Lee Kirby, Canada

 

Location: Dublin.

Sponsor/host
European Seating Symposium
c/o Mary Mc Cormick
Senior Occupational Therapist,
Central Remedial Clinic,
Vernon Avenue
Clontarf
Dublin 3

Dates of session: November, 2011.

Length: One-day session.

Target Audiences

• General audience: The 1-hour didactic presentation is relevant for a broad audience, including administrators and other stakeholders.
• Trainers: The practical component of this workshop is relevant for therapists who have interactions with people who are wheelchair users and their caregivers.
• Wheelchair users and caregivers: The practical component of this workshop would also be relevant for manual wheelchair users and/or their caregivers.

Capacity

• For the 1-hour didactic presentation, there is no limit on the number of participants, space permitting.
• For the practical component of this workshop, we can handle a total of up to 20 trainers and/or wheelchair users, assuming a sufficient number of wheelchairs.

Learning Objectives
On completion of the 1-hour didactic presentation, general-audience attendees will be able to:

• explain the rationale, elements and the research evidence regarding the components of the Wheelchair Skills Program (WSP) for manual wheelchairs operated by their users
• describe the practical steps involved in conducting wheelchair skills training

On completion of the full workshop, trainer attendees will be able to:

1. explain the rationale, elements and the research evidence regarding the components of the Wheelchair Skills Program (WSP) for manual wheelchairs operated by their users
2. describe the practical steps involved in conducting wheelchair skills training
3. demonstrate appropriate assessment, spotting and training techniques
4. implement the WSP in their own settings

On completion of the full workshop, wheelchair-using attendees and/or their caregivers will be able to:

1. briefly describe the components of the Wheelchair Skills Program (WSP) for manual wheelchairs operated by their users
2. describe the practical steps involved in conducting wheelchair skills training
3. demonstrate appropriate approaches to the safe performance of wheelchair skills within their capabilities
4. describe a plan for refining and extending their wheelchair-skill repertoires.

Brief Description of Workshop
The Wheelchair Skills Program (WSP), available free on the Internet, includes useful evaluation and training tools to help practitioners translate this research evidence into clinical practice (1). The low-tech, high-impact WSP is designed to help practitioners optimize the safety and maneuverability challenges that face wheelchair users and their caregivers. This workshop will include a 1-hour didactic introduction to the WSP including wheelchair video demonstrations, the WSP principles and a brief summary of the current body of the evidence. This presentation will occur during the lunch break between practical sessions. The practical portion of the schedule will provide trainer and/or wheelchair-using participants with an opportunity to experience a range of caregiver and manual wheelchair user skills including spotting techniques and assessment methods, but will focus on training issues (both the ‘tricks of the trade’ and motor-skills-learning principles). On Day 1, the workshop will focus on clinical therapists. On Day 2, the workshop will focus on school-based personnel.

Research Evidence
The measurement properties of the Wheelchair Skills Test (WST) have been documented (2-5). The WST has been found to be safe, practical, reliable, valid and useful. The WST has been used as a screening or outcome measure clinically and in a number of studies. The relationships between the objective WST and the questionnaire version (WST-Q) have been reported (6,7). The correlations between the total WST and WST-Q scores were found to be excellent, although the WST-Q scores were slightly higher. The objective WST is a measure of wheelchair-skill capacity, whereas the WST-Q can be used to assess either capacity or performance.

Research evidence has also been accumulating that demonstrates the safety and superior effectiveness of a formal approach to wheelchair skills training of wheelchair users and their caregivers. Regarding the Wheelchair Skills Training Program (WSTP), we initially completed two randomized controlled trials on wheelchair users, one on wheelchair users admitted for initial rehabilitation (8) and one on wheelchair users in the community (9). In both, we found that the WSTP was safe, practical and resulted in significantly greater improvements (2-3 fold) in wheelchair skills performance than standard care. In a later pilot study in a rehabilitation centre (10), we provided less than 50 minutes of training on wheelchair-handling skills to caregivers of wheelchair users. We found that the WSTP was an effective way to improve caregiver skills and that these skills were retained. We have also conducted studies focusing on optimizing the training of specific skills (11,12).

Routhier et al (13) have translated the WSP into Canadian French and have replicated our study on the WSTP in the rehabilitation-centre setting. Mountain et al (14) have demonstrated the positive effect of the WSTP using powered wheelchairs for patients with stroke and additional work on powered wheelchairs is underway. We have also explored use of the WSP in long-term-care settings (15) and less-resourced or post-conflict settings (e.g. India, Jordan and Bosnia) (16).

For rehabilitation professionals who wish to implement the WSP, the on-line materials can be used to provide the necessary knowledge. However, developing the appropriate practical skills is more challenging. One solution is to offer practical workshops (or “boot-camps”) to those interested. But, how effective are such workshops? Some previous studies have shed light on this question; each will be briefly summarized.

Coolen et al (17) reported on a randomized controlled trial (RCT) on 2nd year occupational therapy students, 22 of whom were randomly allocated to receive a 2-hour workshop on the WSP (Version 2.4). From pre- to post-intervention, the students in the training group increased their mean (±SD) percentage WST scores from 64.8% (±9.0) to 81.0% (±5.2) (p < 0.001). Over a comparable period, the 18 students in the Control group increased from 66.0% (±8.0) to 72.4% (±7.1) (p = 0.015). The WSTP group improved to a significantly greater extent (p = 0.005). For a subset of 8 students in the WSTP group who were re-tested 9-12 months later, the mean WST score was 79.7 (±4.1)%, not significantly less than their WST#2 scores (p = 0.29).

Routhier et al (18) reported on 8 participants trained in an 8-hour WSP workshop who were evaluated pre- and post-training with the French-Canadian version of the Wheelchair Skills Test (WST-F) (Version 3.2). There was a significant improvement between pre- and post-training on the WST-F Total Score (73.7% [±8.5] to 84.3% [±10.2], p=0.001) and on the WST-F Advanced Sub-score (11.6% [±27.5] to 42.9% [±34.6], p=0.008).

In a RCT by Kirby et al (19), 24 first- and second-year medical students were randomly allocated into intervention and control groups. The intervention group received a 4-hour workshop. After the workshop, the mean scores on the written knowledge test and practical examination for the intervention group were higher than the control group by 23.9% (p<0.0001) and 34.4% (p<0.0001). The perceptions of the students who took the workshop were highly positive.

Kirby et al (20) reported on a full-day workshop for therapists on WSP 4.1 in a small regional hospital. There was a 20% improvement in the post- vs pre-workshop test scores of 16 participants on a written examination that tested knowledge of the WSP.

To evaluate the perceptions of participants after a 1-day practical workshop for 16 therapists learning to use the Wheelchair Skills Program (WSP), Kirby et al (21) used questionnaires at the end of the workshop (n = 14) and after a follow-up period of 3 months (n = 11). The evaluations were highly positive, with scores in the 78-100% range. 100% of participants said they would recommend the session to others. A variety of useful comments were provided that will guide future workshops.

We recognize that a full-day session is less desirable for learning new motor skills than a number of brief sessions with opportunities between sessions for practice (although the latter is often impractical, since the instructors and/or participants may needs to travel to attend the workshop. However, we are reassured by the literature cited above that much can be accomplished in a one-day session.

REFERENCES

1. Wheelchair Skills Program. www.wheelchairskillsprogram.ca. Accessed December 15, 2010.
2. Kirby RL, Swuste J, Dupuis DJ, MacLeod DA, Monroe R. Wheelchair Skills Test: pilot study of a new outcome measure. Arch Phys Med Rehabil 2002;83:10-18.
3. Kirby RL, Dupuis DJ, MacPhee AH, Coolen AL, Smith C, Best KL, Newton AM, Mountain AD, MacLeod DA, Bonaparte JP. The Wheelchair Skills Test (version 2.4): measurement properties. Arch Phys Med Rehabil 2004;85:794-804.
4. Routhier F, Demers L, Kirby RL, Pervieux I, Depa M, De Serres L, Loiselle F, Dessureault D. Inter-rater and test-retest reliability of the French-Canadian Wheelchair Skills Test (Version 3.2): preliminary findings. Proceedings of the Annual Meeting of RESNA, Phoenix, AZ, June 15-19, 2007.
5. Lindquist NJ, Loudon PE, Magis TF, Rispin JE, Kirby RL, Manns PJ. Reliability of the Wheelchair Skills Test (WST) Version 4.1 for manual wheelchair users. Arch Phys Med Rehabil 2010;91:1752-7.
6. Newton AM, Kirby RL, MacPhee AH, Dupuis DJ, MacLeod DA. Evaluation of manual wheelchair skills: is objective testing necessary or would subjective estimates suffice? Arch Phys Med Rehabil 2002;83:1295-9.
7. Mountain AD, Kirby RL, Smith C. The Wheelchair Skills Test: validity of an algorithm-based questionnaire version. Arch Phys Med Rehabil 2004;85:416-23.
8. MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair skills training program: a randomized clinical trial on wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil 2004;85:41-50.
9. Best KL, Kirby RL, Smith C, MacLeod DA. Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil 2005;86:2316-2323.
10. Kirby RL, Mifflen NJ, Thibault DL, Smith C, Best KL, Thompson KJ, MacLeod DA. The wheelchair-handling skills of caregivers and the effect of training. Arch Phys Med Rehabil 2004 85:2011-9.
11. Kirby R.L., Gillis D.J., Boudreau A.L., Smith C., Rushton P., Clark-Gallant L., Parker K.E., Webber A. Effect of a high-rolling-resistance training method on the success rate and time required to learn the wheelchair wheelie skill: A randomized controlled trial. Am. J. Phys. Med. Rehabil. 2008 87:3.
12. Kirby RL, Bennett S, Smith C, Parker K, Thompson K. Wheelchair curb climbing: randomized controlled comparison of highly structured and conventional training methods. Arch Phys Med Rehabil 2008;89:2342-8.
13. Routhier WST-F Routhier F, Kirby RL, Demers L, Vincent C, Guérette C, Dessureault D, Raymond D, Westwood D. Measurement properties of the French-Canadian version of the Wheelchair Skills Test: Preliminary results. Proceedings 21st Canadian Seating and Mobility Conference, October 4-6, 2006, pp 116-119.
14. Mountain AD, Kirby RL, Eskes GA, Smith C, Duncan H, MacLeod DA, Thompson K. Ability of people with stroke to learn powered wheelchair skills: a pilot study. Arch Phys Med Rehabil 2010;91:596-601.
15. Smith C, Kirby RL. Manual wheelchair skills capacity and safety of residents of a long-term-care facility.
16. Kirby RL, Cooper RA. Applicability of the wheelchair skills program to the Indian context. Disabil. Rehabil. 2007 29:11-12.
17. Coolen AL, Kirby RL, Landry J, MacPhee AH, Dupuis D, Smith C, Best, KL, MacKenzie DE, MacLeod DA. Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students. Arch Phys Med Rehabil 2004;85:1160-7.
18. Routhier F, Kirby RL, Lemay V, Depa M, Pervieux I, Demers L. Efficacy of wheelchair skills training in groups on the wheelchair-skill abilities of health professionals. Proceedings RESNA 2008 Conference. Arlington VA, USA. June 26-30.
19. Kirby RL, Crawford KA, Smith C, Thompson KJ, Sargeant JM. A wheelchair workshop for medical students improves knowledge and skills - a randomized controlled trial. Am J Phys Med Rehabil (in press).
20. Kirby RL, Smith C, Thomas J, Lawhead K, Liem N. Full-day wheelchair skills workshop in Windsor, Ontario for therapist trainers: improvement in examination test scores. Proceedings of the 4th National Spinal Cord Injury Conference, Niagara Falls, ON, October 29-30, 2010, p 15.
21. Kirby RL, Smith C, Rushton PW, Routhier F, Miller WC. Perceptions of therapists after a practical workshop on wheelchair skills. Proceedings of the Annual Meeting of RESNA 2011, Toronto, June (under review).

SCHEDULE

Faculty Biographical Notes

R. Lee Kirby MD, FRCPC is a Professor in the Division of Physical Medicine and Rehabilitation at Dalhousie University in Halifax, Nova Scotia, Canada. Over the past 30 years, he has authored or co-authored over 130 papers in peer-reviewed journals, 10 textbook chapters and over 250 minor publications (mostly abstracts and proceedings of presentations to scientific meetings). He has presented numerous symposia on wheelchair safety, stability and performance to such organizations as RESNA, the International Seating Symposium and the American Academy of Physical Medicine and Rehabilitation.

 

Cher Smith BScOT, MSc (Kinesiology) is an occupational therapist who is the Wheelchair Coordinator at the Queen Elizabeth II Health Sciences Centre and an adjunct professor in the School of Occupational Therapy at Dalhousie University in Halifax, Nova Scotia, Canada. She has been involved in clinical work, education and research about wheelchairs for over 10 years. In 2002, she was acknowledged for her work at the Canadian Seating and Mobility Conference, being awarded the prestigious Phil Mundy Award. She has provided workshops on seating and mobility and has presented symposia on wheelchair skills at the Canadian Seating and Mobility Conference, the International Seating Symposium and RESNA.

 

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