The effects of wheelchair mobility skills and exercise training on physical activity, fitness, skills and confidence in youth using a manual wheelchair

Figures & data

Figure 1. Study design.

Figure 2. Line graph of the change in mean score over time for the total group, program A and C, and program B and D per outcome parameter. *Significant difference in outcome for order of training. UP-WMST: Utrecht Pediatric Wheelchair Mobility Skills Test; SRiT: Shuttle Ride Test; MPST: Muscle Power Sprint Test.

Table 1. Characteristics of participants.

			Split per order of training
	Total group Program A–D (n = 48)	Waiting list group Program A and B (n = 24)	WMS before exercise Program A and C (n = 23)	Exercise before WMS Program B and D (n = 25)
Gender(M/F)	28/20	16/8	12/11	16/9
Age (years), mean (SD)	12.8 (3.1)	14.0 (3.3)	12.9 (3.4)	12.9 (3.0)
Diagnosis
Cerebral palsy	21	11	9	12
Spina bifida	8	6	6	2
Neuromuscular	5	1	2	3
Other	14	6	6	8
Height (cm) mean (SD)	149 (16)	153.9 (14.0)	145.9 (18.1)	151.5 (14.1)
Weight (kg) mean (SD)	44.3 (16.3)	50.5 (15.2)	41.1 (17.7)	46.9 (15.0)
Wheelchair mass^a (kg)	19.4 (3.7)	20 (3.9)	18.6 (3.7)	20.0 (3.8)
Power assisted wheels	7	3	5	2
Experience in wheelchair (years), mean (SD)	8.4 (3.8)	9.3 (4.0)	9.6 (3.8)^b	7.2 (3.6)^b
Ambulation level
Non ambulatory	28	15	15	13
Partly ambulatory	20	9	8	12
Level of education
Regular	30	15	13	9
Special	18	9	10	16

M: male; F: female; n: number of participants; WMS: wheelchair mobility skills; SD: standard deviation.

^a Power assisted wheels not included.

^b Statistical difference between program A, C and B, D.

Table 2. Short- and long-term effects per outcome parameter of combined exercise and wheelchair mobility skills training using a multilevel model analyses.

	Pre-training		Post-training		Follow-up			Post vs. pre-training		Post-training vs. follow-up
Outcome measure	N	Mean (SE)	N	Mean (SE)	N	Mean (SE)	p Value Overall effect	(95% CI)	p Value	(95% CI)	p Value
Physical activity
Active wheelchair use per day (% wear time)	35	6.5 (2.4)	27	8.1 (3.2)	19	7.5 (2.5)	0.01	(0.4;2.0)	<0.01	(–0.7;1.1)	0.73
Wheelchair Mobility Skills
UP-WMST 2.0	48	30.2 (10.7)	48	33.7 (10.1)	37	32.0 (10.0)	<0.001	(2.4;4.5)	<0.001	(–1.1;1.1)	0.99
Confidence in wheelchair mobility
WheelCon-Mobility Dutch Youth	45	109.5 (23.4)	45	118.8 (22.0)	41	117.4 (24.0)	<0.001	(4.5;14.0)	<0.001	(–5.4;4.5)	0.85
Physical fitness
Shuttle Ride Test
Number of shuttles	38	12.2 (3.6)	35	13.3 (3.7)	33	13.1 (2.9)	<0.001	(0.6;1.6)	<0.001	(–0.8;0.2)	0.24
Relative VO2peak (ml/kg/min)	38	26.1 (9.2)	32	27.3 (8.5)	32	26.7 (8.9)	0.71	(–1.4;1.9)	0.77	(–2.1;1.4)	0.67
Muscle Power Sprint Test
Mean power (W)	41	34.4 (27.8)	41	38.5 (28.8)	35	35.1 (21.2)	<0.001	(2.1;6.2)	<0.001	(–4.3;0.2)	0.07
Peak power (W)	41	40.2 (33.0)	41	43.2 (32.0)	35	39.5 (23.4)	<0.001	(0.4;5.4)	0.02	(–5.3;0.1)	0.05

UP-WMST: Utrecht Pediatric Wheelchair Mobility Skills Test; WheelCon-Mobility: Wheelchair Mobility Confidence Scale for Dutch Youth; CI: confidence interval; SE: standard error; N: number of participants; bold font indicates p < 0.01.

Table 3. Unpaired sample t-test total group and waiting list group.

	Waiting list period Program A and B (n = 24)			Training period Program A–D (n = 48)
	n	Pre-waiting list Mean (SD)	Mean change^a (SD)	n	Pre-training Mean (SD)	Mean change^a (SD)	Unpaired sample t-test p Value	Cohen’s D
Active wheelchair use (% wear time)	14	6.5 (1.8)	–1.1 (1.2)	21	6.3 (2.4)	1.1 (2.1)	<0.01	1.2
UP-WMST 2.0	24	32.6 (10.4)	0.3 (3.7)	48	30.2 (10.7)	3.5 (3.6)	0.001	0.88
WheelCon-Mobility Dutch Youth	23	106.7 (23.6)	0.0 (14.8)	45	109.5 (23.4)	9.3 (17.4)	0.03	0.56
Shuttle Ride Test
Number of shuttles	18	12.5 (3.1)	0.4 (1.7)	28	13.0 (2.7)	1.2 (1.2)	0.07	0.57
Relative VO2peak (ml/kg/min)	18	24.6 (6.9)	3.9 (4.0)	28	27.2 (9.0)	0.4 (5.8)	0.03	–0.68
Muscle Power Sprint Test
Mean power (W)	20	33.9 (18.9)	2.6 (4.8)	41	34.4 (27.8)	4.1 (6.5)	0.37	0.25
Peak power (W)	20	38.3 (21.2)	3.9 (5.9)	41	40.2 (32.3)	2.9 (8.7)	0.62	–0.12

UP-WMST: Utrecht Pediatric Wheelchair Mobility Skills Test; WheelCon-Mobility Dutch Youth: Wheelchair Confidence Scale for Dutch Youth; SD: standard deviation; bold font indicates p < 0.01.

^a Mean change: post-training or waiting list period minus respectively pre-training or waiting list period. There are no significant differences between pre-waiting list period and pre-training period scores.

Table

	Pre-training	Post-training	Follow-up
Activ8 Activity monitor	<2 weekdays AND 1 weekend day (n = 7) Declined to participate (n = 1) Software malfunction (n = 5)	<2 weekdays AND 1 weekend day (n = 12) Declined to participate (n = 1) Software malfunction (n = 8)	<2 weekdays AND 1 weekend day (n = 13) Declined to participate (n = 2) Software malfunction (n = 5) Left school (n = 4) Unrelated comorbidity (n = 1) No measurement due to logistic reasons (n = 4)
UP-WMST 2.0	No missing data	No missing data	Left school (n = 4) Unrelated comorbidity (n = 1) No measurement due to logistic reasons (n = 5)
WheelCon-Mobility Dutch Youth	Unable to complete questionnaire (n = 3)	Unable to complete questionnaire (n = 3)	Unable to complete questionnaire (n = 3) Left school (n = 3) Unrelated comorbidity (n = 1)
Shuttle Ride Test
Number of shuttles Relative VO2peak	No maximal effort (n = 9) Measurement burden (n = 1)	No maximal effort (n = 10) No measurement due to logistic reasons (n = 2) Declined to participate (n = 1) Measurement burden (n=2) Software malfunction (n=1)	No maximal effort (n = 6) No measurement due to logistic reasons (n = 2) Left school (n = 4) Unrelated comorbidity (n = 1) Declined to participate (n = 1) Wheelchair malfunction (n = 1) Measurement burden (n=1)
Muscle Power Sprint Test	Power assisted wheels (n = 7)	Power assisted wheels (n = 7)	Power assisted wheels (n = 7) Left school (n = 4) No measurement due to logistic reasons (n = 1) Unrelated comorbidity (n = 1)