Perspectives of inpatient rehabilitation clinicians on the state of manual wheelchair training: a qualitative analysis

Abstract

Purpose

The purpose of this study was to identify clinician knowledge regarding manual wheelchair (MWC) training in an inpatient rehabilitation (IPR) setting, identify current MWC education provided to new manual wheelchair users (MWUs), and determine how MWC training resources can be developed or modified to promote use among IPR clinicians.

Methods

Semi-structured interviews were conducted with 20 licenced IPR clinicians who work with MWUs. Using a traditional qualitative research design, researchers completed open, data-driven coding of interview transcripts. Overarching themes were determined through content analysis.

Results

Participants included 12 physical therapists, six occupational therapists, one physical therapy assistant, and one occupational therapy assistant. Five themes emerged from the interviews: (1) clinician knowledge, education, and experience (2) current training content (3) training environment, (4) desired programme components (5) barriers to implementation. Participants reported receiving minimal education in school and from their employers on training MWUs. While clinicians expressed the importance of MWU education, they used varying training approaches with little standardization. Participants identified that training protocols for IPR are beneficial if they are quick, straightforward, and flexible.

Conclusions

While MWC training occurs during IPR stays, it appears to be inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to evidence-based practices. This is likely due to limited feasibility and awareness of existing MWC training resources. Clinician input gathered from these interviews provides information for how to best integrate MWC training programmes into the rehabilitative process. Findings may inform the development and assessment of more clinically feasible MWC training protocols.

Implications for Rehabilitation

• New manual wheelchair users must learn numerous wheelchair-related skills in order to participate in everyday life activities.

• Manual wheelchair education for new users during inpatient rehabilitation is often inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to existing evidence-based practices.

• Systematic challenges often act as a barrier to the implementation of more comprehensive, structured manual wheelchair training protocols.

• Manual wheelchair training resources must be concise, flexible, customisable, and easy to follow in order to promote increased implementation among inpatient rehabilitation clinicians.

Keywords:

• Clinical practice
• rehabilitation
• manual wheelchair training
• manual wheelchair skills
• manual wheelchair propulsion

Acknowledgements

The authors thank all clinical participants for participating in this study and sharing their perspectives. The authors would also like to thank Megen Devine for her contribution to this project.

Disclosure of interest

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by an Encompass Health Therapy Grant [Grant #172350], the National Institutes of Health, Comprehensive Opportunities in Rehabilitation Research Training [Grant #K12 HD055391] and the Craig H. Neilsen Foundation, Spinal Cord Injury Research on the Translational Spectrum [Grant #176380].