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
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
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
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
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
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
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
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
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
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. 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
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. Development process
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
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. Development process
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.
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. 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
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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.
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. 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).
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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).
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
).
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
.
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
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
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
for the Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury
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
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
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?
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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
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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
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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
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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)
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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
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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
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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$6. 1 and 2 and 3 7. 1 and 2 and 4 or 5
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Hearing loss and wheelchair1. hearing loss2. wheelchair$ 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
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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
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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
10. wheelchair$ and propulsion
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$
7. wheelchair$ and propulsion
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
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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
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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
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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
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