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Impact of a wheelchair education protocol based on practice guidelines for preservation of upper limb function: a randomized trial
Rice LA, Smith I, Kelleher AR, Greenwald K, Boninger ML
Archives of Physical Medicine and Rehabilitation 2014 Jan;95(1):10-19
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To determine if strict utilization of the Paralyzed Veterans of America's Clinical Practice Guidelines for Preservation of Upper Limb Function impacts wheelchair set-up, selection, propulsion biomechanics, pain, satisfaction with life and participation of individuals with new spinal cord injuries DESIGN: Single blinded, randomized clinical trial SETTING: Model Spinal Cord Injury Systems Rehabilitation Facility and community in Pittsburgh, PA PARTICIPANTS: Volunteer sample of 37 manual wheelchair users with new spinal cord injuries MAIN OUTCOME MEASURES: Comparison of wheelchair set-up, selection, propulsion biomechanics, pain, Satisfaction With Life Scale and the Craig Handicap Assessment and Reporting Technique scores at the time of discharge from inpatient rehabilitation, six months and one year post discharge. INTERVENTION: The intervention group was strictly educated on the clinical practice guideline by a Physical and Occupational Therapist in an inpatient rehabilitation facility. The standard of care group received standard therapy services. RESULTS: Participants in the intervention group pushed on tile with significantly lower push frequency (p = 0.02) at the discharge visit. On the ramp, the intervention group used a significantly larger push length (p = 0.03) across all time points. No significant differences were found between groups related to wheelchair set up, selection, pain, satisfaction with life and participation. CONCLUSION: The IG showed better skills on key wheelchair propulsion biomechanics variables related to upper limb health. Use of a structured education program may be an effective method of educating new manual wheelchair users to prevent the development of upper limb impairments in an inpatient setting. Additional follow up testing is necessary to determine if differences seen in propulsion skills translate into decreased pain and improved quality of life in the long term.

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