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Effectiveness of group wheelchair maintenance training for people with spinal cord injury: a randomized controlled trial
Worobey LA, McKernan G, Toro M, Pearlman J, Cowan RE, Heinemann AW, Dyson-Hudson TA, Pedersen JP, Mesoros M, Boninger ML
Archives of Physical Medicine and Rehabilitation 2022 Apr;103(4):790-797
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

To assess the effectiveness of group wheelchair maintenance training and investigate participant characteristics associated with responsiveness to training. Randomized controlled trial with an immediate group and a waitlist control group (WLCG) who received the intervention after a 6-month delay. Four Spinal Cord Injury Model Systems Centers. Manual (MWC; n = 80) and power wheelchair (PWC; n = 67) users with spinal cord injury (n = 147). Two 90-minute structured wheelchair maintenance training program classes with 12 to 20 people per class and separate classes for MWC and PWC users. Each class included in-person hands-on demonstrations and practice of wheelchair maintenance. Separate analysis was completed for MWC and PWC users using the Wheelchair Maintenance Training Questionnaire (WMT-Q) capacity (ability to complete), performance (frequency of completion) and knowledge at baseline, 1 month, 6 months, 6 months pretraining (WLCG only), and 1 year (immediate only). After the intervention, participants in both the immediate and WLCG improved in maintenance capacity (MWC and PWC, p < 0.001) and performance (MWC and PWC, p < 0.001) with training. Only PWC users improved knowledge of wheelchair maintenance (p < 0.001). For both WLCGs (MWC and PWC), there was no difference between the 6-month pretraining time point and baseline. MWC users who responded to training had lower WMT-Q scores for all domains, whereas this was only the case for knowledge for PWC users. Group wheelchair skills training is effective at improving capacity to complete maintenance and performance of maintenance activities for MWC and PWC users, even in a cohort of experienced wheelchair users. For MWC users, improvements were tied to lower WMT-Q scores at baseline, whereas PWC users improved in capacity and performance independent of baseline score. Delivering this training in a structured group format has a lower cost, which might improve adoption into clinical practice.

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