

guid

elin

es re

com

men

d.

Incl

usio

n cr

iteria

re

port

ed. R

esul

t not

re

port

ed fo

r 1

of th

e 12

sub

ject

s. U

sed

own

wc.

Dat

a co

llect

ed fo

r 2

wee

ks.

Dre

ier

et a

l (2

010)

35

n/a

Pos

ition

st

atem

ent

Tilt,

recl

ine

and

elev

atin

g le

g re

sts

for

whe

elch

airs

n/

a n/

a


5. Evidence tables

48

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Laco

ste

et a

l (2

003)

73

IVC

ohor

t stu

dy

Cha

ract

eris

e th

e us

e of

po

wer

ed ti

lt an

d re

clin

e sy

stem

s

Mos

t of t

he s

ubje

cts

(97.

5 %

) w

ere

usin

g th

eir

pow

ered

tilt

and

recl

ine

syst

em e

very

day

and

thei

r sa

tisfa

ctio

n w

as h

igh.

Diff

eren

t dia

gnos

es.

Gro

uped

acc

ordi

ng

to b

asis

of w

c fe

atur

es (p

ower

til

t, po

wer

recl

ine,

bo

th).

Sim

ilarit

ies

not

repo

rted

, con

foun

ders

no

t rep

orte

d, n

o as

sess

or b

lindi

ng.

Que

stio

nnai

re

deve

lope

d fo

r pu

rpos

e.

Mai

nly

desc

riptiv

e.

Mic

hael

et a

l (2

007)

83

n/a

Sys

tem

atic

re

view

D

eter

min

e th

e ef

fect

s of

tilt

in s

pace

sea

ting

on o

utco

mes

for

peop

le

with

neu

rolo

gica

l or

neu

rom

uscu

lar

impa

irmen

t who

can

not

wal

k

19 s

tudi

es

incl

uded

P

oste

rior

tilt c

an re

duce

pre

ssur

es

at th

e in

terfa

ce u

nder

the

pelv

is.

Two

inde

pend

ent

revi

ewer

s co

mpl

eted

ap

prai

sals

for

qual

ity.

Pel

low

(1

999)

103

IVC

ase

serie

s A

sses

s th

e ef

fect

of t

ilt

and

recl

ine

posi

tioni

ng

and

vario

us w

c cu

shio

ns

and

pres

sure

relie

ving

te

chni

ques

in th

e pr

even

tion

of p

ress

ure

sore

s

Peo

ple

with

te

trap

legi

a C

5 an

d ab

ove

n=2

The

gene

ral t

rend

obs

erve

d is

a

redu

ctio

n of

pre

ssur

e re

adin

gs a

t th

e is

chia

l tub

eros

ities

with

tilt

and

recl

ine

posi

tioni

ng. I

ndiv

idua

l and

on

goin

g as

sess

men

t is

esse

ntia

l to

pro

vide

the

best

cus

hion

and

pr

essu

re re

lief t

echn

ique

s.

Pilo

t stu

dy, p

re-

and

post

-tes

t mea

sure

s.

Con

veni

ence

sam

ple.

A

ll m

easu

res

for

both

su

bjec

ts.

SC

IRE

(2

010)

113

n/a

Evi

denc

e sy

nthe

sis

Rev

iew

, eva

luat

e an

d pr

esen

t a s

ynth

esis

with

ke

y po

ints

for

clin

icia

ns

Stu

dies

rela

te to

sp

inal

cor

d in

jury

n/

a R

evie

ws

of re

sear

ch o

n 27

topi

cs re

leva

nt to

sp

inal

cor

d in

jury

.

Technical report


5. Evidence tables

49

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Son

enbl

um e

t al

(200

9)11

4 IV

Coh

ort s

tudy

M

onito

r an

d de

scrib

e th

e us

e of

pow

er ti

lt sy

stem

s in

eve

ryda

y lif

e,

and

whe

ther

tilt

used

to

perfo

rm re

gula

r pr

essu

re

relie

ve li

fts

Full-

time

pow

er

wc

user

s n=

16

Diff

eren

ces

in ti

lt us

e illu

stra

ted

the

varia

bilit

y in

func

tion

and

activ

ity

amon

g us

ers,

and

div

erse

ben

efits

of

a ti

lt sy

stem

for

diffe

rent

use

rs.

Mon

itore

d fo

r 1-

2 w

eeks

on

daily

oc

cupa

ncy,

typi

cal

posi

tion

and

3 ot

her

para

met

ers

for

tilt.

Use

of r

eclin

e fu

nctio

n ex

clud

ed fr

om s

tudy

, si

ngle

gro

up a

naly

sis,

re

sults

for

all s

ubje

cts

repo

rted

.

Spr

igle

et a

l (2

010)

116

III-2

Com

para

tive

coho

rt s

tudy

Q

uant

ify th

e m

agni

tude

s of

load

ing

on th

e se

at a

nd b

ack

durin

g ph

ases

of t

ilt, r

eclin

e an

d st

andi

ng a

nd s

how

th

at th

e am

ount

of f

orce

re

duct

ion

at th

e se

at

wou

ld d

iffer

acr

oss

thes

e 3

met

hods

with

in th

eir

resp

ectiv

e cl

inic

al r

ange

s

n=6

able

-bod

ied

n=10

spi

nal c

ord

inju

red

Sta

ndin

g an

d re

clin

e of

fere

d si

mila

r se

at lo

ad re

duct

ions

at

term

inal

pos

ition

s, th

e re

sults

in

dica

te th

at ti

lt, re

clin

e an

d st

andi

ng s

yste

ms

shou

ld b

e co

nsid

ered

as

a m

eans

of w

eigh

t sh

iftin

g fo

r w

c us

ers.

Incl

usio

n cr

iteria

re

port

ed. O

rder

of

posi

tions

ran

dom

ised

(5

pos

ition

s). G

roup

si

mila

ritie

s re

port

ed,

SC

I gro

up h

eavi

er.

Blin

ding

not

repo

rted

. M

easu

res

on a

ll ou

tcom

es e

xcep

t fo

r on

e ab

le-b

odie

d su

bjec

t who

was

su

bseq

uent

ly e

xclu

ded.

Abb

revi

atio

ns: w

c –

whe

elch

air;

SC

I – s

pina

l cor

d in

jury


5. Evidence tables

50

5.3.

3 E

leva

ting

leg

res

t

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Ais

saou

i et

al (2

000)

2 III

-2N

on-

rand

omis

ed tr

ial

Inve

stig

ate

the

effe

cts

of e

leva

ting

leg

rest

on

post

ure

and

pres

sure

di

strib

utio

n in

a g

roup

of

abl

e-bo

died

sub

ject

s si

ttin

g in

a m

anua

l wc

Two

leg

rest

s te

sted

n=10

pa

rtic

ipan

ts

The

use

of c

onve

ntio

nal l

eg re

st

mod

ifies

the

subj

ects

pos

ture

and

in

duce

s an

incr

ease

of p

ress

ure

unde

r is

chia

l tub

eros

ities

in p

rocl

ine

posi

tion.

Blin

ding

not

repo

rted

, no

loss

to fo

llow

up,

st

atis

tical

repo

rts

of b

etw

een

grou

p co

mpa

rison

s

Dic

iann

o et

al

(200

9)32

n/a

Pos

ition

st

atem

ent a

nd

liter

atur

e re

view

Des

crib

e th

e ty

pica

l clin

ical

ap

plic

atio

ns a

nd p

rovi

de

evid

ence

from

the

liter

atur

e su

ppor

ting

the

appl

icat

ion

of ti

lt, re

clin

e an

d el

evat

ing

leg

rest

s

n/a

n/a

No

qual

ity a

ppra

isal

of

stu

dies

.

Dre

ier

et a

l (2

010)

35

n/a

Pos

ition

st

atem

ent

Tilt,

recl

ine

and

elev

atin

g le

g re

sts

for

whe

elch

airs

n/

a n/

a

Abb

revi

atio

ns: w

c –

whe

elch

air

Technical report


5. Evidence tables

51

5.3.

4 E

leva

ting

sea

t

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Arv

a et

al

(200

9)5

n/a

Pos

ition

pap

er

Pro

vide

an

over

view

of

the

liter

atur

e su

ppor

ting

the

use

of s

eat-

elev

atin

g de

vice

s fo

r w

c us

ers

n/a

Sea

t ele

vatio

ns a

re o

ften

med

ical

ly

nece

ssar

y fo

r en

ablin

g w

c us

ers

to re

ach,

impr

ove

mob

ility

rela

ted

activ

ities

of d

aily

livi

ng, f

acilit

ate

or e

nabl

e tr

ansf

ers,

pro

vide

pee

r he

ight

at d

iffer

ent a

ges,

enh

ance

in

depe

nden

ce a

nd p

rodu

ctiv

ity,

dela

y or

pre

vent

pai

n an

d se

cond

ary

com

plic

atio

ns o

f upp

er

limb.

Din

g (2

008)

33IV

C

ohor

t stu

dy

Exa

min

e th

e us

age

of p

ower

ed s

eatin

g fu

nctio

ns a

mon

g a

grou

p of

wc

user

s du

ring

thei

r ty

pica

l dai

ly a

ctiv

ities

Adu

lt po

wer

wc

user

s n=

12

Sub

ject

s co

nsis

tent

ly a

cces

sed

the

seat

ing

func

tions

thro

ugho

ut th

e da

y an

d sp

ent m

ost o

f the

ir tim

e in

a ti

lted

and/

or re

clin

ed p

ositi

on,

but d

id n

ot re

-pos

ition

them

selv

es

as fr

eque

ntly

as

guid

elin

es

reco

mm

end.

Incl

usio

n cr

iteria

re

port

ed. R

esul

t no

t rep

orte

d fo

r 1

of th

e 12

sub

ject

s.

Use

d ow

n w

c.

Dat

a co

llect

ed fo

r 2

wee

ks.

Mol

drup

et a

l (2

010)

85

n/a

Con

fere

nce

proc

eedi

ngs

Rev

iew

of t

he R

ES

NA

po

sitio

n pa

per

on s

eat

elev

atio

n

n/a

Add

ition

s to

the

pape

r in

clud

e: it

is

an

impo

rtan

t fea

ture

to m

aint

ain

the

abilit

y to

get

into

sta

ndin

g an

d fa

cilit

ate

the

func

tion

of th

e ar

ms

as lo

ng a

s po

ssib

le, i

mpo

rtan

t to

look

at c

ondi

tions

at d

iagn

osis

an

d if

cond

ition

pro

gres

sive

whe

n ch

oosi

ng a

wc

with

sea

t ele

vatio

n.

RE

SN

A

(200

5)10

6

n/a

Pos

ition

pap

er

Pro

vide

a d

efini

tion

and

stat

emen

t of t

he ty

pica

l cl

inic

al a

pplic

atio

ns

for

seat

ele

vatio

n an

d to

ass

ist w

ith d

ecis

ion

mak

ing

and

just

ifica

tion

n/a

Set

ele

vato

rs a

re o

ften

med

ical

ly

nece

ssar

y to

ass

ist i

ndiv

idua

ls

acco

mpl

ish

mob

ility

rela

ted

activ

ities

of

dai

ly li

ving

task

s.

Abb

revi

atio

ns: w

c –

whe

elch

air;

RE

SN

A –

Reh

abilit

atio

n E

ngin

eerin

g &

Ass

istiv

e Te

chno

logy

Soc

iety

of N

orth

Am

eric

a


5. Evidence tables

52

5.4

Pro

pul

sio

n ev

iden

ce t

able

s

5.4.

1 P

ow

er a

ssis

ted

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Alg

ood

et a

l (2

005)

4

IIR

ando

mis

ed

cont

rolle

d tr

ial

(con

ditio

ns)

Test

the

diffe

renc

es

betw

een

a pu

sh

rim-a

ctiv

ated

po

wer

ass

iste

d w

c an

d a

trad

ition

al

man

ual w

c w

hile

per

form

ing

com

mon

driv

ing

activ

ities

and

to

ass

ess

thei

r re

lativ

e m

erits

fo

r pe

ople

with

te

trap

legi

a

Two

cond

ition

s ra

ndom

ly

assi

gned

to p

artic

ipan

ts,

mul

tiple

mea

sure

s ta

ken

for

hear

t rat

e, ti

me

to

com

plet

e th

e co

urse

, an

d a

visu

al a

nalo

gue

scal

e po

st-t

est t

rials

to

dete

rmin

e th

e ea

se o

f ea

ch c

ours

e.n=

15 p

artic

ipan

ts

Pow

er a

ssis

ted

wc

have

the

pote

ntia

l to

impr

ove

func

tiona

l ca

pabi

litie

s du

ring

cert

ain

AD

Ls

espe

cial

ly w

hen

prop

ellin

g up

ra

mps

ove

r un

even

sur

face

s an

d ov

er th

ick

carp

et.

Ord

er o

f wc

and

leve

l of

resi

stan

ce r

ando

mis

ed.

Elig

ibilit

y cr

iteria

spe

cifie

d,

grou

p si

mila

rity

n/a.

A

ll pa

rtic

ipan

ts re

ceiv

ed

trea

tmen

t, st

atis

tical

repo

rtin

g be

twee

n gr

oup

com

paris

ons

and

varia

bilit

y w

ith P

val

ues

and

SD

, mos

t key

out

com

es

mea

sure

d. P

ED

ro s

core

5/1

0.

Coo

per

(200

1)15

II R

ando

mis

ed

cont

rolle

d tr

ial

Eva

luat

e a

nove

l pu

sh r

im a

ctiv

ated

po

wer

ass

iste

d w

c fo

r co

mpl

ianc

e w

ith w

c st

anda

rds,

m

etab

olic

ene

rgy,

co

st d

urin

g pr

opul

sion

and

er

gono

mic

s du

ring

sele

cted

act

iviti

es

of d

aily

livi

ng

A th

ree-

phas

e st

udy,

with

re

peat

ed m

easu

res

in th

e se

cond

and

third

pha

ses.

O

rder

of c

ondi

tions

ra

ndom

ised

. Par

ticip

ants

fu

ll-tim

e co

mm

unity

-dw

ellin

g m

anua

l wc

user

s w

ith S

CI o

r m

ultip

le

scle

rosi

s.n=

11

The

pow

er a

ssis

ted

wc

is

com

plia

nt w

ith s

tand

ards

, re

duce

s th

e en

ergy

dem

and

plac

ed o

n th

e us

er, a

nd s

ubje

cts

rate

d th

e er

gono

mic

s fa

vour

ably

w

hen

com

pare

d w

ith th

eir

pers

onal

wc.

Pow

er a

ssis

ted

wc

may

pro

vide

man

ual w

c w

ith

a le

ss p

hysi

olog

ical

ly s

tres

sful

m

eans

of m

obilit

y w

ith fe

w

adap

tatio

ns to

the

vehi

cle

or

hom

e en

viro

nmen

t nee

ded.

Sam

e gr

oup,

the

num

ber

of

subj

ects

with

the

outc

ome

varia

ble

not r

epor

ted.

No

of s

ubje

cts

with

out

com

e va

riabl

e no

t rep

orte

d. P

val

ues

and

SD

pro

vide

d.

PE

Dro

sco

re 4

/10.

Technical report


5. Evidence tables

53

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Din

g et

al

(200

8)34

II R

ando

mis

ed

cont

rolle

d tr

ial

(ord

er o

f eac

h in

terv

entio

n)

Eva

luat

e th

e im

pact

of p

ush

rim a

ctiv

ated

po

wer

ass

iste

d w

c on

mob

ility,

co

mm

unity

pa

rtic

ipat

ion,

sa

tisfa

ctio

n an

d ps

ycho

soci

al

impa

ct a

mon

g in

divi

dual

s w

ith

tetr

aple

gia

Ord

er o

f use

of e

ach

wc

rand

omis

ed. C

ompl

eted

a

4 w

eek

prot

ocol

(2

wee

k m

anua

l, 2

wee

k po

wer

ass

iste

d), w

ith

mob

ility

leve

ls re

cord

ed

by a

dat

a-lo

gger

. A

dditi

onal

out

com

e m

easu

res,

psy

chos

ocia

l im

pact

sca

le a

nd d

aily

qu

estio

nnai

res

rega

rdin

g co

mm

unity

par

ticip

atio

n.

Par

ticip

ants

man

ual w

c us

ers

with

tetr

aple

gia.

n=15

Par

ticip

ants

cho

se to

use

bot

h w

c si

mila

rly. N

o di

ffere

nces

in

com

mun

ity p

artic

ipat

ion,

sa

tisfa

ctio

n or

psy

cho-

soci

al

impa

ct. H

owev

er th

ere

was

a

stat

istic

al d

iffer

ence

with

pow

er

assi

sted

wc

trav

el fa

ster

. Pow

er

assi

sted

cou

ld b

e a

viab

le

mob

ility

optio

n of

indi

vidu

als

with

te

trap

legi

a es

peci

ally

for

outd

oor.

Onl

y on

e gr

oup,

som

e pa

rtic

ipan

ts d

id n

ot e

ntire

ly

com

plet

e tr

ial.

Sta

tistic

al

repo

rtin

g on

bet

wee

n gr

oup

com

paris

ons

and

SD

. All

ICF

dom

ains

con

side

red.

P

ED

ro 5

/10.

Gia

cobb

i et a

l (2

010)

47

n/a

Qua

litat

ive

stud

y,

grou

nded

th

eory

ana

lysi

s

Ass

ess

wc

user

s’

perc

eptio

ns o

f an

d ex

perie

nces

w

ith p

ower

as

sist

whe

els

usin

g qu

alita

tive

inte

rvie

w m

etho

ds

Qua

litat

ive

inte

rvie

ws

cond

ucte

d be

fore

, dur

ing

and

afte

r us

e of

a p

ower

as

sist

ed w

c. P

artic

ipan

ts

had

one

or m

ore

phys

ical

co

nditi

ons

(par

aple

gia,

te

trap

legi

a, a

mpu

tees

, sp

ina

bifid

a, m

ultip

le

scle

rosi

s, s

trok

e an

d S

CI).

E

xper

ienc

ed w

c us

ers.

n=

20

Pow

er a

ssis

t see

ms

to o

ffer

phys

ical

and

soc

ial b

enefi

ts

for

mos

t wc

user

s. C

linic

ians

sh

ould

con

side

r us

er’s

hom

e en

viro

nmen

t and

ove

rall

life

circ

umst

ance

s be

fore

pr

escr

ibin

g.

Ove

rall

rigou

r hi

gh o

n cr

edib

ility,

tran

sfer

abilit

y,

depe

ndab

ility,

con

firm

abilit

y,

used

ope

n an

d fo

cuse

d co

ding

, pre

sent

ed b

oth

prim

ary

and

seco

ndar

y ev

alua

tions

.


5. Evidence tables

54

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Gie

sbre

cht e

t al

(200

9)48

III-2

Com

para

tive

stud

y,

conc

urre

nt

mix

ed

met

hods

us

ing

a cr

oss-

over

tria

l with

co

ncur

rent

co

ntro

ls

Eva

luat

e pu

sh

rim a

ctiv

ated

po

wer

ass

iste

d w

c pe

rform

ance

am

ong

dual

-use

rs

in th

eir

natu

ral

envi

ronm

ent t

o de

term

ine

whe

ther

th

e po

wer

ass

iste

d w

heel

chai

r w

ould

ser

ve a

s a

satis

fact

ory

alte

rnat

ive

to th

e po

wer

wc

for

com

mun

ity-b

ased

ac

tiviti

es

Ran

dom

isat

ion

of

part

icip

ants

into

‘ord

er

of tr

eatm

ent’

grou

ps –

al

tern

ativ

ely

assi

gned

in

ord

er o

f enr

olm

ent.

Par

ticip

ants

aw

are

of

inte

rven

tion.

Mul

tiple

ou

tcom

e m

easu

res

used

incl

udin

g nu

mbe

r of

hou

rs re

port

ed u

sing

th

e di

ffere

nt w

c, u

ser

satis

fact

ion,

psy

chos

ocia

l an

d fu

nctio

n.n=

8

For

som

e in

divi

dual

s re

quiri

ng

pow

er m

obilit

y, th

e po

wer

as

sist

ed w

c m

ay p

rovi

de a

n al

tern

ativ

e to

the

pow

er w

c.

P v

alue

s pr

ovid

ed, m

edia

n,

and

rang

e fo

r al

l mea

sure

s.

Ligh

thal

l-H

aube

rt e

t al

(200

9)77

III-2

N

on-

rand

omis

ed

tria

l

Com

pare

sp

atio

-tem

pora

l pr

opul

sion

ch

arac

teris

tics

and

shou

lder

mus

cle

activ

ity in

per

sons

w

ith c

ervi

cal

SC

I pro

pellin

g a

man

ual w

c an

d a

push

rim

act

ivat

ed

pow

er a

ssis

ted

wc

on a

sta

tiona

ry

ergo

met

er

Com

paris

on o

f con

trol

w

c w

ith p

ower

ass

iste

d,

conv

enie

nce

sam

ple,

ad

ult m

ales

with

te

trap

legi

an=

14

For

peop

le w

ith c

ompl

ete

tetr

aple

gia,

pus

h ph

ase

shou

lder

m

uscl

e ac

tivity

was

dec

reas

ed in

th

e po

wer

ass

ist c

ompa

red

with

st

anda

rd p

ush

rim w

c in

dica

ting

a re

duct

ion

in d

eman

ds.

Out

com

e m

easu

res

assu

med

to b

e do

ne w

ith

all p

artic

ipan

ts, n

ot s

tate

d.

Com

paris

ons

betw

een

whe

elch

airs

and

spe

ed, w

ith

P v

alue

s, v

aria

bilit

y an

d po

int

mea

sure

s.

Technical report


5. Evidence tables

55

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Nas

h et

al

(200

8)92

II R

ando

mis

ed

cont

rolle

d tr

ial

Test

the

effe

cts

of

push

rim

act

ivat

ed

pow

er a

ssis

ted

wc

on th

e en

erge

tics

and

perc

eptu

al

resp

onse

s to

st

eady

-sta

te a

nd

inte

nsity

-gra

ded

wc

prop

ulsi

on

in p

erso

ns w

ith

para

pleg

ia, a

nd

tetr

aple

gia

havi

ng

chro

nic

shou

lder

pa

in

Mal

es o

ver

19 y

ears

, al

l chr

onic

and

mot

or

com

plet

e pa

rapl

egia

and

te

trap

legi

an=

18

Use

of p

ower

ass

iste

d by

pe

rson

s w

ith p

arap

legi

a an

d te

trap

legi

a ha

ving

sho

ulde

r pa

in

sign

ifica

ntly

low

ers

ener

gy c

ost,

perc

eive

d ex

ertio

ns c

ompa

red

to m

anua

l wc

prop

ulsi

on, w

hich

in

crea

ses

dist

ance

pro

pelle

d.

Ran

ge o

f mea

sure

s us

ed

for

met

abol

ic a

naly

sis,

all

subj

ects

com

plet

ed a

ll co

nditi

ons.

All

had

outc

ome

mea

sure

s co

mpl

eted

. C

ompa

rison

bet

wee

n w

c ty

pes,

with

P v

alue

s an

d S

D.

PE

Dro

6/1

0.

Abb

revi

atio

ns: w

c –

whe

elch

air,

AD

L –

activ

ities

of d

aily

livi

ng; S

D –

sta

ndar

d de

viat

ion;

SC

I – s

pina

l cor

d in

jury

; IC

F –

Inte

rnat

iona

l Cla

ssifi

catio

n of

Fun

ctio

ning

5.4.

2 D

rive

whe

el p

osi

tio

n

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Den

ison

&

Gra

yton

(200

2)26

n/

a R

epor

t on

wc

test

s D

eter

min

e th

e m

erits

an

d w

eakn

esse

s of

fro

nt, c

entr

e an

d re

ar

whe

el d

rives

, exp

lain

the

fact

ors

whi

ch c

ontr

ibut

e to

wc

perfo

rman

ce a

nd

prov

ide

clin

icia

ns w

ith

the

info

rmat

ion

Use

d st

anda

rd

test

labo

rato

ries

and

com

paris

on

test

s on

var

ious

w

c.

Defi

nitio

ns p

rovi

ded,

fact

ors

influ

enci

ng w

c pe

rform

ance

, m

anoe

uvra

bilit

y (e

.g. t

urni

ng r

adiu

s,

shap

e of

spa

ce).

Koo

ntz

et a

l (2

010)

70

IVC

ase

serie

s D

eter

min

e th

e m

inim

um

spac

e re

quire

d fo

r w

heel

ed m

obilit

y de

vice

us

ers

to p

erfo

rm 4

m

anoe

uvra

bilit

y ta

sks

and

to in

vest

igat

e th

e im

pact

of s

elec

ted

desi

gn a

ttrib

utes

Con

veni

ence

sa

mpl

e

n=10

9 m

anua

l w

cn=

100

pow

er

wc

n=14

sco

oter

us

ers

Bet

wee

n 10

% a

nd 1

00%

of u

sers

w

ould

not

be

able

to m

anoe

uvre

in

spa

ces

that

mee

t cur

rent

ac

cess

ibilit

y gu

idel

ines

.

Gro

upin

gs b

ased

on

desi

gn fe

atur

es. B

etw

een

grou

p an

alys

is. P

oint

m

easu

res

and

mea

sure

s of

var

iabi

lity

repo

rted

.


5. Evidence tables

56

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d fi

ndin

gs

Co

mm

ents

Min

kel (

2005

)84n/

a E

xper

t opi

nion

an

d co

nsum

er

advi

ce

Ess

entia

l ele

men

ts to

co

nsid

er w

hen

obta

inin

g w

heel

ed m

obilit

y

n/a

n/a

Pel

legr

ini e

t al

(201

0)10

2 III

-3C

ompa

rison

st

udy

with

out

cont

rols

, pos

t-te

st

Det

erm

ine

whe

ther

m

anoe

uvra

bilit

y va

ried

betw

een

elec

tric

wc

Test

ed w

c us

ers

with

th

ree

diffe

rent

po

wer

ed

indo

or/o

utdo

or

wc

n=12

Diff

eren

ces

in m

anoe

uvra

bilit

y ex

ist

betw

een

elec

tric

wc

belo

ngin

g to

the

sam

e ca

tego

ry. P

ract

ical

an

d st

anda

rd te

sts

prov

ide

com

plem

enta

ry a

nd c

onco

rdan

t in

form

atio

n.

Ran

dom

isat

ion

of o

rder

of

wc,

par

ticip

ants

trai

ned

for

60 m

ins,

indo

or a

nd

outd

oor

test

s. N

on-

para

met

ric s

tatis

tics

used

. M

edia

n an

d in

ter-

quar

tile

rang

e.

Abb

revi

atio

ns: w

c –

whe

elch

air

5.5

Trai

ning

evi

den

ce t

able

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Bes

t et a

l (2

005)

7 II

Ran

dom

ised

co

ntro

lled

tria

l

Test

whe

ther

wc

skills

tr

aini

ng o

f com

mun

ity-

base

d m

anua

l wc

user

s is

effi

caci

ous,

saf

e an

d pr

actic

al

Com

mun

ity

base

d w

c us

ers,

hal

f w

ith m

uscu

lar

dyst

roph

y,

half

with

ne

urol

ogic

al

diso

rder

sn=

22 (1

5 m

ales

)

WC

ski

lls tr

aini

ng o

f co

mm

unity

-bas

ed m

anua

l w

c us

ers

is e

ffica

ciou

s, s

afe

and

prac

tical

.

PE

Dro

sco

re 8

/10,

sta

tistic

al

com

paris

ons

betw

een

grou

ps,

grou

ps s

imila

r at

bas

elin

e, b

lindi

ng

not r

epor

ted,

trai

ner

appe

ars

to

have

don

e bo

th g

roup

s. O

utco

me

mea

sure

s fo

r 91

% o

f sub

ject

s.

Technical report


5. Evidence tables

57

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Bon

apar

te

(200

4)8

III-1

P

seud

o-ra

ndom

ised

co

ntro

lled

tria

l

Test

whe

ther

dur

ing

whe

elie

trai

ning

, ad

ding

the

proa

ctiv

e ba

lanc

e st

rate

gy to

the

conv

entio

nal r

eact

ive

bala

nce

stra

tegy

in

crea

ses

succ

ess

rate

, de

crea

ses

trai

ning

tim

e,

and

less

ens

post

ural

sw

ay d

urin

g th

e w

heel

ie

wc

user

s,

incl

uded

abl

e-bo

died

sub

ject

sn=

22

The

addi

tiona

l str

ateg

y di

d no

t im

prov

e w

heel

ie

succ

ess

rate

, tra

inin

g tim

e or

pos

tura

l sw

ay. O

lder

wc

user

s re

quire

mor

e tr

aini

ng

time.

Man

y su

ch u

sers

can

le

arn

this

ski

ll if

give

n th

e op

port

unity

.

PE

Dro

sco

re 5

/10.

Ran

dom

al

loca

tion

but b

alan

ced

grou

ps

for

gend

er, a

ge, d

iagn

osis

. S

peci

fic r

ando

mis

atio

n m

etho

d no

t rep

orte

d, b

lindi

ng n

ot

repo

rted

. The

re w

ere

(6 d

rop-

outs

) 78%

sub

ject

s w

ith o

utco

me

mea

sure

s. P

ossi

ble

conf

ound

ers

of u

nfam

iliarit

y w

ith w

c fo

r ab

le-

bodi

ed p

artic

ipan

ts.

Con

sort

ium

fo

r S

pina

l C

ord

Med

icin

e (2

005)

13

n/a

Gui

delin

e P

rese

rvat

ion

of u

pper

lim

b fu

nctio

n fo

llow

ing

spin

al c

ord

inju

ry

n/a

n/a

Ref

er to

Sec

tion

5.7

for

AG

RE

E

ratin

g

Coo

len

et a

l (2

004)

14

IIR

ando

mis

ed

cont

rolle

d tr

ial

Test

whe

ther

a b

rief

form

alis

ed p

erio

d of

wc

skills

trai

ning

, ad

ded

to th

e st

anda

rd

curr

icul

um, r

esul

ts in

si

gnifi

cant

ly g

reat

er

over

all i

mpr

ovem

ent

in w

c sk

ills th

an a

st

anda

rd u

nder

grad

uate

oc

cupa

tiona

l the

rapy

cu

rric

ulum

alo

ne

Uni

vers

ity

stud

ents

n=22

The

wc

skills

trai

ning

pr

ogra

m is

an

effe

ctiv

e w

ay to

impr

ove

the

wc

skills

per

form

ance

of O

T st

uden

ts.

PE

Dro

sco

re 7

/10.

Ran

dom

ly

allo

cate

d to

gro

ups

by n

umbe

rs,

no s

igni

fican

t diff

eren

ce b

etw

een

grou

ps, b

lindi

ng n

ot re

port

ed.

Initi

al o

utco

me

mea

sure

s fo

r 87

%

of s

ubje

cts

for

wc

skills

trai

ning

1,

but o

nly

355

for

wc

skills

trai

ning

3.

Out

com

e m

easu

res

for a

ll su

bjec

ts,

stat

istic

al c

ompa

rison

s be

twee

n gr

oups

.

Coo

per

et a

l (2

002)

16

IV

Cas

e se

ries

Det

erm

ine

the

driv

ing

char

acte

ristic

s of

ele

ctric

po

wer

ed w

c us

ers

durin

g un

rest

ricte

d co

mm

unity

act

iviti

es

and

com

pare

the

activ

ity

leve

ls a

mon

g an

act

ive

grou

p an

d a

grou

p of

re

gula

r us

ers

Mix

ed d

iagn

osis

n=17

Pow

er w

c us

ers

mos

t ac

tive

in th

e af

tern

oon

and

even

ing,

litt

le v

aria

tion

in

spee

d or

dis

tanc

e dr

iven

pe

r da

y. V

eter

ans

mor

e ac

tive

durin

g a

typi

cal

wee

k at

hom

e, m

axim

um

theo

retic

al d

ista

nce

is le

ss

than

8 k

m.

Gro

uped

acc

ordi

ng to

pla

ce o

f re

crui

tmen

t, on

e gr

oup

recr

uite

d w

hen

atte

nded

vet

eran

wc

gam

es.

Som

e be

twee

n gr

oup

com

paris

ons

for

two

grou

ps. N

o bl

indi

ng

repo

rted

. App

ears

dat

a fo

r al

l su

bjec

ts.


5. Evidence tables

58

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Coo

per

et a

l (2

005)

17

n/a

Des

crip

tive

over

view

O

utlin

e vi

rtua

l rea

lity

envi

ronm

ents

as

a po

ssib

le tr

aini

ng to

ol fo

r w

c us

er tr

aini

ng

n/a

Out

lines

use

of v

irtua

l rea

lity

for

key

para

met

ers

e.g.

jo

ystic

k tu

ning

inte

rface

an

d as

sess

men

t, vi

rtua

l dr

ivin

g si

mul

atio

n, m

obilit

y tr

aini

ng fo

r th

ose

with

vis

ual

impa

irmen

t.

Cor

fman

(2

003)

18

IV

Cas

e se

ries

com

paris

on

stud

y

Mea

sure

the

resp

onse

of

a te

st d

umm

y w

hile

tr

aver

sing

com

mon

ob

stac

les

enco

unte

red

by u

sers

of e

lect

ric-

pow

ered

wc

to

dete

rmin

e w

heth

er

optim

al w

c fit

, use

of

seat

belts

and

driv

ing

spee

d af

fect

the

frequ

ency

and

sev

erity

of

pow

er w

c tip

s an

d fa

lls

Test

dum

my

used

P

erso

ns w

ho u

se p

ower

w

c sh

ould

use

sea

tbel

ts

and

leg

rest

s w

hile

driv

ing

thei

r po

wer

wc

and

clin

icia

ns s

houl

d in

clud

e co

mm

on d

rivin

g ta

sks

whe

n as

sess

ing

the

prop

er p

ower

w

c se

t-up

.

Rep

eate

d po

st-t

est m

easu

res.

N

o bl

indi

ng re

port

ed, 4

diff

eren

t w

c us

ed w

ith s

ame

test

dum

my.

O

utco

me

data

for

all c

ombi

natio

ns,

stat

istic

al re

port

ing

of b

etw

een

grou

p co

mpa

rison

s, o

nly

poin

t mea

sure

s, n

o va

riabi

lity

as o

utco

me

mea

sure

was

di

chot

omou

s.

Daw

son

&

Thor

nton

(2

003)

23

n/a

Sin

gle

case

st

udy

Eva

luat

e th

e po

tent

ial

use

of a

n in

door

el

ectr

ical

ly p

ower

ed

wc

with

2 p

eopl

e w

ith

unila

tera

l neg

lect

, w

heth

er tr

aini

ng

impr

oved

acc

urac

y to

dr

ive

Sin

gle

inci

dent

rig

ht

hem

isph

ere

lesi

on fo

llow

ing

stro

ke. S

tudy

ov

er 8

wee

ks,

AB

A s

ingl

e su

bjec

t des

ign,

dr

ivin

g ac

cura

cy

mea

sure

d ea

ch w

eekd

ay.

Two

wee

ks o

f tr

aini

ng, 3

0 m

inut

es e

ach

wee

kday

.n=

2

Par

ticip

ants

lear

ned

to d

rive

the

pow

ered

wc

desp

ite

pers

istin

g ne

glec

t. Ta

sk

spec

ific

trai

ning

sho

uld

be

used

. Uni

late

ral n

egle

ct

shou

ld n

ot r

ule

out p

atie

nts

bein

g co

nsid

ered

for

pow

er

wc.

Fur

ther

rese

arch

is

need

ed.

Sm

all s

ampl

e re

sult,

con

side

red

prel

imin

ary.

Sco

re 9

/11

on

SC

ED

sca

le, o

bser

ver

bias

in

ter-

rate

relia

bilit

y no

t rep

orte

d,

inde

pend

ence

of a

sses

sors

not

re

port

ed (l

ikel

y to

be

occu

patio

nal

ther

apis

t).

Technical report


5. Evidence tables

59

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

De

Gro

ot e

t al

(200

8)25

II R

ando

mis

ed

cont

rolle

d tr

ial

Eva

luat

e th

e ef

fect

of 7

w

eek

low

inte

nsity

han

d rim

wc

trai

ning

on

the

sub-

max

imal

met

abol

ic

cost

, mec

hani

cal

effic

ienc

y an

d pr

opul

sion

in

abl

e-bo

died

pa

rtic

ipan

ts

Abl

e-bo

died

m

ales

n=21

A lo

w in

tens

ity 7

wee

k tr

aini

ng p

roto

col h

as a

be

nefic

ial e

ffect

on

the

mec

hani

cal e

ffici

ency

an

d m

etab

olic

cos

t of

wc

prop

ulsi

on in

abl

e-bo

died

sub

ject

s. Im

prov

ed

mec

hani

cal e

ffici

ency

se

ems

to b

e th

e re

sult

of c

hang

es in

pro

puls

ion

tech

niqu

e.

PE

Dro

7/1

0, r

ando

mis

atio

n to

gr

oup

alth

ough

met

hod

not

stat

ed. N

ot k

now

n w

heth

er

allo

catio

n co

ncea

led,

no

stat

istic

al

diffe

renc

es b

etw

een

grou

ps,

subj

ects

not

info

rmed

of p

urpo

se,

asse

ssor

s an

d th

erap

ist b

lindi

ng

not r

epor

ted,

out

com

e m

easu

res

for

all s

ubje

cts.

Bet

wee

n gr

oups

st

atis

tical

com

paris

ons

repo

rted

.

De

Gro

ot e

t al

(200

9)24

IV

Cas

e se

ries

Det

erm

ine

if ve

rbal

tr

aini

ng w

ith v

isua

l fe

edba

ck im

prov

ed

man

ual w

c pr

opul

sion

an

d ex

amin

e th

e di

ffere

nces

bet

wee

n th

ose

with

par

aple

gia

and

tetr

aple

gia

Man

ual w

c us

ers

n=9

Verb

al tr

aini

ng c

an

prod

uce

chan

ges

in p

ush

biom

echa

nics

of m

anua

l w

c us

ers.

Lon

ger

trai

ning

m

ay b

e ne

eded

to s

usta

in

prop

ulsi

on c

hang

es. R

esul

ts

confi

rm d

iffer

ent p

ropu

lsio

n te

chni

ques

bet

wee

n th

ose

with

par

aple

gia

and

thos

e te

trap

legi

a.

Pre

- an

d po

st-t

est m

easu

res.

Tr

aini

ng o

n tr

eadm

ill, w

ith v

erba

l an

d vi

sual

feed

back

to in

crea

se

push

leng

th. O

utco

me

mea

sure

s fo

r 75

%.

Edw

ards

&

McC

lusk

ey

(201

0)37

IV

Coh

ort s

tudy

In

vest

igat

e th

e ch

arac

teris

tics

of a

dults

w

ho u

se p

ower

wc

and

scoo

ters

, exp

lore

th

e pr

oces

s of

pow

er-

mob

ility

prov

isio

n an

d ex

amin

e th

e be

nefit

s an

d ch

alle

nges

of u

se

Con

veni

ence

sa

mpl

e, s

urve

ys

n=20

2

Pow

er-m

obilit

y de

vice

s ha

ve m

any

bene

fits

for

user

s, b

ut c

an h

ave

nega

tive

outc

omes

like

ac

cide

nts,

resu

lting

in

inju

ries.

Fur

ther

rese

arch

is

need

ed.

Cro

ss-s

ectio

nal s

urve

y.

App

roxi

mat

ely

650

surv

eys

dist

ribut

ed th

roug

h co

unci

ls,

pers

onal

con

tact

s an

d di

sabi

lity

orga

nisa

tions

. No

conf

ound

ers

iden

tified

. Com

paris

ons

mad

e be

twee

n w

c an

d sc

oote

r us

ers

on o

utco

me

mea

sure

s, g

roup

si

mila

rity

n/a.


5. Evidence tables

60

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Hal

l et a

l (2

005)

51

IV

Cas

e se

ries

Des

crib

e 2

pow

er

mob

ility

trai

ning

pr

otoc

ols

with

a

com

paris

on o

f pos

t-tr

aini

ng d

rivin

g pe

rform

ance

Sub

ject

s ov

er

70, t

wo

site

s fo

r tr

aini

ngn=

5 si

te 1

n=

7 si

te 2

Driv

ing

perfo

rman

ce w

as

asso

ciat

ed w

ith fa

cilit

y,

gend

er, t

ype

of d

evic

e us

ed

and

trai

ning

dur

atio

n, a

ll of

whi

ch v

arie

d be

twee

n fa

cilit

ies

and

trai

ning

pr

ogra

ms.

Elig

ibilit

y re

port

ed, g

roup

ed

acco

rdin

g to

trai

ning

site

. Pos

t-te

st m

easu

res

only.

No

stat

istic

al

diffe

renc

e be

twee

n gr

oups

. B

lindi

ng n

ot re

port

ed fo

r th

erap

ists

an

d su

bjec

ts, b

ut in

one

site

the

asse

ssor

was

blin

ded.

Out

com

e m

easu

res

for

92%

of s

ubje

cts,

be

twee

n gr

oup

trea

tmen

t co

mpa

rison

s w

ith m

easu

res

of

varia

bilit

y re

port

ed.

Har

rison

et a

l (2

002)

53

IV

Cas

e se

ries

The

appl

icat

ion

of tw

o vi

rtua

l env

ironm

ents

to

the

asse

ssm

ent a

nd

trai

ning

of i

nexp

erie

nced

po

wer

ed w

c us

ers,

in

term

s of

con

trol

of t

he

chai

r an

d ro

ute

findi

ng

Nov

ice

wc

user

s n=

6V

irtua

l env

ironm

ents

re

pres

ent a

pot

entia

lly

usef

ul m

eans

of a

sses

sing

an

d tr

aini

ng n

ovic

e po

wer

ed w

c us

ers.

Elig

ibilit

y cr

iteria

not

pro

vide

d,

2 di

ffere

nt e

nviro

nmen

ts, n

o co

ntro

l gro

up, n

o bl

indi

ng o

r gr

oup

sim

ilarit

y. O

utco

me

data

fo

r 60

% o

n en

viro

nmen

t 1 a

nd

33%

for

envi

ronm

ent 2

, not

all

subj

ects

com

plet

ed a

ll ro

utes

, no

envi

ronm

ent

com

paris

ons.

Has

dai e

t al

(199

8)54

III-2

C

ase

cont

rol

Eva

luat

e th

e ab

ility

of a

ba

sic

driv

ing

sim

ulat

or

prog

ram

to e

valu

ate

and

trai

n ch

ildre

n w

ith

disa

bilit

ies

in th

eir

abilit

y to

ope

rate

a p

ower

ed

wc

Chi

ldre

n w

ith

mus

cula

r dy

stro

phy

or

cere

bral

pal

syn=

22

A s

imul

ator

pro

gram

can

as

sist

in th

e de

velo

pmen

t an

d ev

alua

tion

of th

e sk

ills

requ

ired

to o

pera

te a

po

wer

ed w

c.

Con

trol

s w

ere

expe

rienc

ed d

river

s.

Elig

ibilit

y cr

iteria

onl

y pa

rtia

lly

repo

rted

. Gro

uped

acc

ordi

ng to

ex

perie

nced

ver

sus

novi

ce w

c us

er, g

roup

s di

ffere

nt a

t bas

elin

e (s

ex a

nd le

vel o

f wc

use)

but

sim

ilar

for

age

and

cogn

itive

leve

l, bl

indi

ng

not p

ossi

ble,

out

com

e m

easu

res

for

all s

ubje

cts,

in b

oth

grou

ps,

betw

een

grou

p co

mpa

rison

re

port

ed w

ith s

tatis

tics

– S

D,

mea

n.

Technical report


5. Evidence tables

61

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Jann

ink

et a

l (2

008)

61

II R

ando

mis

ed

cont

rolle

d tr

ial

Inve

stig

ate

the

poss

ibilit

y of

usi

ng a

n el

ectr

ic

scoo

ter

sim

ulat

ion

prog

ram

in a

dditi

on to

co

nven

tiona

l ele

ctric

sc

oote

r tr

aini

ng to

trai

n fu

ture

use

rs d

rivin

g sk

ills

Str

oke

surv

ivor

s n=

5 co

ntro

ln=

5 tr

eatm

ent

Pat

ient

s w

ith s

trok

e w

ere

satis

fied

with

the

elec

tric

sco

oter

sim

ulat

ion

trai

ning

, bot

h gr

oups

im

prov

ed (c

onve

ntio

nal a

nd

sim

ulat

ed).

PE

Dro

4/1

0. E

ligib

ility

crite

ria

not r

epor

ted,

tech

niqu

e fo

r ra

ndom

isat

ion

not r

epor

ted,

no

gro

up s

imila

rity

or b

lindi

ng

repo

rted

, out

com

e m

easu

re fo

r al

l sub

ject

s. L

imite

d in

terv

entio

n/co

ntro

l gro

up c

ompa

rison

s.

Kilk

ens

et a

l (2

005)

64

III-3

Cro

ss-

sect

iona

l- re

tros

pect

ive

coho

rt s

tudy

Test

the

hypo

thes

is th

at

wc

skill

perfo

rman

ce

is p

ositi

vely

rela

ted

to

part

icip

atio

n

SC

I 1 y

ear

post

-di

scha

rge

from

re

habi

litat

ion

n=81

(56

para

pleg

ia, 2

5 te

trap

legi

a, 1

7 in

com

plet

e)

For

pers

ons

with

SC

I who

ar

e m

anua

l wc

user

s,

wc

skill

perfo

rman

ce is

m

oder

atel

y as

soci

ated

to

part

icip

atio

n. T

rain

ing

of w

c sk

ills h

as to

be

an im

port

ant

goal

of r

ehab

ilitat

ion.

Not

all

part

icip

ants

obt

aine

d th

ree

wc

circ

uit s

core

s, w

ith p

hysi

cal

stra

in s

core

low

est n

=46

, but

al

l par

ticip

ants

com

plet

ed th

e si

ckne

ss im

pact

pro

file

mea

sure

.

Kirb

y et

al

(200

5)65

III-2

C

ompa

rativ

e st

udy

with

ca

se c

ontr

ol

Do

able

-bod

ied

peop

le

sim

ulat

ing

hem

iple

gia

(one

arm

and

one

leg)

ha

ve a

s m

uch

diffi

culty

pe

rform

ing

wc

skills

as

peop

le w

ith h

emip

legi

a

n=20

trea

tmen

t gr

oup

with

he

mip

legi

a (s

trok

e)

n=20

con

trol

gr

oup

Bot

h gr

oups

exp

erie

nced

si

mila

r di

fficu

lties

whe

n pe

rform

ing

wc

skills

, whi

ch

sugg

ests

ther

e ar

e in

here

nt

diffi

culti

es w

ith th

e ta

sk.

Con

trol

s w

ere

able

-bod

ied.

No

rand

omis

atio

n, in

tent

of p

roje

ct

conc

eale

d fro

m a

ble-

bodi

ed,

blin

ding

of t

hera

pist

s no

t pos

sibl

e,

grou

ps s

imila

r at

bas

elin

e,

outc

ome

mea

sure

s av

aila

ble

for

all s

ubje

cts,

sta

tistic

al re

port

ing

of

betw

een

grou

p co

mpa

rison

s.

Kirb

y et

al

(200

8)66

II R

ando

mis

ed

cont

rolle

d tr

ial

Test

whe

ther

a h

ighl

y st

ruct

ured

trai

ning

m

etho

d fo

r w

c cu

rb-

clim

bing

requ

ires

less

tr

aini

ng ti

me

than

co

nven

tiona

l tra

inin

g,

and

whe

ther

this

m

etho

d in

crea

ses

succ

ess

rate

, red

uces

th

e ne

ed fo

r sp

otte

r in

terv

entio

ns a

nd

redu

ces

part

icip

ants

pe

rcep

tions

of d

ifficu

lty

Abl

e-bo

died

su

bjec

tsn=

16 (7

tr

eatm

ent,

9 co

ntro

l)

In c

ompa

rison

with

a

conv

entio

nal m

etho

d fo

r cu

rb-c

limbi

ng, a

hig

hly

stru

ctur

ed m

etho

d se

ems

to re

quire

less

than

50%

of

the

trai

ning

tim

e fo

r ab

le-

bodi

ed p

artic

ipan

ts, w

hich

ha

s im

plic

atio

ns fo

r tr

aini

ng.

PE

Dro

sco

re 7

/10.

Ran

dom

isat

ion

to in

terv

entio

n an

d co

ntro

l gro

ups,

m

etho

d of

allo

catio

n no

t cle

ar,

sing

le tr

aine

r fo

r bo

th g

roup

s (n

o bl

indi

ng),

asse

ssor

s bl

inde

d,

outc

ome

mea

sure

s fo

r 89

%,

outc

ome

mea

sure

s sa

me

for

each

gr

oup.

Sta

tistic

al re

port

ing

of

betw

een

grou

p co

mpa

rison

s.


5. Evidence tables

62

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Kirb

y et

al

(200

8)67

II R

ando

mis

ed

cont

rolle

d tr

ial

Test

whe

ther

wc

trai

ning

met

hod

that

be

gins

in a

hig

h-ro

lling

resi

stan

ce s

ettin

g im

prov

es th

e su

cces

s ra

te a

nd re

duce

s th

e tr

aini

ng ti

me,

whe

ther

ot

her

fact

ors

(e.g

. age

, ge

nder

) affe

ct tr

aini

ng

time

Abl

e-bo

died

, no

wc

expe

rienc

e n=

48

Nei

ther

suc

cess

rat

e no

r tr

aini

ng ti

me

for

wc

skill

acqu

isiti

on b

y ab

le-b

odie

d le

arne

rs a

re im

prov

ed b

y a

trai

ning

met

hod

usin

g hi

gh

resi

stan

ce ro

lling.

PE

Dro

sco

re 6

/10.

Ran

dom

ised

bl

ock

man

ner

to g

roup

s, n

ot

know

n if

conc

eale

d al

loca

tion,

no

sign

ifica

nt d

iffer

ence

s be

twee

n gr

oups

, blin

ding

not

repo

rted

. O

utco

me

mea

sure

s fo

r 96

%

subj

ects

.

Mac

Phe

e (2

004)

78

II R

ando

mis

ed

cont

rolle

d tr

ial

Test

whe

ther

a b

rief,

form

alis

ed p

erio

d of

ad

ditio

nal w

c sk

ills

trai

ning

is s

afe

and

resu

lts in

sig

nific

antly

gr

eate

r im

prov

emen

ts

in w

c sk

ills p

erfo

rman

ce

than

a s

tand

ard

reha

bilit

atio

n pr

ogra

m

Mix

ed

diag

nose

sn=

35 (2

0 m

uscu

losk

elet

al

diso

rder

s, 1

5 ne

urol

ogic

di

sord

ers)

The

wc

skills

trai

ning

pr

ogra

m h

as a

clin

ical

ly

sign

ifica

nt e

ffect

on

the

inde

pend

ent w

heel

ed

mob

ility

of n

ew w

c us

ers.

PE

Dro

sco

re 7

/10.

Ran

dom

isat

ion

conc

eale

d af

ter

deci

sion

mad

e fo

r in

clus

ion.

Gro

ups

sim

ilarit

y re

port

ed w

ith n

o si

gnifi

cant

di

ffere

nces

, no

blin

ding

repo

rted

, al

thou

gh b

lindi

ng o

f ass

esso

r in

ferr

ed, o

utco

me

data

for

79%

of

subj

ects

, int

entio

n to

trea

t ana

lysi

s,

betw

een

grou

p co

mpa

rison

s, P

va

lues

and

SD

pro

vide

d.

McC

lusk

ey &

K

ay (2

008)

81

n/a

Opi

nion

C

omm

ent o

n th

e pr

opos

al fo

r a

com

pete

ncy

driv

ing

test

for

new

use

rs o

f m

otor

ised

sco

oter

s

n/a

Pro

pose

a m

ore

cons

erva

tive

prac

tice

and

rese

arch

reco

mm

enda

tions

th

an th

at p

ublis

hed

by N

itz

(200

8).99

Nitz

(200

8)99

IV

Cas

e se

ries

Util

ise

the

impl

emen

tatio

n of

a

new

com

pete

ncy

test

in

ord

er to

defi

ne s

kills

re

quire

d to

saf

ely

driv

e a

mot

oris

ed s

coot

er

Hea

lth s

ubje

cts,

te

st re

peat

ed

3 tim

es to

de

term

ine

prac

tice

effe

ct

on p

rofic

ienc

y n=

10

Driv

ing

skills

for

mot

oris

ed s

coot

er n

eed

to b

e ta

ught

and

lear

ned

with

ass

essm

ent f

or

com

pete

ncy

befo

re

unre

stric

ted

com

mun

ity

driv

ing

is a

llow

ed.

Sub

ject

s ne

ver

driv

en s

coot

er

befo

re. N

o gr

oup

allo

catio

n,

conf

ound

ers

linke

d to

ris

k of

driv

er

diffi

culty

, no

grou

p co

mpa

rison

s re

port

ed, o

r bl

indi

ng. S

ubje

cts

com

plet

ed te

st a

t lea

st o

nce,

onl

y 20

% re

-tes

ted,

ass

essm

ent d

river

co

mpe

tenc

y te

st (m

otor

veh

icle

).

Technical report


5. Evidence tables

63

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Rod

gers

et a

l (2

001)

107

IV

Long

itudi

nal,

pre-

and

po

st-t

est

Com

pare

pre

- an

d po

st-

trai

ning

bio

mec

hani

cal

and

phys

iolo

gica

l ch

arac

teris

tics

of w

c pr

opul

sion

in m

anua

l wc

user

s

Man

ual w

c us

ers

n=19

Trai

ning

effe

cts

for

a ra

nge

of fa

ctor

s (e

.g.

incr

ease

d ex

erci

se lo

ads

for

stre

ngth

enin

g ac

tiviti

es,

decr

ease

d st

roke

freq

uenc

y,

incr

ease

d m

axim

um e

lbow

ex

tens

ion

angl

e, in

crea

sed

trun

k an

d sh

ould

er fl

exio

n/ex

tens

ion)

.

Trea

tmen

t gro

up o

nly,

ther

efor

e no

blin

ding

, out

com

e m

easu

res

for

all s

ubje

cts,

pre

- an

d po

st-t

est

stat

istic

al c

ompa

rison

s.

Spa

eth

et a

l (2

008)

115

IV

Cas

e se

ries

Dev

elop

and

test

a

wc

virt

ual d

rivin

g en

viro

nmen

t tha

t can

pr

ovid

e qu

antifi

able

m

easu

res

of d

rivin

g ab

ility,

offe

r dr

iver

tr

aini

ng a

nd m

easu

re

the

perfo

rman

ce o

f al

tern

ativ

e co

ntro

ls

TBI a

mbu

lato

ry

and

non-

ambu

lato

ry

n=8

(7 m

ale)

Test

ing

and

inst

rum

ente

d re

al w

c ca

n va

lidat

e vi

rtua

l dr

ivin

g en

viro

nmen

t and

as

sess

whe

ther

virt

ual

driv

ing

skills

tran

sfer

to

actu

al d

rivin

g.

One

gro

up, r

ando

m a

lloca

tion

to tr

aini

ng o

rder

, allo

catio

n co

ncea

lmen

t not

repo

rted

, no

blin

ding

of t

hera

pist

s, s

ubje

cts

or a

sses

sors

repo

rted

. Out

com

e m

easu

res

avai

labl

e fo

r al

l sub

ject

s.

For

both

con

ditio

ns b

etw

een

grou

p st

atis

tical

com

paris

ons,

poi

nt

mea

sure

s an

d va

riabi

lity

repo

rted

(P

val

ue a

nd S

D).

van

Velz

en e

t al

(200

9)12

6

II P

rosp

ectiv

e co

hort

stu

dy

Des

crib

e th

e nu

mbe

r of

peo

ple

with

SC

I who

re

turn

ed to

wor

k 1

year

af

ter

disc

harg

e fro

m

inpa

tient

reha

bilit

atio

n an

d to

inve

stig

ate

whe

ther

retu

rn to

wor

k ca

n be

pre

dict

ed fr

om

wc

capa

city

at d

isch

arge

af

ter

corr

ectio

n fo

r co

nfou

nder

s

SC

I sub

ject

s n=

118

Ret

urn

to w

ork

was

su

cces

sful

in 3

3% o

f su

bjec

ts, w

c ca

paci

ty w

as

inde

pend

ently

rela

ted

to

retu

rn to

wor

k, th

eref

ore

it is

reco

mm

ende

d to

trai

n w

c ca

paci

ty in

the

cont

ext o

f re

turn

to w

ork.

Mai

n ou

tcom

e m

easu

re re

turn

to

wor

k at

leas

t one

wee

k. N

o gr

oup

allo

catio

n, o

nly

one

grou

p w

as

follo

wed

up

from

the

time

of in

jury

. C

onfo

unde

rs id

entifi

ed a

s a

mar

ker

of r

isk

for

retu

rn to

wor

k. S

tatis

tical

gr

oup

com

paris

ons

repo

rted

, ou

tcom

e m

easu

res

for

88%

of

subj

ects

.


5. Evidence tables

64

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Web

ster

(2

001)

133

III-2

C

ase

cont

rol

stud

y In

vest

igat

e w

heth

er

a co

mpu

ter

assi

sted

tr

aini

ng p

rogr

am

for

patie

nts

with

left

unila

tera

l neg

lect

wou

ld

decr

ease

sym

ptom

s of

th

is d

isor

der

n=20

trea

tmen

t gr

oup,

all

from

inpa

tient

re

habi

litat

ion

n=20

con

trol

gr

oup

Com

pute

r as

sist

ed tr

aini

ng

can

redu

ce u

nila

tera

l ne

glec

t sym

ptom

s on

ex

perim

enta

l tas

ks a

nd

som

e m

easu

res

of a

ccid

ent

risk.

Elig

ibilit

y cr

iteria

repo

rted

in

anot

her

artic

le. N

ot c

lear

whe

ther

th

e co

ntro

l is

an h

isto

rical

con

trol

, no

sig

nific

ant d

iffer

ence

bet

wee

n gr

oups

at b

asel

ine,

blin

ding

not

re

port

ed. O

utco

me

mea

sure

s fo

r 95

% o

f sub

ject

s, s

tatis

tical

re

port

ing

for

betw

een

grou

p co

mpa

rison

s –

mea

sure

s of

va

riabi

lity.

Wie

land

t &

Str

ong

(200

0)13

7

n/a

Lite

ratu

re

revi

ew

Exa

min

e th

e po

st-

disc

harg

e co

mpl

ianc

e of

indi

vidu

als

with

pr

escr

ibed

ada

ptiv

e eq

uipm

ent

Dat

abas

es

CIN

AH

L an

d M

edlin

e; 3

1 st

udie

s in

clud

ed

Five

cat

egor

ies

of fa

ctor

s th

at a

ffect

com

plia

nce:

m

edic

al-r

elat

ed, c

lient

-re

late

d, e

quip

men

t-re

late

d,

asse

ssm

ent-

rela

ted

and

trai

ning

-rel

ated

. A

sses

smen

t-re

late

d fa

ctor

s in

clud

ed e

valu

atio

n of

cl

ient

’s e

nviro

nmen

t and

pe

rson

al n

eeds

, not

just

di

agno

sis.

No

stud

y ap

prai

sal c

ondu

cted

, st

udie

s w

ere

surv

eys

of

com

plia

nce.

O

utco

me

of s

tudi

es c

onsi

dere

d in

clud

ed n

atur

e of

use

, the

tim

e of

fo

llow

-up

and

sam

ple

size

s.

Abb

revi

atio

ns: w

c –

whe

elch

air;

TB

I – tr

aum

atic

bra

in in

jury

; SC

I – s

pina

l cor

d in

jury

; OT

– oc

cupa

tiona

l the

rapy

; SD

– s

tand

ard

devi

atio

n; A

BA

– (t

hree

pha

ses:

A=

base

line

cond

ition

s, B

=in

terv

entio

n, A

=re

turn

to b

asel

ine

cond

ition

s)

Technical report


5. Evidence tables

65

5.6

Mai

nten

ance

evi

den

ce t

able

Aut

hor

and

ye

arLe

vel o

f ev

iden

ce

Stu

dy

des

crip

tio

n S

tud

y o

bje

ctiv

e o

r q

uest

ion

Po

pul

atio

n o

r st

udy

sam

ple

S

tud

y re

sult

s an

d

find

ing

s C

om

men

ts

Fitz

gera

ld e

t al

(200

5)39

IV

C

ohor

t stu

dy

Ass

ess

wc

dura

bilit

y an

d its

ef

fect

on

user

sat

isfa

ctio

n A

dult

wc

user

sn=

130

Bet

ter

unde

rsta

ndin

g of

wc

mai

nten

ance

and

re

pair

issu

es w

ill gu

ide

impr

ovem

ents

in w

c de

sign

an

d en

hanc

e th

e co

mm

unity

pa

rtic

ipat

ion

of in

divi

dual

s w

ho u

se w

c.

Con

veni

ence

sam

ple,

no

grou

p al

loca

tion,

out

com

e m

easu

re o

f que

stio

nnai

re

– no

relia

bilit

y an

d va

lidity

da

ta. C

onfo

unde

rs

iden

tified

dia

gnos

is a

nd

hour

s us

ed p

er d

ay, b

ut

not l

inke

d to

ris

k or

cau

se.

Gro

ups

sim

ilar

at b

asel

ine,

ou

tcom

e m

easu

res

for

85%

.

Han

sen

et a

l (2

004)

52

II R

ando

mis

ed

cont

rolle

d tr

ial

Inve

stig

ate

whe

ther

ac

tive

inte

rven

tion

usin

g a

com

pile

d ch

eckl

ist f

or

wc

chec

k-up

s in

crea

ses

user

sat

isfa

ctio

n an

d/or

de

crea

ses

acci

dent

s, n

ear-

acci

dent

s an

d pr

essu

re

sore

s

Reg

iste

red

wc

user

sn=

216

Mos

t wc

user

s ar

e un

able

to

det

erm

ine

on th

eir

own

whe

n ad

just

men

ts a

re

need

ed. A

n ac

tive

chec

k-up

on

man

ually

ope

rate

d w

c se

ems

to re

duce

acc

iden

ts.

PE

Dro

6/1

0.

Ran

dom

isat

ion

by

num

bers

, 2 g

roup

s: a

ctiv

e in

terv

entio

n an

d st

anda

rd

inte

rven

tion.

No

sign

ifica

nt

diffe

renc

es a

t bas

elin

e.

Blin

ding

not

repo

rted

, an

alys

ed b

y in

tent

ion

to tr

eat.

Sta

tistic

al

betw

een

trea

tmen

t gr

oup

com

paris

ons

with

m

easu

res

of v

aria

bilit

y.

McC

lure

et a

l (2

009)

80

II P

rosp

ectiv

e co

hort

stu

dy

Inve

stig

ate

the

frequ

ency

of

repa

irs th

at o

ccur

red

in a

6 m

onth

per

iod,

th

e co

nseq

uenc

es o

f br

eakd

owns

on

wc

user

s liv

ing

with

SC

I, an

d w

heth

er

ther

e is

an

asso

ciat

ion

with

in

crea

sed

num

ber

of re

pairs

an

d ad

vers

e co

nseq

uenc

es

Sub

ject

s ob

tain

ed

thro

ugh

Mod

el s

pina

l co

rd in

jury

sys

tem

s ce

ntre

s da

ta b

ase

n=22

13

Freq

uent

repa

irs a

nd

brea

kdow

n ca

n ne

gativ

ely

impa

ct o

n pe

rson

’s li

fe b

y de

crea

sing

par

ticip

atio

n an

d th

reat

enin

g he

alth

and

sa

fety

.

Con

veni

ence

sam

ple

surv

ey, e

ligib

ility

crite

ria

repo

rted

, con

foun

ders

id

entifi

ed in

clud

ing

pow

er

vers

us m

anua

l wc

use

linke

d to

incr

ease

d ris

k of

repa

ir, n

ot a

lloca

ted

to g

roup

s, n

o bl

indi

ng

repo

rted

, out

com

es fo

r 10

0% s

ubje

cts.

Abb

revi

atio

ns: w

c –

whe

elch

air;

SC

I – s

pina

l cor

d in

jury


5. Evidence tables

66

5.7

Exi

stin

g g

uid

elin

es e

vid

ence

tab

le

Aut

hor

and

yea

rO

rgan

isat

ion

Ove

rall

ob

ject

ive

of

the

gui

del

ine

Stu

dy

out

com

e o

r fi

ndin

gs

Ap

pra

isal

by

AG

RE

E

too

l119

acro

ss a

ll d

om

ains

Con

sort

ium

for

Spi

nal C

ord

Med

icin

e (2

000)

12

In c

onju

nctio

n w

ith th

e P

aral

ysed

Vet

eran

s of

A

mer

ica

Gui

danc

e on

the

prev

entio

n an

d m

anag

emen

t of

pres

sure

ulc

ers

follo

win

g sp

inal

cor

d in

jury

Rec

omm

enda

tions

on

the

prev

entio

n, n

utrit

ion,

as

sess

men

t fol

low

ing

the

onse

t of a

pre

ssur

e ul

cer,

trea

tmen

t, co

mpl

icat

ions

, sup

port

sur

face

s an

d po

sitio

ning

for

man

agin

g tis

sue

load

s.

61%

Con

sort

ium

for

Spi

nal C

ord

Med

icin

e (2

005)

13

In c

onju

nctio

n w

ith th

e P

aral

ysed

Vet

eran

s of

A

mer

ica

Gui

danc

e on

the

pres

erva

tion

of u

pper

lim

b fu

nctio

n fo

llow

ing

spin

al

cord

inju

ry

Rec

omm

enda

tions

on

the

asse

ssm

ent,

ergo

nom

ics,

eq

uipm

ent s

elec

tion,

trai

ning

and

env

ironm

enta

l ad

apta

tions

, exe

rcis

e, m

anag

emen

t of a

cute

and

su

bacu

te u

pper

lim

b in

jurie

s an

d pa

in, a

nd c

hron

ic

pain

trea

tmen

t to

mai

ntai

n fu

nctio

n.

44.2

%

Technical report


6. Working party

67

Name Position Organisation

Jeanine Allaous Senior Occupational TherapistBrain Injury

Royal Rehabilitation Centre

Adrian Byak PhysiotherapistSpinal Cord Injury

Assistive Technology Seating Service Northern Sydney Central Coast Health Service Private Practice

Danielle Collins Senior Occupational TherapistSpinal Cord Injury

Prince of Wales Hospital Spinal Unit

Allie Di Marco Occupational TherapistSpinal Cord Injury

Private practice

Linda Elliot Statewide Equipment Advisor EnableNSWHealth Support Services NSW Health

Bill Fisher Rehabilitation Engineer Assistive Technology Seating Service Northern Sydney Central Coast Health Service

Kate Hopman Senior Occupational TherapistTraumatic Brain Injury

Liverpool Hospital Brain Injury Rehabilitation Unit

Greg Killeen Consumer representative

Suzanne Lulham Director, Service Delivery Lifetime Care & Support Authority

Jodie Nicholls Senior Occupational TherapistBrain Injury

Westmead Brain Injury Rehabilitation UnitRepresentative of Occupational Therapy Australia – NSW Division

Thi Hong Nguyen Consumer representative

Sally Oates Project Officer EnableNSWHealth Support Services NSW Health

Lesley Radbron Senior Service Development and Review Officer

Lifetime Care & Support Authority

Lyndall Ross Senior Occupational TherapistBrain Injury

Mid Western Brain Injury Rehabilitation Program

Charisse Turnball Senior Occupational TherapistProject Officer and author of Spinal Seating education website

State Spinal Cord Injury Service Seating professional development program

Sue Lukersmith Project Officer Lifetime Care & Support Authority / EnableNSW

Working party6


7. Consumer and public consultation

68

Consumer and public consultation was integral to the guideline development process. There were two consumer representatives on the working party. Their involvement assisted throughout the development in terms of the scope, key topics and priorities, and clinical questions, as well as providing feedback on terminology and sources of grey literature. Further consumer and public input was sought during the development phase. Key consumer and stakeholder organisations provided feedback.

The consumer information was reviewed by consumers and their feedback incorporated to improve the document. The consumer information sheet was also rigorously assessed for plain English.

The draft guidelines were widely circulated to over 50 stakeholder organisations, consumer groups and individuals for review and comment in March 2011. Four international peer reviewers provided feedback. All comments received were considered in the finalisation of the document.

The organisations and individuals who received the document for external review and comment include:

• Professional associations

» Occupational therapy

» Physiotherapy

» Suppliers

• Individual consumers

• Consumer representative organisations

» Brain injury

» Spinal cord injury

• Medical and therapy specialists (NSW and interstate)

• Seating clinics

• Specialist equipment resource organisation

• Academics and researchers

• Specialist statewide services

» Spinal cord injury

» Brain injury

Consumer and public consultation 7

Technical report


8. Appendices

69

Appendix 1 Clinical questions

A. General

1. When is the optimal time for assessment of the individual and definitive prescription of a wheeled mobility device following a TBI or SCI?

2. Should the appropriate seating system be identified before the wheelchair?

3. At what stage should the discharge/home environment and potential modifications be considered in the prescription process?

4. When is the optimal time for review of the outcome of prescribed wheeled mobility?

5. What are common reasons for non-use of prescribed wheeled mobility? Should these be considered in the prescription process?

B. Assessment of the client’s functional need for a mobility aid

6. What should the goals include for the prescription of wheeled mobility as an intervention?

7. What predictors (influences) should be used to determine if there is a long-term need for wheeled mobility?

8. How will the outcomes be assessed?

9. What training should be provided (manual/powered)?

10. What parameters are required to ensure OHS for clients and attendant care workers when using wheeled mobility?

11. What are the considerations for using public and private transport?

C. Assessment of the client’s capacity to use a manual/powered wheeled mobility device

12. What is best practice assessment of the client’s (carers) capacity to use a manual/powered wheeled mobility device? This should include efficient and safe use.

13. Where is the optimal place(s) for assessment (home assessment, community assessment, transport assessment)?

14. Is there a need for a power wheelchair at a specific level of function/mobility? Is there a need at a specific age?

15. What level of visual acuity and field of vision is needed to operate a wheeled mobility device safely? How should vision be assessed?

16. Are there any co-morbid conditions or risk factors (e.g. epilepsy or other conditions that may result in loss of consciousness) which preclude the use of a manual/power wheeled mobility device in the community?

17. How can it be confirmed that a person has sufficient compensation for any recent hearing loss to be able to safely use a wheeled mobility device?

18. Are there particular medications or drugs (prescribed or illegal) that preclude or restrict the use of a wheeled mobility device (manual/powered/scooter)?

19. What are the psycho-social considerations for a power/manual wheeled mobility device, e.g. acceptance of disability, including family/carer/client?

20. What activities place greater stress on the upper limb?

Appendices 8


8. Appendices

70

Manual 21. What are the cognitive requirements to operate a manual wheelchair?

22. What are the behavioural requirements to operate a manual wheelchair?

23. What are the perceptual requirements to operate a manual wheelchair?

24. What range of motion of the upper limb is required to operate a manual wheelchair?

25. What shoulder and upper limb strength is required to operate a manual wheelchair?

26. Is there evidence to indicate that a manual wheelchair enhances or maintains cardiovascular fitness? What is the frequency of use to achieve this?

Power 27. What are the cognitive requirements to operate a power wheelchair/scooter?

28. What are the behavioural requirements to operate a power wheelchair/scooter?

29. What are the perceptual requirements to operate a power wheelchair/scooter?

30. What upper limb strength and control is required to drive a power wheelchair/scooter?

31. What transfer, head control, balance and sitting abilities are required for power wheelchair/scooter use?

D. Parameters to be considered with respect to wheeled mobility features

32. What parameters should be considered with respect to potential client changes, e.g. width due to weight increase or growth?

33. What parameters should be used to determine whether a client requires tilt in space in their seating system?

34. Does a lightweight wheeled mobility device and seating system reduce the incidence of shoulder pain (or other symptoms) and/or over-use syndromes for users and/or attendant care workers?

35. Does a solid back rest (firm postural support) make pushing a manual wheeled mobility device more efficient?

36. Does power assist reduce the shoulder and wrist forces required when pushing?

37. What is the best alternative control system for people unable to use hand controls (e.g. chin controls)?

38. Are there benefits to titanium frames (e.g. ‘better ride’, less vibration, reduced incidence or intensity of user’s pain/neuropathic pain)?

39. What is the fatigue life of a titanium wheelchair frame compared to the lightweight frame?

40. What are the indicators for variable seat elevation in powered wheelchairs?

41. What should be considered when assessing compatibility with transport options (e.g. self-drive, transfer options)?

42. What parameters/advantages are considerations for each drive position (rear/front/mid wheel drive) for indoor/outdoor use?

43. What are the parameters that determine the need for recline features?

44. What are the parameters that determine the need for leg elevation?

45. What are the parameters that determine the need for tilt?

46. What are the advantages of push rims and hand rims?

Two wheelchairs 47. What are the indicators for the prescription of two wheelchairs?

Technical report


8. Appendices

71

E. Re-assessment of the client in context (client, wheeled mobility device and environment interface

48. What are reliable outcome measures of wheeled mobility intervention? (tools)

49. When and where should the client be re-assessed? (related to seating reviews and q. 12).

During guideline development, for a range of reasons, the working party decided it was not appropriate to include the following questions:

12. What is best practice assessment of the client’s (carers) capacity to use a manual/powered wheeled mobility device? This should include efficient and safe use.

19. What are the psycho-social considerations for a power/manual wheeled mobility device, e.g. acceptance of disability, including family/carer/client?

46. What are the advantages of push rims and hand rims?

49. When and where should the client be re-assessed?

Appendix 2 Literature searches

Organisations and websites searched and the search terms used to identify other relevant publications

Table 3 Searches for existing guidelines

Organisation Search terms

National Guideline Clearing House (US) wheelchair all publications available on website

Scottish Intercollegiate Guidelines Network (SIGN) all publications available on website

Royal College of Physicians all publications available on website

Canadian Medical Association Infobase wheelchair spinal cord injury mobility wheeled mobility brain injury scooter

Healthlinks, University of Washington wheelchair

Institute for Clinical Systems Improvement wheelchair wheeled mobilitywheelmobilityspinal cord injury brain injury traumatic brain injury closed head injury

National Health and Medical Research Council / National Institute of Clinical Studies

all guidelines available on website

New Zealand Guidelines Group all guidelines available on website

National Institute for Health and Clinical Excellence all publications available on website

Agency for Healthcare Research and Quality all publications available on website

OpenClinical all publications available on website


8. Appendices

72

Centre for Health Evidence (Canada) all publications available on website, user guides

Oxford Centre for Evidence-Based Medicine resources

Clinical Information Access Portal, clinical guidelines

guidelines section

Physiotherapy Evidence Database (PEDro) wheelchair spinal cord injury traumatic brain injury scooter wheel wheeled mobility

OTseeker wheelchair wheel wheeled mobility spinal cord injury traumatic brain injury scooter

Psychological Database for Brain Impairment Treatment Efficacy (PsycBITE)

traumatic brain injurymovement and motor problems independent/self-care/ADL

World Health Organization (WHO) wheelchair spinal cord injurytraumatic brain injurybrain injuryscooterwheeled mobility

Cochrane Database wheelchair traumatic brain injury brain injury spinal cord injury

American Congress of Rehabilitation Medicine (ACRM)

wheelchair traumatic brain injury spinal cord injury

Centers for Disease Control and Prevention (CDC) wheelchair spinal cord injury traumatic brain injury scooter

Implementation Science (BioMed Central) wheelchair spinal cord injury traumatic brain injury scooter

European Federation of Neurological Societies (EFNS)

wheelchair spinal cord injury traumatic brain injury

Guidelines International Network (GIN) wheelchair traumatic brain injury spinal cord injury

Technical report


8. Appendices

73

National Library of Guidelines (UK) wheelchair traumatic brain injury spinal cord injury

Spinal Cord Injury Rehabilitation Evidence (SCIRE) all publications available on website

Mount Sinai TBI Central all publications available on website

Paralyzed Veterans of America (PVA) all publications available on website

Queensland Health all publications available on website

Brain Trauma Foundation all publications available on website

When potentially relevant guidelines were identified, there was a keyword search within the document: wheelchair, wheel, mobility, wheeled mobility, spinal cord injury, brain injury, traumatic brain injury, scooter.

Organisation’s websites and resources

Able data, assistive technology http://www.abledata.com/abledata.cfm

Australian Rehabilitation and Assistive Technology (ARATA) http://www.arata.org.au/

Brain Foundation http://www.brainaustralia.org.au/

Brain Net Brain Research and Integrative Neuroscience Network http://www.brainnet.net/

Centre for Neuroskills http://www.neuroskills.com/index.shtml

USA TechGuide http://www.usatechguide.org/

Consortium for children, youth disabilities and special care needs http://gucchd.georgetown.edu/products/Consortium%20Brief%2012.pdf

Georgia Tech http://www.pe.gatech.edu/conted/servlet/edu.gatech.conted.course.ViewCourseDetails?COURSE_ID=915

Institute of Rehabilitation Research and Development http://www.irrd.ca/resource.asp

Institute of Electrical and Electronics Engineers, technical literature http://ieeexplore.ieee.org/Xplore/login.jsp?url=/iel5/10755/33900/01616091.pdf?arnumber=1616091

International Seating Symposium http://www.seatingandmobility.ca/IntSeatingSymposium.aspx

Monash University, Monash Epworth Research Centre – Brain Injury http://www.med.monash.edu.au/spppm/research/merrc/ – Wheelchair Symposiums

National Pressure Advisory Panel http://www.npuap.org/resources.htm

Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) http://www.rstce.pitt.edu/RSTCE_Resources/RSTCE_Resources.html


8. Appendices

74

RAND research organisation http://rand.org/about/glance.html

Seating, Mobility Outcomes and Evidence http://www.permobil.nl/upload/holland/Seminar%202007/Schmeler%20Permobil%20Europe%202007%20Handout.pdf

Spinal Cord Injury Rehabilitation Evidence http://www.scireproject.com/

Spinal Cord Injury Congress http://www.ifkb.nl/news/SCIcongress/Rose.pdf

Ingenta connect, scholarly research http://www.ingentaconnect.com/content/klu/586/2004/00000013/00000004/art00012?crawler=true

University of Washington, rehabilitation http://sci.washington.edu/projects_and_research/published_articles.asp

Wheelchair outcome tools http://www.mscare.org/cmsc/images/journal/pdf/journal_2006_v7_n3_Wheelchair_Outcome.pdf

Wheelchair net http://www.wheelchairnet.org/WCN_ProdServ/Consumers/evaluation.html

Wheelchair skills program Dalhousie University http://www.wheelchairskillsprogram.ca/

Appendix 3 Search terms for clinical questions

Due to the anticipated paucity of relevant research, a very broad search on Medline was initially performed using the search term wheelchair$. There were 970 citations, the abstracts for which were individually checked for relevance. However each clinical questions was searched again with key terms.

General

Optimal time or place for assessment or review 1. wheelchair$

2. optimal time$

3. 1 and 2

4. wheelchair fitting (MESH)

5. prescript$

6. time$ (MESH time factors, time perception, time or time management or time$)

7. 1 and 5

8. 1 and 5 and 6

9. 1 and 5 and 2

10. As above for optimal place

Discharge/home environment and potential modifications 1. home modification$ and when

2. wheelchair$

3. 1 and 2 (CINAHL)

Technical report


8. Appendices

75

Medline, Embase and PsychInfo 1. modifications

2. home

3. 1 and 2

4. modification

5. 2 and 4

6. environment

7. 2 and 6

8. environment and modifications

Non-use and abandonment, disuse, non-use assistive technology, wheelchairs 1. assistive technology

2. disuse$

3. 1 and 2

4. non-use$

5. 1 and 4

6. wheelchair$

7. 6 and 2, 6 and 4,

8. fail$

9. 1 and 8

10. 6 and 8

11. fatigue$

12. 1 and 11

13. 6 and 11

14. scooter$

15. 14 and 2, 14 and 4, 14 and 8, 14 and 11

16. abandon$

17. 1 and 16, 6 and 16, 14 and 16

18. breakdown

19. 6 and 18

Wheelchair and transport considerations 1. wheelchair$ or scooter or wheeled mobility

2. public and transport

3. 1 and 2

4. private and transport

5. 1 and 4

Outcomes 1. wheelchair$ or scooter or wheeled mobility

2. outcome$ and measure$

3. 1 and 2

4. effective$

5. 3 and 4

6. change$ and time$

7. 1 and 6


8. Appendices

76

Better/best ride and sitting comfort/vibration1. wheelchair and vibration

2. wheelchair$ and vibrat$

3. wheelchair$ and ride and comfort

4. wheelchair$ and best ride or comfort

5. wheelchair$ and better ride or comfort

6. spinal and cord and injur$ or parapleg$ or tetrapleg$ or quadrapleg$

7. 5 and 6

8. brain injur$

9. 5 and 8

10. wheelchair$ and discomfort

11. wheelchair$ and discomfort and brain injur$

12. wheelchair$ and discomfort and spinal and cord and injur$)

13. wheelchair$ and sit$ and comfort

14. 6 and 13

15. 8 and 13

Assessment, re-assessment and functional need

Goals 1. wheelchair$

2. goal$

3. 1 and 2

4. wheel$ mobility

5. 2 and 4

6. scooter$

7. 2 and 6

8. client goal$ (subject headings: ADL, patient care planning, brain injuries, health services accessibility, motivation, physician-patient relations, client goal$)

9. 1 and 8

10. patient goal$,(subject headings: goals, decision making, cognition disorders, patient care planning, quality of life, patient goal$)

11. 1 and 10

12. 4 and 10

13. 6 and 10

14. therapy goal$ (subject headings: goals, adult, middle aged, aged, occupational therapy, therapy goal$, students)

15. therapist goals (subject headings: locomotion, health personnel and physical therapy modalities)

16. 1 and 15

Predictors to determine long-term need 1. predictors, risk factors prognosis (exploded)

2. wheelchair$

3. 1 and 2

4. need$

5. 3 and 4

6. influence$

7. 4 and 2 and 6

8. wheel$ and mobility

Technical report


8. Appendices

77

9. 1 and 4 and 8

10. 6 and 4 and 8

11. prognosis or predictor$

12. 1 and 11

13. influence$

14. need$

15. 1 and 13 or 14

Hoffer system of classification of ambulatory capacity1. gait (usual limits)

2. assessment

3. 1 and 2

4. spinal and cord and injury

5. 3 and 4

6. ambulat$ and capacity

7. 4 and 6

Training 1. training

2. wheelchair$ or wheeled mobility or scooter

3. 1 and 2

4. wheelchair$

5. skills and training

6. 4 and 5

7. mobility capacity

8. 4 and 7

9. wheeled and mobility

10. 9 and 1

11. skills$

12. develop$ and 11

13. 4 and 11

14. 4 and 12

15. as above but for scooter$

Occupational health and safety 1. wheelchair$

2. wheeled mobility

3. occupational and health

4. safety or ergonomic$

5. 1 or 2 and 3

6. 1 or 2 and 4

Assessment and capacity

User capacity 1. best practice 2. use3. wheelchair$ 4. wheeled and mobility 5. scooter$6. 1 and 2 and 3 7. 1 and 2 and 4 or 5


8. Appendices

78

Hearing loss and wheelchair1. hearing loss2. wheelchair$ or wheel$ mobility or scooter$3. 1 and 24. hear$5. audition$6. 2 and 5

Hearing continued 1. hearing impairment or hearing loss

2. wheelchair$

3. 1 and 2

4. hearing capacity or hearing loss (subject headings: hearing loss, central, partial, hearing screening, rehabilitation of hearing impaired)

5. 2 and 4

6. recent hearing loss

7. recent hearing impairment

8. 2 and 6

9. 2 and 7

10. wheel$ mobility or scooter$

11. 4 and 10, 6 or 7 and 10

International Journal of Audiology 1. hearing and loss

2. hearing

3. wheelchair$

4. 1 or 2 and 3

5. driving

6. 2 and 5

7. 2 and impairment and 3

8. 2 and impairment and 5

9. 1 and 5

Visual acuity and wheelchair 1. vision

2. wheelchair$ or wheel$ mobility or scooter$

3. 1 and 2

4. visual acuity

5. 2 and 4

6. field AND vision (subject headings: visual fields, vision disorders, adult, vision, ocular, space perception, contrast sensitivity, visual acuity, functional laterality)

7. 2 and 6

8. Field of vision (subject headings: visual acuity, vision disorders, ocular or visual fields, space perception)

9. driving

10. 2 and 9

11. 8 and 9 and 2

Technical report


8. Appendices

79

Co-morbid conditions or risk factors 1. wheelchair$

2. wheeled mobility

3. co-morbid

4. risk$

5. 1 or 2 and 3

6. 1 or 2 and 4

Medication or drug use that precludes wheeled mobility 1. wheelchair

2. drug$

3. 1 and 2

4. medication$

5. 1 and 4

6. driving and drug$

7. driving and medication$

8. 1 and 6

9. 1 and 7

10. driving

11. 10 and 4

Wheelchair and cognition, perception, behaviour 1. wheelchair$ or scooter$

2. cogniti$

3. mobility aids

4. 1 and 2 and 3

5. perception

6. 1 and 2 and 5

7. 6 and 3

8. behaviour or depression or aggressi$ or impulsiv$ or suicide

9. 1 and 8

10. accident$ or injur$ or self concept

11. 1 and 10

12. 1 and risk and tak$

13. 1 and depress$ or impulsive$ or aggress$

Manual wheelchairs and cardiovascular fitness 1. wheelchair$

2. cardiovascular or aerobic and fitness

3. 1 and 2

Upper limb and activities Weight

1. wheelchair$

2. width or wide

3. 1 and 2

4. wheelchair$ and width

5. 1 and height$

6. 1 and lightweight

7. weight

8. 1 and 7


8. Appendices

80

Overhead movements

1. overhead and activit$

2. wheelchair$

3. 1 and 2

Transfers

1. wheelchair$

2. transfer$

3. 1 and 2

Pushing

1. wheelchair$

2. push$

3. hill$

4. 1 and 2 or 3

5. 1 and 2 and 3

Upper limb and requirement for range of motion 1. wheelchair$ or scooter$

2. manual wheelchair$

3. wheelchair$ and propulsion

4. wheeled mobility

5. range of motion

6. 1 and upper and limb and 5

7. 1 and wrist$ and 5

8. 1 and shoulder$ and 5

9. arm and range of motion


11. upper limb or arm

12. 1 and 11

Upper limb strength 1. upper limb

2. arm

3. power assist$

4. wheelchair$ or wheeled mobility

5. 3 and 4

6. manual and wheelchair$


8. spinal cord injury or traumatic brain injury

9. strength

10. 1 and 9

Wheelchair and scooter features

Wheelchair and user changes 1. wheelchair$ or scooter or wheeled mobility

2. user and change$

3. client and change$

4. patient and change$

5. 1 and 2 or 3 or 4

Technical report


8. Appendices

81

Titanium1. wheelchair$ or wheeled mobility

2. titanium

3. failure$

4. breakdown

5. 1 and 2 and 3

6. 1 and 2 and 4

7. aluminum

8. 1 and 7 and 3, 1 and 7 and 4

9. failure$

10. 1 and 2 and 9, 1 and 7 and 9

11. wheelchair$

12. pole and motor

13. 11 and 12

14. ultralight

15. ultralight and 11

Tilt and recline1. wheelchair$ or wheeled mobility

2. 1 and tilt

3. 1 and angle$

4. 1 and recline$

5. seat and recline$

6. seat and back angle

7. chair$ and recline

8. chair$ and back angle

9. seat back and angle

10. seat back and tilt

11. tilt-in-space and 1

12. tilt-in-space and chair$

Leg elevation 1. wheelchair$ or wheeled mobility

2. 1 and leg elevation

3. 1 and elevation

4. 1 and calf support

5. 1 and foot plate

6. 1 and leg lift

7. 1 and foot and plate

8. sitting and knee and extension

9. seat and leg and elevation

10. chair$ and leg and elevation

11. sitting and leg and elevation


8. Appendices

82

Back support 1. wheelchair$

2. back and support

3. 1 and 2

4. wheel$ mobil$

5. back support

6. 4 and 5

7. 1 and 5

8. 2 and 4

9. lumbar support (limited mesh terms to lumbar support, orthotics and furniture)

10. 1 and 9

11. 4 and 9

12. back rest

13. 4 or 1 and 12

Wheelchair and foot propulsion 1. wheelchair$ or scooter or wheeled mobility

2. 1 and foot and propulsion

Seat elevation 1. wheelchair$ or scooter or wheeled mobility

2. seat and elevat$

3. 1 and 2

4. seat and rais$

5. 1 and 4

Drive position (rear/front/mid wheel drive), also searched web of science1. wheelchair$ or scooter or wheeled mobility

2. motor drive position

3. drive and position

4. 1 and 2

5. 1 and 3

6. axle position

7. 1 and 6

8. front and wheel and drive and 1

9. front wheel drive motor

10. rear wheel drive

11. 1 and 10

12. motor drive

13. motor

14. 1 and 13

15. 1 and 12

16. wheelchair$ and drive

Wheelchair maintenance 1. wheelchair$ or scooter or wheeled mobility

2. 1 and maintenance or repair

3. 1 and width

4. 1 and height

5. 1 and weight

Technical report


8. Appendices

83

Appendix 4 Abbreviations

ADL Activities of daily living

AGREE Appraisal of Guidelines for Research and Evaluation

AT Assistive technology

CI Confidence interval

CINAHL Cumulative Index to Nursing and Allied Health Literature

CRPD Convention on the Rights of Persons with Disabilities

DARE Database of Abstracts of Reviews of Effects

EMG Electromyogram

ICF International Classification of Functioning

LTCSA Lifetime Care & Support Authority

MRI Magnetic resonance imaging

NHMRC National Health and Medical Research Council

OHS Occupational health and safety

OT Occupational therapy

PCDA Power-mobility Community Driving Assessment

PEDro Physiotherapy Evidence Database

PICO Participant Intervention Comparator Outcome

RCT Randomised controlled trial

RESNA Rehabilitation Engineering and Assistive Technology Society of North America

SCED Single Case Experimental Design

SCI Spinal cord injury

SCIRE Spinal Cord Injury Rehabilitation Evidence

SD Standard deviation

TBI Traumatic brain injury

WC Wheelchair

WHO World Health Organization


References

84

References

1. Abel, T., Platen, P., Rojas Vega, S., Schneider, S., and Str¸der, H.K., Energy expenditure in ball games for wheelchair users. Spinal Cord, 2008. 46(12): p. 785-790.

2. Aissaoui, R., Heydar, S., Dansereau, J., and Lacoste, M., Biomechanical analysis of legrest support of occupied wheelchairs: Comparison between a conventional and a compensatory legrest. IEEE Transactions on Rehabilitation Engineering, 2000. 8(1): p. 140-148.

3. Akbar, M., Balean, G., Brunner, M., Seyler, T.M., Bruckner, T., Munzinger, J., Grieser, T., Gerner, H.J., and Loew, M., Prevalence of rotator cuff tear in paraplegic patients compared with controls. The Journal of Bone and Joint Surgery, 2010. 92(1): p. 23-30.

4. Algood, S., Cooper, R., Fitzgerald, S., and Boninger, M., Effect of a pushrim-activated power-assist wheelchair on the functional capabilities of persons with tetraplegia. Archives of Physical Medicine and Rehabilitation, 2005. 86(3): p. 380-386.

5. Arva, J., Schmeler, M., Lange, M., Lipka, D., Rosen, L., RESNA Position on the application of seat-elevating devices for wheelchair users. Assistive Technology, 2009. 21: p. 69-72.

6. Beekman, C.E., Miller-Porter, L., Schoneberger, M., Energy cost of propulsion in standard and ultralight wheelchairs in people with spinal cord injuries. Physical Therapy, 1999. 79(2): p. 146-158.

7. Best, K., Kirby, R., Smith, C., and Macleod, D., Wheelchair skills training for community-based manual wheelchair users: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 2005. 86(12): p. 2316-2323.

8. Bonaparte, J., Learning to perform wheelchair wheelies: Comparison of 2 training strategies. Archives of Physical Medicine and Rehabilitation, 2004. 85(5): p. 785-793.

9. Boninger, M.L., Cooper, R.A., Baldwin, M.A., Shimada, S., Koontz, A., Wheelchair pushrim kinetics: Body weight and median nerve function Archives of Physical Medicine and Rehabilitation, 1999. 80: p. 910-915.

10. Boninger, M.L., Dicianno, B.E., Cooper, R.A., Towers, J.D., Koontz, A.M., Shoulder magnetic resonance imaging abnormalities, wheelchair propulsion and gender Archives of Physical Medicine and Rehabilitation, 2003: p. 1615-1620.

11. Collinger, J., Boninger, M., Koontz, A., Price, R., Sisto, S., Tolerico, M., and Cooper, R., Shoulder biomechanics during the push phase of wheelchair propulsion: A multisite study of persons with paraplegia. Archives of Physical Medicine and Rehabilitation, 2008. 89(4): p. 667-676.

12. Consortium for Spinal Cord Medicine, Pressure ulcer prevention and treatment following spinal cord injury: A clinical practice guideline for health care professionals., Paralyzed Veterans of America, Editor. 2000, PVA: Washington p. 80.

13. Consortium for Spinal Cord Medicine, Preservation of upper limb function following spinal cord injury: A clinical practice guideline for health-care professionals, National Guideline Clearinghouse, Editor. 2005, Paralyzed Veterans of America. p. 36.

14. Coolen, A., Kirby, R., Landry, J., Macphee, A., Dupuis, D., Smith, C., Best, K., Mackenzie, D., and Macleod, D., Wheelchair skills training program for clinicians: A randomized controlled trial with occupational therapy students. Archives of Physical Medicine and Rehabilitation, 2004. 85(7): p. 1160-1167.

15. Cooper, R., Evaluation of a pushrim-activated, power-assisted wheelchair. Archives of Physical Medicine and Rehabilitation, 2001. 82(5): p. 702-708.

16. Cooper, R., Wolf, E., Fitzgerald, S., Dobson, A., Ammer, W., Boninger, S., T., Trefler, E., Hobson, D., Burdett, R., Cooper, R.A, and Cooper, R., Evaluation of selected sidewalk pavement surfaces. 2002, University of Pittsburgh: Pittsburg. p. 23.

17. Cooper, R.A., Simpson, R., Fitzgerald, S.G., Spaeth, D.M., Songend, G., Koontz, A.M., Cooper, R., Kim, J., Boninger, M.L., Virtual reality and computer-enhanced training applied to wheeled mobility: An overview of work in Pittsburgh Assistive Technology, 2005. 17: p. 159-170.

18. Corfman, T., Tips and falls during electric-powered wheelchair driving: Effects of seatbelt use, legrests, and driving speed. Archives of Physical Medicine and Rehabilitation, 2003. 84(12): p. 1797-1802.

19. Cowan, R., Nash, M., Collinger, J., Koontz, A., and Boninger, M., Impact of surface type, wheelchair weight, and axle position on wheelchair propulsion by novice older adults. Archives of Physical Medicine and Rehabilitation, 2009. 90: p. 1076-1083.

20. Cowan, R. and Nash, M., Cardiovascular disease, SCI and exercise: Unique risks and focused countermeasures. Disability and Rehabilitation, 2010. 32(26): p. 2228-2236.

21. Cullen, B., Neuropsychological predictors of powered wheelchair use: A prospective follow-up study. Clinical Rehabilitation, 2008 22: p. 836-846.

Technical report


References

85

22. Dallmeijer, A., van der Woude, L., Veeger, H., and a., H., Effectiveness of force application in manual wheelchair propulsion in persons with spinal cord injuries. American Journal of Physical Medicine & Rehabilitation, 1998. 77(3): p. 96-102.

23. Dawson, J. and Thornton, H., Can patients with unilateral neglect following stroke, drive electrically powered wheelchairs? British Journal of Occupational Therapy, 2003. 66(11): p. 496-504.

24. de Groot, K., Hollingsworth, H., Morgan, K., Morris, C., and Gray, D., The influence of verbal training and visual feedback on manual wheelchair propulsion. Disability & Rehabilitation, 2009. 4(2): p. 86-94.

25. de Groot, S., Debruin, M., Noomen, S., and van der Woude, L., Mechanical efficiency and propulsion technique after 7 weeks of low-intensity wheelchair training. Clinical Biomechanics, 2008.

26. Denison, I. and Grayton, D. Power wheelchairs – A new definition 2002 [cited 2010 10/8/2010]; Available from: http://www.assistive-technology.ca/topics.html.

27. Desroches, G., Dumas, R., Pradon, D., Vaslin, P., Lepoutre, F.-X., and ChËze, L., Upper limb joint dynamics during manual wheelchair propulsion. Clinical Biomechanics, 2010. 25(4): p. 299-306.

28. Desroches, G., Aissaoui, R., Bourbaonnais, D., Effect of system tilt and seat to backrest angles on load sustained by shoulder during wheelchair propulsion. Journal of Rehabilitation Research and Development, 2006. 43(7): p. 871-882.

29. Devillard, X., Rimaud, D., Roche, F., and Calmels, P., Effects of training programs for spinal cord injury. Annales de RÈadaptation et de MÈdecine Physique, 2007. 50(6): p. 490-498.

30. Dewey, A., Rice-Oxley, M., and Dean, T., A qualitative study comparing the experiences of tilt-in-space wheelchair use and conventional wheelchair use by clients severely disabled with multiple sclerosis. British Journal of Occupational Therapy, 2004. 67: p. 65-74.

31. Di Marco, A., Wheelchair prescription in spinal cord injury: Outcomes after 5 years (Masters Thesis), in School of Health Sciences, Division of Health Sciences. 2005, University of South Australia: Adelaide. p. 117.

32. Dicianno, B.E., Arva, J., Lieberman, J.M., Schmeler, M.R., Souza, A., Phillips, K., Lange, M., Cooper, R., Davis, K., and Betz, K.L., RESNA Position on the application of tilt, recline, and elevating leg rests for wheelchairs. Assistive Technology, 2009. 21: p. 13-22.

33. Ding, D., Usage of tilt-in-space, recline, and elevation seating functions in natural environment of wheelchair users. The Journal of Rehabilitation Research and Development, 2008. 45(7): p. 973-984.

34. Ding, D., Souza, A., Cooper, R.A., Fitzgerald, S.G., Cooper, R., Kelleher, A., and Boninger, M.L., A preliminary study on the impact of pushrim-activated power-assist wheelchairs among individuals with tetraplegia. American Journal of Physical Medicine & Rehabilitation, 2008. 87(10): p. 821-829.

35. Dreier, H., Hansen, E., Moldrup, L., Pool, J., Rodby-Bousquet, E., and Werge, B., Tilt, recline and elevating legrests for wheelchairs, in Proceedings from the 4th International Interdisciplinary Conference on Posture and Wheeled Mobility. 2010: Glasgow.

36. Dubowsky, S., Rasmussen, J., Sisto, S., and Langrana, N., Validation of a musculoskeletal model of wheelchair propulsion and its application to minimizing shoulder joint forces. Journal of Biomechanics, 2008. 41(14): p. 2981-2988.

37. Edwards, K. and McCluskey, A., A survey of adult power wheelchair and scooter users. Disability and Rehabilitation: Assistive Technology, 2010. 5(6): p. 411-419.

38. Evans, S., Frank, A.O., Neophytou, C., and de Souza, L., Older adults’ use of, and satisfaction with, electric powered indoor/outdoor wheelchairs. Age and Ageing, 2007. 36(4): p. 431-435.

39. Fitzgerald, S., Collins, D., Cooper, R., Tolerico, M., Kelleher, A., Hunt, P., Martin, S., Impink, B., and Cooper, R., Issues in maintenance and repairs of wheelchairs: A pilot study Journal of Rehabilitation Research and Development, 2005. 42(6): p. 853-862.

40. Forslund, E.B., Granstrˆm, A., Levi, R., Westgren, N., and Hirschfeld, H., Transfer from table to wheelchair in men and women with spinal cord injury: Coordination of body movement and arm forces. Spinal Cord, 2007. 45(1): p. 41-48.

41. Fukuoka, Y., Nakanishi, R., Ueoka, H., Kitano, A., Takeshita, K., Itoh, M., The effects of wheelchair training on VO2 kinetics and participants with spinal cord injury. Disability and Rehabilitation: Assistive Technology, 2006. 1(3): p. 167-174.

42. Gagnon, D., Comparison of peak shoulder and elbow mechanical loads during weight-relief lifts and sitting pivot transfers among manual wheelchair users with spinal cord injury. The Journal of Rehabilitation Research and Development, 2008. 45(6): p. 863-874.

43. Gagnon, D., Nadeau, S., Noreau, L., Eng, J., and Gravel, D., Trunk and upper extremity kinematics during sitting pivot transfers performed by individuals with spinal cord injury. Clinical Biomechanics, 2008. 23(3): p. 279-290.

44. Gagnon, D., Koontz, A.M., Brindle, E., Boninger, M.L., and Cooper, R.A., Does upper-limb muscular demand differ between preferred and nonpreferred sitting pivot transfer directions in individuals with a spinal cord injury? The Journal of Rehabilitation Research and Development, 2009. 46(9): p. 1099.


References

86

45. Gagnon, D., Nadeau, S., Noreau, L., Eng, J.J., and Gravel, D., Electromyographic patterns of upper extremity muscles during sitting pivot transfers performed by individuals with spinal cord injury. Journal of Electromyography and Kinesiology, 2009. 19(3): p. 509-520.

46. Garber, S. and Bunzel, R., Wheelchair utilization and satisfaction following cerebral vascular accident. Journal of Rehabilitation Research and Development, 2002. 39(4): p. 521-534.

47. Giacobbi, P.R., Levy, C.E., Dietrich, F.D., Winkler, S.H., Tillman, M.D., and Chow, J.W., Wheelchair users’ perceptions of and experiences with power assist wheels. American Journal of Physical Medicine & Rehabilitation, 2010. 89(3): p. 225-234.

48. Giesbrecht, E.M., Ripat, J.D., Quanbury, A.O., and Cooper, J.E., Participation in community-based activities of daily living: Comparison of a pushrim-activated, power-assisted wheelchair and a power wheelchair. Disability & Rehabilitation: Assistive Technology, 2009. 4(3): p. 198-207.

49. Grieve, J., Dickerson, C., Overhead work: Identification of evidence-based exposure guidelines. Occupational Ergonomics, 2008. 8(2008): p. 53-66.

50. Gutierrez, D., Mulroy, S., Newsam, C., Gronley, J., and Perry, J., Effect of fore-aft seat position on shoulder demands during wheelchair propulsion: Part 2 An electromyographic analysis. Journal of Spinal Cord Medicine, 2005. 28: p. 222-229.

51. Hall, K., Partnoy, J., Tenenbaum, S., and Dawson, D., Power mobility driving training for seniors: A pilot study. Assistive Technology, 2005. 17: p. 47-56.

52. Hansen, R., Tresse, S., and Gunnarsson, R.K., Fewer accidents and better maintenance with active wheelchair check-ups: a randomized controlled clinical trial. Clinical Rehabilitation, 2004. 18(6): p. 631-639.

53. Harrison, A., Derwent, G., Enticknap, A., Rose, F., and Attree, A., The role of virtual reality technology in the assessment and training of inexperienced powered wheelchair users. Disability & Rehabilitation, 2002. 24(11): p. 599-606.

54. Hasdai, A., Jessel, A., Weiss, L., Use of a computer simulator for training children with disabilities in the operation of a powered wheelchair. The American Journal of Occupational Therapy, 1998. 52(3): p. 215-220.

55. Hatchett, P., Requejo, P., Mulroy, S., Lighthall Haubert, L., Eberly, V., Conners, S., Impact of gender on shoulder torque and manual wheelchair usage for individuals with paraplegia: A preliminary. Topics in Spinal Cord Injury Rehabilitation, 2009. Fall p. 79-89.

56. Higuchi, T., Hatano, N., Soma, K., and Imanaka, K., Perception of spatial requirements for wheelchair locomotion in experienced users with Tetraplegia. Journal of Physiological Anthropology, 2009. 28(1): p. 15-21.

57. Hillier, S., Grimmer-Somers, K., Merline, T., Middleton, P., Salisbury, J., Tppher, R., and Watson, A., FORM: An Australian method for formulating and grading recommendations in evidence-based clincial guidelines. Medical Research Methodology, 2011. 11(23).

58. Hoffman, T., Bennett, S., and Del Mar, C., Evidence-based practice across the health professions. 1st ed. 2010, Sydney: Elsevier.

59. Hughes, B., Sawatzky, B., and Hol, A., A comparison of spinergy versus standard steel-spoke wheelchair wheels. Archives of Physical Medicine and Rehabilitation, 2005. 86(3): p. 596-601.

60. Jae, S.Y., Heffernan, K.S., Lee, M., and Fernhall, B., Arterial structure and function in physically active persons with spinal cord injury. Journal of Rehabilitation Medicine, 2008. 40(7): p. 535-538.

61. Jannink, M.J.A., Erren-Wolters, C.V., de Kort, A.C., and van der Kooij, H., An electric scooter simulation program for training the driving skills of stroke patients with mobility problems: A pilot study. CyberPsychology & Behavior, 2008. 11(6): p. 751-754.

62. Janssen, T., Dallmeijer, A., Veeger, D., and van der Woude, L., Normative values and determinants of physical capacity in individuals with spinal cord injury. Journal of Rehabilitation Research and Development, 2002. 39(1): p. 29-39.

63. Janssen, T., Dallmeijer, A., van der Woude, L., Physical capacity and race performance of handcycle users. Journal of Rehabilitation Research and Development, 2001. 38(1): p. 33-40.

64. Kilkens, O., Post, M., Dallmeijer, A., van Asbeck, F., Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation. Journal of Rehabilitation Research and Development, 2005. 42(3): p. 65-73.

65. Kirby, L., Adams, C., MacPhee, A., Coolen, A., Harrison, E., Eskes, G., Smith, C., MacLeod, D., and Dupuis, D., Wheelchair-skill performance: Controlled comparison between people with hemiplegia and able-bodied people simulating hemiplegia. Archives of Physical Medicine & Rehabilitation, 2005. 86: p. 387-393.

66. Kirby, L., Bennett, S., Smith, C., Parker, K., and Thompson, K., Wheelchair curb climbing: Randomized controlled comparison of highly structured and conventional training methods. Archives of Physical Medicine & Rehabilitation 2008. 89: p. 2342-2348.

Technical report


References

87

67. Kirby, R.L., Gillis, D.J., Boudreau, A.L., Smith, C., Rushton, P., Clark-Gallant, L., Parker, K.E., and Webber, A., Effect of a high-rolling-resistance training method on the success rate and time required to learn the wheelchair wheelie skill. American Journal of Physical Medicine & Rehabilitation, 2008. 87(3): p. 204-214.

68. Kittel, A., DiMarco, A., and Stewart, H., Factors influencing the decision to abandon manual wheelchairs for three individuals with a spinal cord injury. Disability & Rehabilitation, 2002. 24(1/2/3): p. 106-114.

69. Koontz, A., Cooper, R., Boninger, M., Souza, A., Fay, B., Shoulder kinematics and kinetics during two speeds of wheelchair propulsion. Journal of Rehabilitation Research and Development, 2002. 39(6): p. 635-650.

70. Koontz, A.M., Brindle, E.D., Kankipati, P., Feathers, D., and Cooper, R.A., Design features that affect the maneuverability of wheelchairs and scooters. Archives of Physical Medicine and Rehabilitation, 2010. 91(5): p. 759-764.

71. Kotajarvi, B., Sabick, M., An, K., Zhao, K., Kaufman, K., Basford, J., The effect of seat position on wheelchair propulsion biomechanics. Journal of Rehabilitation Research and Development, 2004. 41(3B): p. 403-414.

72. Kulig, K., Newsam, C., Mulroy, S., Rao, S., Gronley, J., Bontrager, E., Perry, J., The effect of level of spinal cord injury on shoulder joint kinetics during manual wheelchair propulsion. Clinical Biomechanics, 2001. 16: p. 744-751.

73. Lacoste, M., Weiss-Lambrou, R., Allard, M., Dansereau, J., Powered tilt/recline systems: Why and how are they used? Assistive Technology, 2003. 15: p. 58-68.

74. Lal, S., Premature degenerative shoulder changes in spinal cord injury patients. Spinal Cord, 1998. 36: p. 186-189.

75. Letts, L., Wilkins, S., Law, M., Stewart, D., Bosch, J., and Westmorland, M. Critical review form- Qualitative studies (Version 2.0). 2007; Available from: http://fhs.mcmaster.ca/rehab/ebp/pdf/qualguidelines.pdf

76. Letts, L., Dawson, D., Bretholz, I., Kaiserman-Goldenstein, E., Gleason, J., McLellan, E., Norton, L., Roth, C., Reliability and validity of the Power-Mobility Community Driving Assessment. Assistive Technology, 2007. 19: p. 154-163.

77. Lighthall-Haubert, L., Requejo, P.S., Mulroy, S.J., Newsam, C.J., Bontrager, E., Gronley, J.K., and Perry, J., Comparison of shoulder muscle electromyographic activity during standard manual wheelchair and push-rim activated power assisted wheelchair propulsion in persons with complete tetraplegia. Archives of Physical Medicine and Rehabilitation, 2009. 90(11): p. 1904-1915.

78. MacPhee, A., Wheelchair skills training program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation. Archives of Physical Medicine and Rehabilitation, 2004. 85(1): p. 41-50.

79. Massengale, S., Folden, D., McConnell, P., Stratton, L., Whitehead, V., Effect of visual perception, visual function, cognition and personality on power wheelchair use in adults. Assistive Technology, 2005. 17: p. 108-121.

80. McClure, L.A., Boninger, M.L., Oyster, M.L., Williams, S., Houlihan, B., Lieberman, J.A., and Cooper, R.A., Wheelchair repairs, breakdown, and adverse consequences for people with traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 2009. 90(12): p. 2034-2038.

81. McCluskey, A. and Kay, L., Basic driving skills should be practiced before going on-road with a motorized scooter but universal testing is not warranted. Patient Education and Counseling, 2008. 73(1): p. 168-169.

82. Mercer, J., Boninger, M., Koontz, A., Ren, D., Dysonhudson, T., and Cooper, R., Shoulder joint kinetics and pathology in manual wheelchair users. Clinical Biomechanics, 2006. 21(8): p. 781-789.

83. Michael, S., Porter, D., and Pountney, T., Tilted seat position for non-ambulant individuals with neurological and neuromuscular impairment: A systematic review. Clinical Rehabilitation, 2007. 21: p. 1063-1074.

84. Minkel, J.L., Obtaining wheelchair mobility: Essential elements to consider, National Institute on Disability and Rehabilitation Research, Editor. 2005, The Consortium for Children and Youth with Disabilities and Special Health Care Needs. p. 4.

85. Moldrup, L., Werge, B., Rodby-Bousquet, E., Pool, J., Hansen, E., and Dreier, H. The application of seat-elevating devices for wheelchair users,. in Proceedings of the 4th International Interdisciplinary Conference on Posture and Wheeled Mobility. 2010. Glasgow.

86. Morrow, M.M.B., Hurd, W.J., Kaufman, K.R., and An, K.-N., Shoulder demands in manual wheelchair users across a spectrum of activities. Journal of Electromyography and Kinesiology, 2010. 20(1): p. 61-67.

87. Mortensen, W. and Miller, W., The wheelchair procurement process: Perspectives of clients and prescribers. Canadian Journal of Occupational Therapy, 2008. 75(3): p. 167-175.

88. Mukherjee, G., Bhowmik, P., and Samanta, A., Physical fitness training for wheelchair ambulation by the arm crank propulsion technique. Clinical Rehabilitation, 2001. 15(2): p. 125-132.

89. Mukherjee, G. and Samanta, A., Wheelchair charity: A useless benevolence in community-based rehabilitation. Disability & Rehabilitation, 2005. 27(10): p. 591-596.

90. Mulroy, S., Effects of spinal cord injury level on the activity of shoulder muscles during wheelchair propulsion: an electromyographic study. Archives of Physical Medicine and Rehabilitation, 2004. 85(6): p. 925-934.


References

88

91. Mulroy, S., Newsam, C., Gutierrez, D., Requejo, P., Gronley, J., Lighthall Haubert, L., and Perry, J., Effects of fore-aft seat position on shoulder demands during wheelchair propulsion: Part 1. Journal of Spinal Cord Medicine, 2005. 28(214-221).

92. Nash, M., Koppens, D., Vanhaaren, M., Sherman, A., Lippiatt, J., and Lewis, J., Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury. Archives of Physical Medicine and Rehabilitation, 2008. 89(11): p. 2080-2085.

93. National Health and Medical Research Council, How to use the evidence:assessment and application of scientific evidence, NHMRC, Editor. 2000.

94. National Health and Medical Research Council (NHMRC), How to review the evidence: Systematic identification and review of the scientific literature. 1999: Canberra.

95. National Health and Medical Research Council (NHMRC), Additional levels of evidence and grades for recommendations for developers of guidelines. 2009: Canberra.

96. National Institute for Clinical Excellence. Guideline Development Methods -Information for National collaborating centres and guideline developers. Feburary 2004 updated 2005; Available from: www.nice.org.uk.

97. Newsam, C., Rao, S., Mulroy, S., Gronley, J., Bontrager, E., Perry, J, Three dimensional upper extremity motion during manual wheelchair propulsion in men with different levels of spinal cord injury. Gait and Posture, 1999. 10: p. 223-232.

98. Nilsson, L., Eklund, M, Driving to learn: Powered wheelchair training for those with cognitive disabilities. International Journal of Therapy and Rehabilitation, 2006. 13(11): p. 517-527.

99. Nitz, J., Evidence from a cohort of able bodied adults to support the need for driver training for motorized scooters before community participation. Patient Education and Counseling, 2008. 70(2): p. 276-280.

100. Papadimitriou, C., Becoming en-wheeled: The situated accomplishment of re-embodiment as a wheelchair user after spinal cord injury. Disability & Society, 2008. 23(7): p. 691-704.

101. Pape, L., Kim, J., and Weiner, B., The shaping of individual meanings assigned to assistive technology: A review of personal factors. Disability & Rehabilitation, 2002. 24(1): p. 5-20.

102. Pellegrini, N., Bouche, S., Barbot, F., Fig, egrave, re, M., Guillon, B., and Lofaso, F., Comparative evaluation of electric wheelchair manoeuvrability. Journal of Rehabilitation Medicine, 2010. 42(6): p. 605-607.

103. Pellow, T., A comparison of interface pressure readings to wheelchair cushions and positioning: A pilot study. D’Ergotherapie, 1999. June: p. 140-149.

104. Physiotherapy evidence database. PEDro Scale. 1999; Available from: http://www.pedro.org.au/english/downloads/pedro-scale/.

105. Price, R., Ashwell, Z., Chang, M., Boninger, M., Koontz, A., and Sisto, S., Upper-limb joint power and its distribution in spinal cord injured wheelchair users: Steady-state self-selected speed versus maximal acceleration trials. Archives of Physical Medicine and Rehabilitation, 2007. 88(4): p. 456-463.

106. RESNA-Rehabilitation Engineering and Assistive Technology Society of North America, RESNA position on the application of seat-elevating devices for wheelchair users. 2005, RESNA: Arlington.

107. Rodgers, M., Keyser, R., Rasch, E., Gorman, P., Russell, P, Influence of training on biomechanics of wheelchair propulsion. Journal of Rehabilitation Research and Development, 2001. 38(5): p. 505-511.

108. Sabick, M., Kotajarvi, B., and An, K., A new method to quantify demand on the upper extremity during manual wheelchair propulsion. Archives of Physical Medicine and Rehabilitation, 2004. 85(7): p. 1151-1159.

109. Samuelsson, K. and Wressle, E., User satisfaction with mobility assistive devices: An important element in the rehabilitation process. Disability & Rehabilitation, 2008. 30(7): p. 551-558.

110. Samuelsson, K., Larsson, H., Thyberg, M, Wheelchair intervention – a client centred approach. Technology and Disability, 1999. 10: p. 123-127.

111. Sawatzky, B., Kim, W., and Denison, I., The ergonomics of different tyres and tyre pressure during wheelchair propulsion. Ergonomics, 2004. 47(14): p. 1475-1483.

112. Sawatzky, B., Slobogean, G., Reilly, C., Chambers, C., and Hol, A., Shoulder pain in adult and childhood onset wheelchair users. Journal of Rehabilitation Research and Development 2005. 42(3 (Supplement): p. 1-8.

113. SCIRE. Spinal Cord Injury Rehabilitation Evidence SCIRE Version 3 2010; Available from: http://www.scireproject.com/rehabilitation-evidence.

114. Sonenblum, S.E., Sprigle, S., and Maurer, C.L., Use of power tilt systems in everyday life. Disability & Rehabilitation: Assistive Technology, 2009. 4(1): p. 24-30.

115. Spaeth, D., Mahajan, H., Karmarkar, A., Collins, D., Cooper, R., and Boninger, M., Development of a wheelchair virtual driving environment: Trials with subjects with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 2008. 89(5): p. 996-1003.

Technical report


References

89

116. Sprigle, S., Maurer, C., Sonenblum, S, Load distribution in variable position wheelchairs in people with spinal cord injury. Journal of Spinal Cord Medicine, 2010. 33(1): p. 58-64.

117. Tate, R., McDonald, S., Perdices, M., Togher, L., Schultz, R., and Savage, S., Rating the methodological quality of single-subject designs and n-of-1 trials: Introducing the Single-Case Experimental Design (SCED) Scale. Neuropsychological Rehabilitation, 2008. 18(4): p. 385-401.

118. Tefft, D., Guerette, P., and Furumasu, J., Cognitive predictors of young children’s readiness for powered mobility. Developmental Medicine & Child Neurology, 1999. 41: p. 665-670.

119. The AGREE Research Trust, Appraisal of guidelines for research & evaluation II. 2009: London.

120. Tordi, N., Dugue, B., Klupzinski, D., Rasseneur, L., Rouillon, J., and Lonsdorfer, J., Interval training program on a wheelchair ergometer for paraplegic subjects Spinal Cord, 2001. 39(532-537).

121. TranSPOT, Transport safety guidelines for people with a disability, SPOT on DD, Editor. 2010: Sydney.

122. United Nations Office of the High Commissioner for Human Rights. Convention on the Rights of Persons with Disabilities. 2006 [downloaded on16/5/2009]; Available from: http://www2.ohchr.org/english/law/disabilities-convention.htm.

123. Valent, L., Dallmeijer, A., Houdijk, H., Slootman, H., Post, M., and Vanderwoude, L., Influence of hand cycling on physical capacity in the rehabilitation of persons with a spinal cord injury: A longitudinal cohort study. Archives of Physical Medicine and Rehabilitation, 2008. 89(6): p. 1016-1022.

124. van der Woude, L.H.V., Bouw, A., van Wegen, J., van As, H., Veeger, D., and de Groot, S., Seat height: Effects on submaximal hand rim wheelchair performance during spinal cord injury rehabilitation. Journal of Rehabilitation Medicine, 2009. 41(3): p. 143-149.

125. van Drongelen, S., van der Woude, L., Janssen, T., Angenot, E., Chadwick, E., and Veeger, D., Mechanical load on the upper extremity during wheelchair activities. Archives of Physical Medicine and Rehabilitation, 2005. 86(6): p. 1214-1220.

126. van Velzen, J.M., de Groot, S., Post, M.W.M., Slootman, J.R., van Bennekom, C.A.M., and van der Woude, L.H.V., Return to work after spinal cord injury. American Journal of Physical Medicine & Rehabilitation, 2009. 88(1): p. 47-56.

127. VanSickle, D., Cooper, R., Boninger, M., and DiGiovine, C., Analysis of vibrations induced during wheelchair propulsion. Journal of Rehabilitation Research and Development, 2001. 38(4): p. 409-421.

128. Veeger, D., Meershoek, L., van der Woude, L., and Langenhoff, J., Wrist motion in handrim wheelchair propulsion. Journal of Rehabilitation Research and Development, 1998. 35(3): p. 305-313.

129. Veeger, H., Rozendaal, L., and van der Helm, F., Load on the shoulder in low intensity wheelchair propulsion. Clinical Biomechanics, 2002. 17: p. 211-218.

130. Verza, R., Carvalho, M., Battaglia, M., and Uccelli, M., An interdisciplinary approach to evaluating the need for assistive technology reduces equipment abandonment. Multiple Sclerosis, 2006. 12: p. 88-93.

131. Vorrink, S., Vanderwoude, L., Messengerg, A., Cripton, P., Hughes, B., and Sawatzky, B., Comparison of wheelchair wheels in terms of vibration and spasticity in people with spinal cord injury. Journal of Rehabilitation Research and Development, 2008. 45(9): p. 1269-1280.

132. Walach, H., Falkenberg, T., Fonnebo, V., Lewith, G., and Jonas, W., Circular instead of hierarchical: Methodological principles for the evaluation of complex interventions. BMC Medical Research Methodology, 2006. 6(29): p. 9.

133. Webster, J., Computer-assisted training for improving wheelchair mobility in unilateral neglect patients. Archives of Physical Medicine and Rehabilitation, 2001. 82(6): p. 769-775.

134. Wei, S., Wrist kinematic characterization of wheelchair propulsion in various seating positions: Implication to wrist pain. Clinical Biomechanics, 2003. 18(6): p. S46-S52.

135. Weiss-Lambrou, R., Tremblay, C., LeBlanc, R., Lacoste, M., and Dansereau, J., Wheelchair seating aids: How satisfied are consumers? Assistive Technology, 1999. 11: p. 43-53.

136. Wessels, R., Dijcks, M., Soede, M., Gelderblom, G., and De Witte, L., Non-use of provided assistive technology devices, a literature overview. Technology and Disability, 2003. 15: p. 231-238.

137. Wielandt, T. and Strong, J., Compliance with prescribed adaptive equipment: A literature review. British Journal of Occupational Therapy, 2000. 63(2): p. 65-75.

138. World Health Organization, Towards a common language for functioning, disability and health – ICF, WHO/EIP/GPE/CAS, Editor. 2002, WHO: Geneva.

139. World Health Organization, Guidelines on the provision of manual wheelchairs in less resourced settings. 2008, WHO: Geneva.

Technical report for the Guidelines for the … › __data › assets › pdf_file › ...Technical...

Documents

Transcript of Technical report for the Guidelines for the … › __data › assets › pdf_file › ...Technical...