Wheelchair service provision education for healthcare professional students, healthcare personnel and educators across low- to high-resourced settings: a scoping review

Figures & data

Figure 1. PRISMA-ScR flowchart.

A flowchart diagram representing the articles' selection process through the steps of identification, screening, eligibility, and inclusion stages.

Table 1. Purpose, design, location, and target population of included studies.

Study title (author, year)	Study purpose	Location and setting	Study design	Target population (n)
Descriptive studies
Final Year Students’ Knowledge on Basic Manual Wheelchair Provision: The State of Occupational Therapy Programs in Colombia. (Toro-Hernandez et al., 2020) [15]	To assess the current wheelchair provision knowledge of final year occupational therapy students through ISWP Basic Wheelchair Service Knowledge Test.	Colombia [UM] Academic	Cross-sectional e-mail survey.	OT students (n = 83)
Undergraduate physiotherapy students’ basic wheelchair provision knowledge: a pilot study in two universities in Colombia. (Toro-Hernandez et al., 2019) [16]	To evaluate basic manual wheelchair provision knowledge in final-year physiotherapy undergraduate students in two programs in Colombia.	Colombia [UM] Academic	Cross-sectional Study.	PT students (n = 116)
Integration of wheelchair service provision education: current situation, facilitators and barriers for academic rehabilitation programs worldwide. (Fung et al., 2019) [17]	To develop an in-depth global portrait of the wheelchair service provision education offered in academic rehabilitation programs, the process of its integration and the associated facilitators and barriers.	11 countries [H = 4, UM = 2, LM = 3, L = 2] Academic	Semi-structured qualitative interviews.	Faculty members in OT, PT, and P&O (n = 14)
Wheelchair Service Provision Course – Evaluation Report. 2018 [42]	To provide a comprehensive theoretical understanding of Wheelchair Service Delivery and to develop an understanding of the theoretical principles, skills and knowledge underlying the management skills and knowledge in the management of wheelchair service delivery.	148 countries: [H, UM, LM, L] Organization	Program evaluation.	PT clinicians, students, assistants and healthcare professionals (n = 5559)
Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology. (Smith et al., 2018) [41]	To review the current capacity of human resources in enabling access to AT as well as the systems and processes within which they function.	Global	Review paper.	Workforce for provision of AT services
Wheelchair service provision education and training in low and lower middle income countries: a scoping review. (McSweeney et al., 2017) [19]	To review wheelchair provision education and training for personnel in the field of in LLMIC and identify where gaps exist.	LLMIC^a [UM = 6, LM = 49, L = 29]	Scoping review.	Not applicable
Development and evaluation of a wheelchair service provision training of trainers programme. (Munera et al., 2017) [46]	To understand if the WSTPt is an effective mechanism to train aspiring wheelchair service provision trainers.	South Africa and Thailand [UM], Kenya [LM] Community	Action research; mixed-methods surveys & focus groups.	Trainees who passed ISWP Basic training (n = 22)
Wheelchair service provision education in academia. (Fung et al., 2017) [18]	To develop an enhanced understanding of the current wheelchair service provision education provided in professional rehabilitation programmes worldwide.	21 countries [H = 8, UM = 7, LM = 5, L = 1] Academic	Cross-sectional online survey.	Educational institutions worldwide (n = 72)
Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users. (Toro-Hernandez et al., 2017) [47]	To develop a WMTP as a tool for clinicians to teach wheelchair users (and caregivers) in a group setting to perform basic maintenance at home in the USA and to develop a WMT-Questionnaire.	USA [H] Academic, Research Laboratory and Clinic	Mixed methods: cross-sectional online survey and formative research.	Clinicians and Wheelchair Users, Content Development Experts and Graduate medical and PT students (n = 17)
A description of manual wheelchair skills training curriculum in entry-to-practice occupational and physical therapy programs in Canada. (Best et al., 2015) [59]	To describe the current entry-to practice MWC skills training curriculum in OT and PT programs.	Canada [H] Academic	Cross-sectional online survey.	Directors of academic (OT/PT) programs (n = 28)
Impact of training for wheelchair service specialists. (White et al., 2003) [51]	To describe the development of a university-validated course, designed to enhance the knowledge, clinical skills and academic ability of both therapists and engineers who now work in wheelchair services.	England and Northern Ireland [H] Clinic	Cross-sectional postal survey.	OT, PT and bio-medical engineers (n = 24)
Assessment for the Prescription of Wheelchairs: What Training is Available to Therapists? (Silcox et al., 1995) [60]	To discover the amount of time spent on and some of the content of the training presently available to therapists, both in college and from the wheelchair service.	UK [H] Academic and Clinic	Cross-sectional postal survey.	Academicians and practitioners (n = 95)
Experimental studies
Efficacy of a Remote Train-the-Trainer Model for Wheelchair Skills Training Administered by Clinicians: A Cohort Study with Pre- vs. Post-Training Comparisons. (Worobey et al., 2021) [45]	To test the hypotheses that remote training improves trainer confidence and, when these trainers train others, the capacity and confidence of the trainees improves.	USA [H] Academic	[Quasi-experimental design] Cohort study with pre- versus post-training comparisons.	Clinician trainers (n = 7) and able-bodies trainees (n = 19)
Effect of an interventional educational wheelchair program on medical students’ understanding of manual wheelchair use. (Gilbert et al., 2021) [44]	To identify the effect of an educational interactive wheelchair program on medical students’ understanding of wheelchair use.	USA [H] Academic	[Quasi-Experimental Design] Repeated-measures survey study with postintervention comparison.	Medical students (n = 123)
Improvement and retention of wheelchair training skills for students in entry-level occupational therapy education. (Giesbrecht et al., 2021) [43]	To assess the effectiveness of a boot camp on capacity and self-efficacy in wheelchair skills and self-efficacy in clinical practice, retention of improvements, and effective boot camp attributes.	Canada [H] Academic	Mixed-methods: Cohort design using blinded repeated measures quantitative evaluation and qualitative questionnaire.	OT students (n = 42)
Using remote learning to teach clinicians manual wheelchair skills: a cohort study with pre- vs post-training comparisons. (Worobey et al., 2020) [48]	To test the hypothesis that remote learning to teach clinicians manual wheelchair skills is effective.	USA [H] Clinic	[Quasi-Experimental Design] Cohort study with pre- vs post-training comparisons.	Physiotherapists and Occupational therapists (n = 41)
A condensed wheelchair skills training ‘boot camp’ improves students’ self-efficacy for assessing, training, spotting, and documenting manual and power wheelchair skills. (Smith et al., 2019) [49]	To test the hypothesis that the WSTP, added to the standard curriculum, would result in significantly greater overall improvements in wheelchair skills than a standard undergraduate OT curriculum alone.	Canada [H] Academic	[Quasi-experimental design] Pre-post study.	OT students (n = 44)
Wheelchair skills training for occupational therapy students: comparison of university-course versus “boot camp” approaches. (Rushton et al., 2019) [31]	To test the hypothesis that occupational therapy students who receive wheelchair skills training education using a distributed-practice university-course approach versus a condensed-practice boot camp approach results in greater improvements post-intervention in relevant outcomes.	Canada [H] Academic	Quasi-experimental design.	OT students and OT graduates (n = 55)
Comparing the effectiveness of a hybrid and in-person courses of wheelchair service provision knowledge: a controlled quasi-experimental study in India and Mexico. (Burrola-Mendez et al., 2019) [22]	To compare the effectiveness of a Hybrid Course and In-person Course in English and Spanish in increasing knowledge in basic level wheelchair service provision.	Mexico [UM] India [LM] Clinic	Quasi-experimental design.	Rehabilitation sciences students or professionals who have not taken the ISWP Basic Test (n = 81)
Implementation of the hybrid course on basic wheelchair service provision for Colombian wheelchair service providers. (Burrola-Mendez et al., 2018) [23]	To evaluate the influence of the Spanish Hybrid Course on Basic Wheelchair Service Provision, a training based on the WHO WSTP-Basic level.	Colombia [UM] Community	[Quasi-experimental design] Pre–post repeated measures.	Wheelchair service providers (n = 15)
Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts. (Burrola-Mendez et al., 2018) [29]	To develop and evaluate a blended learning approach for the WHO WSTP-Basic level.	USA [H] Academic	Quasi-experimental design.	Students, staff and professors from OT, PT, RST, P&O programs (n = 6)
Developing wheelchair training program for rehabilitation and occupational therapy students. (Sarsak et al., 2018) [50]	To develop the minimum skills and knowledge required by personnel involved in wheelchair service delivery, and to integrate the WTP into the regular rehabilitation curricula and training programs.	Jordan [UM] Academic	Quasi-experimental design.	OT students (n = 40)
Preliminary Evidence to Support a “Boot Camp” Approach to wheelchair Skills Training for Clinicians and Learning Effects of Self-Learning Tool. (Giesbrecht et al., 2015) [30]	To evaluate the impact of providing intensive large-group training on wheelchair-specific self-efficacy and skill capacity among occupational therapy students.	Canada [H] Academic	[Quasi-Experimental Design] Repeated-measures without a control group.	OT students (n = 65)
A Wheelchair Workshop for Medical Students Improves Knowledge and Skills A Randomized Controlled Trial. (Kirby et al., 2011) [55]	To test the hypothesis that a multicomponent workshop about wheelchairs, tailored for undergraduate medical students, is effective in improving medical students’ wheelchair-related knowledge, skills, and attitudes.	Canada [H] Academic	Randomized controlled trial.	Medical students (n = 26)
Wheelchair Skills Training Program for Clinicians: A Randomized Controlled Trial With Occupational Therapy Students. (Coolen et al., 2004) [56]	To test the hypothesis that the WSTP, added to the standard curriculum, would result in significantly greater overall improvements in wheelchair skills than a standard undergraduate OT curriculum alone.	Canada [H] Academic	Randomized controlled trial.	OT students (n = 40)

AT: assistive technology; H: high-income countries; ISWP: International Society of Wheelchair Professionals; L: low-income countries; LM: lower middle-income countries; LLMIC: low and lower middle-income countries; MWC: manual wheelchairs; OT: occupational therapy; PT: physical therapy; UM: upper middle-income countries; WHO: World Health Organization; WMTP: wheelchair maintenance training programme; WHO WSTP: World Health Organization Wheelchair Service Training Package; WSTP: wheelchair skills training program; WSTPt: Wheelchair Service Training of Trainers Programme; WTP: wheelchair training program.

^aThe study used the 2018 World Bank classification. The classification has changed since then.

^bThe information inside the brackets ([ ]) was inferred based on what the authors reported in the manuscripts.

Table 2. Development, integration and delivery of wheelchair service provision education.

In-text citation	Course development	Learning environment	Integrated into University Program	Delivery
		Teaching activities/resources		Course (format, level, duration)	Who delivered the course
(A) Development, integration and delivery of a novel course
Gilbert et al., 2021 [44]	Resources  Not Reported  Content Lecture: Epidemiology; wheelchair etiquette; recommendations for communication with persons with a disability.  Video: Appropriate prescriptions; types and components including cushions; wheelchair-related shoulder pain, pressure injuries, and medical complications associated with wheelchair mechanical malfunction; personal wheelchair-related experience; clips of advanced wheelchair skills and adaptive recreational activities.  Process Not reported  Developers Experienced clinicians.	[In-person] Lecture, video and interactive wheelchair experience [synchronous]	Yes	Format Mandatory Component of Clerkship [condensed]  Level Undergraduate: 4th year  Duration 2 h.	Not reported
Sarsak et al., 2018 [50]	Resources WHO WSPT-Basic level and intermediate and unspecified educational resources  Content Seating biomechanics; postural supports; manual and power wheelchairs; seat functions; wheelchair functional outcomes; clinical implications and special cases; occupational therapist role in wheelchair provision process; accessibility issues; wheelchair skills training; wheelchair adjustments  Process 3 phases: pre-test phase, WTP phase, and post-test phase.  Developers Researchers in the Department of Occupational Therapy at the University of Jordan.	[In-person] Interactive lecture, handouts, group work and exercises [synchronous]	Yes	Format Training program [optional]  Level Undergraduate  Duration 4 × 5-h sessions. 1 session/week over 4 consecutive weeks.	Not reported
Toro-Hernandez et al., 2017 [47]	Resources Wheelchair provision guidelines and wheelchair service training developed by the WHO, RESNA and Australian guidelines  Content Inspection and maintenance activities  Process Phase 1. An online survey sent to experts with at least one year of experience maintaining, repairing or providing wheelchairs.   Phase 2. First draft of the program using the WHO material format.   Phase 3. Two review rounds of the first draft by experts in wheelchair provision, maintenance and wheelchair user-related training.  Developers University-based team (undergraduate and graduate students, research scientist, clinical coordinator, rehabilitation science professor, communications specialist).	[In-person] Lecture, video, handouts and practice [synchronous]	No	Format [Training program]  Level Continuing education  Duration 6-h course + 2 training sessions (2-h sessions on 2 sequential days).	Not reported
White et al., 2003 [51]	Resources Not reported  Content Topic areas such as pressure management, postural management and equipment knowledge.  Process A postal survey was undertaken by 165 wheelchair service therapists and 160 wheelchair service managers. Developers Not Reported	Not reported Lecture, practice, work-based tasks (resource file, informative visit, case studies, reflective diary) [synchronous]	Yes	Format [Optional course] Core module of generalist knowledge and additional specialist courses. With credit recognition  Level Continuing education  Duration Not reported.	Range of professionals and service users.
(B) Adaptation and integration of existing training courses
Worobey et al., 2021 [45]	Resources Wheelchair skills program Teaching activities/resources Videos [asynchronous self-study] Process Not reported Team Not reported	Online	No	Format Training of trainers program Level Continuing education Duration Not reported.	Not reported
Giesbrecht et al., 2021 [43]	Resources Wheelchair skills program Teaching activities/resources Boot camp: Online tutorial [asynchronous self-study], demonstration and verbal instruction, practice with strategic feedback [synchronous role play] Process Not reported Team Not reported	[Online and In-person]	Yes	Format Compulsory advanced clinical skills course Level Graduate Duration 4 h.	Expert instructor
Worobey et al., 2020 [48]	Resources Wheelchair skills program Teaching activities/resources Instructional video-recordings and handouts [asynchronous self-study], dyad practice with self-selected frequency and duration of sessions and remote asynchronous feedback Process Not reported Team Not reported	Online	No	Format [Optional condensed education: boot camp] Level Undergraduate and continuing education Duration Variable. Average of 3 sessions. Session durations [15–120] min. Total time for practice and spotting combined [40–330] min.	Content expert + experienced trainer-of-trainers with experience in wheelchair training and provision.
Smith et al., 2019 [49]	Resources Wheelchair skills program Teaching activities/resources Lecture, demonstration, and hands-on training [synchronous] Process Not reported Team Not reported	[In-person]	No	Format [Optional condensed education] Bootcamp Level Graduate Duration 2 days. 6.5 h dedicated to both manual or power wheelchair skills.	5 individuals with extensive training in the wheelchair skills program.
Burrola-Mendez et al., 2019 [22]	Resources WHO WSPT Basic level Teaching activities/resources Online: Discussion forums, case studies, short quizzes, videos and interactive activities [asynchronous], mandatory synchronous meetings, in-person training In-person: Theoretical and practical sessions occurred simultaneously [synchronous] Process Not reported Team Not reported	Hybrid Online and In-person	No	Format [Training program] Level Undergraduate, graduate and continuing education Duration Online: Online section: 2 weeks, 9 modules: 12 h, meetings: 4 h. In-person section: 3 consecutive days, 8 h per day. In-person only: 5 consecutive days, 8 h per day.	Online: Online section: ISWP Hybrid Course developer and staff In-person section: Trained Occupational Therapist, Medical Doctor, Biomedical Engineer and Physical Therapist In-person only: Trained Occupational Therapist, Medical Doctor and Biomedical Engineer.
Rushton et al., 2019 [31]	Resources WHO-8 steps wheelchair service provision, Wheelchair Skills Program Teaching activities/resources University course: Lecture, case studies, demonstration and practice [synchronous] Boot camp: Lecture, demonstration and practice [synchronous] Process Not reported Team Not reported	[In-person]	Yes	Format Optional credited course and [Optional Condensed Education] Boot camp Level Graduate and continuing education Duration University course: 15 weeks, 24 h Boot camp: 8 h.	University instructors]
[42]	Resources Guidelines on the provision of manual wheelchairs in less-resourced settings developed by the WHO Teaching activities/resources Lecture, quiz, videos, case studies, discussion forums [asynchronous] Process HI completed the French translation of the programme of courses. Team Physiopedia, the International Committee of the Red Cross and Humanity & Inclusion.	Online	No	Format [MOOC] 4-Course Program + 1 Optional Course Level Undergraduate and continuing education Duration 17 h over 4 weeks. [4–6] h each course.	Not reported
Burrola-Mendez et al., 2018 [23]	Resources WHO WSPT-Basic level Teaching activities/resources [Discussion forums and videos [asynchronous], mandatory synchronous meetings, in-person training]^a Process Not reported Team Not reported	Hybrid	No	Format [Training program] Level Continuing education Duration Online section: 2 weeks, synchronous meetings of 90 min each. In-person section: 3½ days, 8 h per day.	Online section: ISWP staff and ISWP Hybrid Course developer In-Person section: Trained Physical Therapist, Medical Doctor, and Biomedical Engineer.
Burrola-Mendez et al., 2018 [29]	Resources WHO WSPT-Basic level Teaching Activities/resources Discussion forums and videos [asynchronous], mandatory synchronous meetings, in-person training Process 2 rounds of internal and external revisions. First round: A module prototype was developed and distributed to the HSC members to collect feedback about the visual design of the course, the modules’ sections and the layouts. Second round: All modules and their respective content were created and distributed via the online platform. For this round, feedback was solicited on curriculum content and platform access. Learning objectives were developed according to the WHO WSTP-Basic level. Team Online section: Multidisciplinary members from high-, middle- and low-income countries with experience in delivering wheelchair training and developing educational programs for high- and low-resource settings.	Hybrid	No	Format [Training program] Level Undergraduate and Graduate Duration Online section: 8 modules (average of 10 h), 3 synchronous meetings of 90 min each. In-person section: 3 days of in-person training, 8-9 h per day.	2 Trained physical therapists; 1 occupational therapist.
Munera et al., 2017 [46]	Resources WHO Wheelchair Service Training of Trainers Programme (WSTPt) Teaching activities/resources Didactic training and practice [synchronous] Process Not reported Team Not reported	Not reported	No	Format Training of trainers program Level Continuing education Duration 5 days.	Advanced-level wheelchair service providers and experienced WHO WSTP trainers.
Giesbrecht et al., 2015 [30]	Resources Wheelchair skills program Teaching activities/resources Lecture, instruction, demonstration and practice [synchronous] Process Not reported Team Not reported	[In-person]	No	Format [Optional condensed education] Boot camp Level Graduate Duration 4.5-h: 1-h overview of the WSTP + 3.5 h of hands-on training.	Two experienced occupational therapists, with WSTP training and > 5 years of clinical experience.
Kirby et al., 2011 [55]	Resources Wheelchair skills program Teaching activities/resources Lecture, practice, community experience and reflective exercise [synchronous], self-study [asynchronous] Process Not reported Team Focus group of a senior medical student, a family physician, a community-based wheelchair user, a community-based caregiver, a physiatrist, and an occupational therapist.	[In-person]	No	Format [Training program] workshop Level Undergraduate Duration Approximately 4 h: 45-min didactic presentation + 2-hour practical experience (3 × 40-min stations) + approximately 60-min community experience + approximately 15-min reflective exercise.	Experienced occupational therapist, rehabilitation engineer, and physiatrist.
Coolen et al., 2004 [56]	Resources Wheelchair skills program Teaching activities/resources WSTP: Instructional video and practice with feedback [synchronous] Standard curriculum: Lecture and practice [synchronous], community experience [asynchronous] Process Not reported Team Not reported	[In-person]	Yes	Format Component of a course Level Undergraduate Duration WSTP: 2–3 h Standard curriculum: 1^st year: 2 × 3-h sessions + 4 h of community experience over a 2-week period, 3d year: 3 × 2-h, 4th year: 2 × 3-h.	Not reported
(C) Wheelchair service provision education: State of integration
Fung et al., 2019 [17]	Resources WHO package, motivation packages from motivation Charitable Trust, United Kingdom, WHO Community-Based Rehabilitation Learning Community, Wheelchair Skills Program, Pittsburgh Maintenance Package Teaching activities/resources Lecture, case studies, videos, patient models and practice.	Not applicable	Yes	Format Mostly components of a course. Optional wheelchair-specific course Level Undergraduate and continuing education Duration Variable. [3–40] h.	[Educators across academic rehabilitation programs and resource settings].
Best et al., 2015 [59]	Teaching activities/resources Lecture, instruction, demonstration, practice, and extra-curricular activity (exposure during clinical placements, spending a day in a wheelchair) [synchronous].	Not applicable	Yes	Format Mandatory course and component of a course Level Undergraduate Duration Variable. [<1,>6] h: 8 institutions delivered >6 h training; 8 institutions delivered <5 h training; 5 institutions offered no training.	Not reported
Silcox et al., 1995 [60]	Teaching activities/resources Not reported	[In-person]	Yes	Format Not reported Level Undergraduate and continuing education Duration Variable. 17.73 h (mean) in OT and PT Colleges. 8.52 h (mean) in Wheelchair Service Centres.	[Trainers in OT and PT Colleges and Wheelchair Service Centres].

Sub-question #1. “How are wheelchair service provision education curricula developed, integrated and delivered”.

AT: assistive technology; HI: humanity & inclusion; ICRC: International Committee of the Red Cross; MOOC: Massive Open Online Courses; OT: occupational therapy; PT: physical therapy; RESNA: Rehabilitation Engineering and Assistive Technology Society of North America; SCI: spinal cord injury; WHO WSTP: World Health Organization Wheelchair Service Training Package; WSTP: Wheelchair Skills Training Program; WTP: Wheelchair Training Program.

The information inside the brackets ([ ]) was inferred based on what the authors reported in the manuscripts.

^aReferenced in “Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts.”

Table 3. Wheelchair service provision education: course effectiveness and competencies.

In-text citation Sample size	Targeted competencies	Outcome measure	Outcome measure characteristics (type, construct measure, response scale, administration time)	Educational effectiveness
Testing effectiveness
Worobey et al., 2021 [45] N = 7 clinicians and 19 trainees	Skill self-efficacy	1. WST-Q 4.3 version 2. SEATS-M 3. Video-recordings of the trainees	1: [subjective], capacity and confidence, [3-point Likert scale] (2 = yes, 1 = yes with difficulty, 0 = no) and (0 = not at all confident,1 = somewhat confident,2 = confident). 2: [subjective], self-report measure of clinicians’ self-efficacy to assess, train and spot each WST skill, 4-point [Likert] scale from 0 to 4 (not at all confident, somewhat confident, neutral, fairly confident, completely confident) 3: [subjective], trainees’ performance upon skill acquisition (WST capacity scores of 1 or 2) evaluated by researchers.	Skill 1. Trainee 4-item median [IQR] WST-Q scores significantly increased with training for capacity (13% [6,31] to 88% [75,88], p < 0.001) and confidence (13% [0,31] to 88% [81,100], p < 0.001). Self-Efficacy 2. The median [IQR] pre-training 32-item SEATS scores for assessment, training and spotting were 62% [53, 86], 57% [57, 84], and 96% [77, 97]. Trainer confidence increased for assessment (p = 0.003) and training (p = 0.002), but not spotting (p = 0.056).
Gilbert et al., 2021 [44] N = 123	Knowledge	Pre and post surveys	[subjective], understanding of (1) impact of manual wheelchair use, (2) challenges of manual wheelchair use, (3) manual wheelchair skills, and (4) wheelchair etiquette, 14 items scored on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) and open-ended questions.	The mean ± SD pre-and post-survey section scores for the main outcome measures were as follows: 3.9 ± 0.7 and 4.4 ± 0.6 for the impact of manual wheelchair use, 3.1 ± 1.0 and 4.4 ± 0.6 for challenges of manual wheelchair use, 2.4 ± 0.9 and 4.4 ± 0.7 for manual wheelchair skills, and 2.5 ± 1.0 and 4.0 ± 0.8 for wheelchair etiquette, respectively. Two-tailed sign tests demonstrated improvement from pre- to post-survey for all four outcome measure summary scores (p < 0.001). These score improvements remained significant after data were stratified for gender, prior wheelchair experience, and prior PM&R rotation experience.
Giesbrecht et al., 2021 [43] N = 42	Skill Self-efficacy	1. WST-Q 2. Wheelcon-M 3. SEATS	1: [objective], wheelchair skill capacity, 3-point Likert scale (2 = yes; 1 = yes, with difficulty, 0 = no) 2: subjective, self-report, manual wheelchair confidence,11-point Likert scale (0 = not confident; 10 = completely confident). 3: [subjective], self-efficacy for assessing, training, spotting, and documentation,5-point Likert scale (1 = not at all confident, 5 = completely confident).	Skill Post-hoc analyses revealed a significant increase from T1(prior to boot camp) to T2(following boot camp) for all measures and subscales At follow-up WST-Q had decreased significantly (p < 0.001) Self-efficacy Post-hoc analyses revealed a significant increase from T1 to T2 for all measures and subscales 2. WheelCon Total and Self-management subscale showed a statistically significant increase, indicating scores had been maintained and improved further by T3. 3. The remaining measures did not demonstrate significant change, indicating they were also maintained at follow-up.
Smith et al., 2020 [49] N = 44	Skill Self-efficacy	1. SEATS-M 2. SEATS-P 3. WST-Q for manual and power wheelchair users	1 and 2: [subjective], self-efficacy for assessing, training, spotting, and documentation,5-point Likert scale (1 = not at all confident, 5 = completely confident). 3: [subjective], self-reported wheelchair skills capacity;32 items for manual wheelchair users and 29 items power wheelchair users.	Skill WST-Q capacity scores increased by 47.17% for manual wheelchair skills and by 37.08% for power wheelchair skills (p= <0.001) Self-efficacy Students’ scores improved between 28.39% and 35.28% (p= <0.001) for all domains of the SEATS (assessing, training, spotting, and documentation).
Burrola-Mendez et al., 2019 [22] N = 81	Knowledge	ISWP Basic Test	[objective], basic wheelchair service provision knowledge, multiple-choice, approximately one hour to complete.	The sensitivity analysis did not show changes in the significance of the differences of differences between the Hybrid and In-person groups in the total knowledge score nor in the subgroup analyses. However, both study groups experienced statistically significant improvements in the primary outcome when comparing post- and pre-test scores (p < 0.0001).
Rushton et al., 2019 [31] N = 55	Skill Self-efficacy	1. WST-Q 2. WheelCon-M 3. SEATS	1: subjective, self-reported capacity, confidence, and performance in wheelchair skills, 2: subjective, self-reported measure of wheelchair confidence,11-point Likert scale (0 = not confident; 10 = completely confident). 3: [subjective], self-report measure of a clinicians’ self-efficacy to assess, train, spot and document wheelchair skills, 5-point Likert scale (1 = not at all confident, 5 = completely confident).	Skill There were no significant differences in change scores (T2–T1) between the experimental and control groups on the WST-Q capacity (log transformation, F 1,53 = 0.47, p = 0.497, eta squared = 0.01), WST-Q confidence (F1,54 = 0.14, p = 0.707, eta squared = 0.00), WheelCon (F = 4.0, p = 0.051, eta squared = 0.07), Self-efficacy SEATS assessment (log transformation, F = 0.00, p = 0.969, eta squared = 0.00), SEATS training (F1,53 1,55 = 0.46, p =.502, eta squared = 0.01), SEATS spotting (F = 0.57, p = 0.453, eta squared = 0.01) and SEATS documentation (F 1,53 1,4 8 = 2.8, p = 0.099, eta squared = 0.06).
Burrola-Mendez et al., 2018 [23] N = 15	Knowledge	ISWP Basic Test	[objective], basic wheelchair service provision knowledge, multiple-choice, approximately one hour to complete.	Mean post assessment -scores were significantly higher (Mean (M) = 56.13, Standard deviation (SD) = 7.8), than pre-assessment scores (M = 50.07, SD = 8.38, t(14) = 4.923, p = <0.0001). All domains, except for Fitting presented an increase in mean scores between pre-test and post-test. Assessment reported a significant difference in the pre-test scores (M = 13.93, SD = 2.19) and post-test scores (M = 16.33, SD = 2.06), t(14) = 5.041, p = <0.0001.
Burrola-Mendez et al., 2018 [29] N = 6	Knowledge	ISWP Basic Test	[objective], basic wheelchair service provision knowledge, multiple-choice.	Post-assessments scores were significantly higher (M = 64.17, SD = 5.41) than pre-assessments scores (M = 53.33, SD = 1.66), t(5) = 4.897, p = 0.004; Cohen’s d = 1.99.
Sarsak et al., 2018 [50] N = 40	Knowledge	Paper-based test: WTP Test	Knowledge improvement, multiple-choice, approximately 30 min.	At pre-test, the mean pre-WTP test score was 2.92 with the minimum average score of 1/10 and the maximum average score of 4/10; however, at post-test, the mean post-WTP test score was 7.32 with the minimum average score of 4/10, and the maximum average score of 10/10. Wilcoxon signed ranks test showed that there was a significant difference between pre-test and post-test WTP results for all students (p < 0.001).
Munera et al., 2017 [46] N = 22	Self-Efficacy	1. Trainee satisfaction surveys 2. Focus groups 3. Training Competency assessment tool	1: [subjective test], includes self-assessment question on confidence in delivering the WHO WSTP. 2: Not reported. 3: Not reported.	There was an increase in confidence to deliver the training after the WHO WSTPt. Participants reported an average of 80.6% confidence to deliver the WHO WSTPt after the training.
Toro-Hernandez et al., 2016 [47] N = 17	Knowledge	WMT-Q	[objective and subjective], wheelchair maintenance knowledge, multiple-choice and open-ended questions.	Mean difference in knowledge between pre and post-training a. Manual wheelchair open-ended − 25 (p < 0.007) b. Powered wheelchair − 21.9 (not statistically significant) c. Multiple choice − 27.3 (p < 0.007). d. Capacity − 51.6 (p < 0.007).
Giesbrecht et al., 2015 [30] N = 65	Skill Self-efficacy	1. WST-Q version 4.2 2. WheelCon-M short form version	1: [subjective], self-reported capacity to perform wheelchair skills, [3-point Likert scale] (2 = yes, 1 = yes with difficulty, 0 = no), with a total possible score of 64 points. 2: [subjective], self-reported in [test-taker] ability to safely perform different wheelchair-related activities, 11-point Likert scale (0 = not confident, 10 = completely confident).	Skill At post intervention, the WST-Q score mean increased by 24.7 (95% confidence interval, 22.1–27.3; p=.000), reflecting a 38.6% improvement (Cohen d = 2.8). Self-efficacy The WheelCon-M mean score improved by 3.0 (95% confidence interval, 2.5–3.3; p = 0.000).
Kirby et al., 2011 [55] N = 26	Knowledge Skill Self-efficacy	1. Written knowledge test, 2. Practical examination 3. The Scale of Attitudes Towards Disabled Persons 4. Survey	1: [objective], knowledge about the prevalence of wheelchairs in the community, safety, the method by which wheelchairs are provided and modified to fit the individual needs of users, the WSP (Wheelchair Skills Program), and the principles of motor skills learning, true/false, multiple-choice, and short-answer type of questions, approximately 30 min to complete. 2: [objective], wheelchair skills, approximately 30 min for each participant to complete this examination. 3: [subjective], attitudes towards persons with disability, 6-point Likert scale (from I disagree very much" to "I agree very much." 4: [subjective], Student’s perception of overall workshop experience, free-response comments. 5-point Likert-type scale (1="very poor", 5= "very good").	Knowledge The difference in the means ± SD was 23.9% ± 7.5% (95% confidence interval, 17.6–30.3%; p < 0.0001). Skill 2. The difference in the means ± SD was 34.4% ± 9.6% (95% confidence interval, 26.3–42.5%; p < 0.0001). 3. The difference in the means was 1.6% (p = 0.93). Self-efficacy The perceptions of the students who took the workshop were highly positive.
Coolen et al., 2004 [56] N = 40	Knowledge Skill	1. WST 2. WST-K	1: objective, wheelchair skills, 2: [knowledge test on how to perform wheelchair skills].	Knowledge For the WSTP group, the total percentage WST-K scores were greater than the WST scores by mean differences of 13.4% before training (p<.0001) and 16.7% after training (P_.0001). For the second-year control group, the mean differences were 13.6% before training (p<.0001) and 9.1% after training (p<.0001). Skill Students in the second-year control group increased their mean percentage WST scores by 9.7% (p<.015), whereas those in the WSTP group increased by 25.0% (p<.001). The WSTP group improved to a greater extent (p<.005). The mean WST 2 and 3 scores did not differ significantly (p<.29). The mean WST score of the fourth-year control group was significantly lower than the WST 2 score of the second-year WSTP group (p<.0001) but not the second-year control group (p<.58).
White et al., 2003 [51] N = 24	Knowledge	Survey	[subjective], benefits and support required for future participants in a university-based course.	Increase in Knowledge (71%) – use of the information to train others (92%), engaging in further personal research activities (88%) – these aspects were rated good by the participants.
Testing competency
Toro-Hernandez et al., 2020 [15] N = 83	Knowledge	ISWP Basic Test	[objective test], manual basic wheelchair service provision knowledge, [multiple-choice].	Average Total Domain pass scores per university Assessment – 57.6%; prescription – 51.3%; process – 51.0%; production – 48.5%; fitting – 23.7%; user training – 44.9%; follow-up – 49.2% Total score – 48% None of the participants passed the test.
Toro-Hernandez et al., 2019 [16] N = 116	Knowledge	ISWP Basic Test	[objective test], manual basic wheelchair service provision knowledge, [multiple-choice], <105 min.	Median and inter quartile ranges for each Domain Assessment–Median = 68.4 IQR [57.9–73.7]; prescription–median = 50.0 IQR [41.7–58.3]; process–median = 70.0 IQR [50.0–80.0]; production–median = 40.0 IQR [20.0–60.0]; fitting–median = 30.0 IQR [20.0–40.0]; user training–median = 46.7 IQR [36.0–60.0]; follow-up–median = 50.0 IQR [25.0–75.0] None of the participants passed the test.

Sub-question #2.“What are the expected skills and competencies after wheelchair service provision education and how are these evaluated?.”

Sub-question #3. "What is the evidence for educational effectiveness and clinical impact, and how are these measured?”

SEATS: self-efficacy in assessing, training, and spotting; SEATS-M: self-efficacy in assessing, training, and spotting manual wheelchair skills; SEATS-P: self-efficacy in assessing, training, and spotting power wheelchair skills; Wheelcon-M: Wheelchair Use Confidence Scale for Manual Wheelchair Users; WMT-Q: Wheelchair Maintenance Training Questionnaire; WST: wheelchair skills test; WST-K: wheelchair skills test – knowledge; WST-Q: wheelchair skills test questionnaire; WTP:  wheelchair training program.

The information inside the brackets ([ ]) was inferred based on what the authors reported in the manuscripts.

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