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Sol M.1,2, Verschuren O.2,3,4, De Groot L.5, De Groot J.F.1,3,4, Visser-Meily A.2
1HU University of Applied Sciences Utrecht, Research Group Lifestyle and Health, Utrecht, Netherlands, 2University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands, 3University Medical Center Utrecht, Wilhemina Children's Hospital, Child Development and Exercise Center, Utrecht, Netherlands, 4University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Partner of Shared Utrecht Pediatric Exercise Research Lab, Utrecht, Netherlands, 5De Hoogstraat Rehabilitation, Utrecht, Netherlands
Background: Children with various physical disabilities, such as cerebral palsy or spina bifida, are dependent on their wheelchair for participation in daily life. Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. In adults, several studies have reported on the importance of WMS training to overcome mobility problems and improve participation. Several WMS outcome measures have been developed for adults, but none of these have been validated for children.
Purpose: The objective of this study is to develop a WMS outcome measure for children.
Methods: A three phase mixed method approach was used to develop a WMS outcome measure, combining evidence from literature with clinical expertise of children using a manual wheelchair, their parents and health care professionals. Phase 1: Item identification of WMS items through a systematic review using the COnsensus-based Standards for the selection of health Measurement Instruments recommendations. Phase 2: Item selection of relevant WMS items for children, using focus groups and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing.
Results: Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis.
Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children.
Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons.
Conclusion(s): The newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice.
Implications: Wheelchair skill training has the potential to become an important aspect in the rehabilitation program for children using a manual wheelchair. With this newly developed outcome measure the effectiveness of such a program can be evaluated. In addition, the individual performance on the UP-WMST could help children, parents and health care professionals determine treatment goals.
Funding acknowledgements: Funded by an unconditional grant (PRO-4-03) of the Dutch Foundation Innovation Alliance (SIA-RAAK).
Topic: Disability & rehabilitation
Ethics approval: Ethical approval for the pilot study was given by the research board of the De Hoogstraat Rehabilitation.
All authors, affiliations and abstracts have been published as submitted.
