Wheelchair Skills Test in simulated versus community settings: a mixed-methods crossover study of experienced motorized mobility scooter users

Abstract

Purpose

The Wheelchair Skills Test (WST) is commonly conducted in a simulated setting. Although the WST can be done in the community setting, its usefulness in this setting has not been systematically evaluated. The purpose of this study was to compare the WST in the simulated versus community settings, and to explore participants’ perceptions of performing in each environment.

Methods

For this mixed-methods study, we studied 20 motorized mobility scooter users who had used their devices for ≥ 3 months. Each participant completed the WST Version 4.3 twice in random order – once in a simulated setting and once in their community within a two-week period. Semi-structured interviews were conducted after completion of the WST in both environments. A self-report version of the WST (WST-Q) was also completed that measured perceived capacity, frequency of skill performance, and confidence.

Results

The mean (SD) total WST score in the simulated setting was 88.9% (8.6) and 92.7% (7.8) in the community setting. The two WST scores were moderately correlated (r = 0.306, p = 0.190). Community-setting WST scores were moderately correlated with WST-Q confidence scores. Simulated-setting scores were moderately correlated with WST-Q frequency scores. Although most participants preferred performing the WST in their communities due to convenience and familiarity, they perceived the simulated setting to be reflective of their community settings.

Conclusion

Despite challenges, community-based testing may provide a better reflection of everyday performance for scooter users than testing in a simulated environment.

IMPLICATIONS FOR REHABILITATION

• Wheelchair Skills Test (WST) scores obtained from conducting the assessment in the community may be different from those obtained from conducting the assessment in a simulated setting.

• Since the WST conducted in the community likely provides different information from the WST conducted in the lab, clinicians should carefully consider which environment to access wheelchair skills in.

• In an urban, community setting, all WST skills were able to be found within a one block radius of participants’ homes.

Keywords:

• Mobility scooter
• skills training
• confidence
• test environment

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Provided by an open operating grant from the Canadian Institutes of Health Research (CIHR) [F15-00959].

Notes on contributors

Sharon Jang

Sharon Jang received her Master of Occupational Therapy and Master of Rehabilitation Sciences from the University of British Columbia. Her work in research has focused on user experiences of mobility aids such as scooters and wheelchairs, and working with individuals with spinal cord injuries. Through these projects she has become well versed in conducting qualitative and quantitative research.

R. Lee Kirby

Physiatrist Dr. Lee Kirby focuses on wheelchair safety, performance and skills training to improve the mobility of people living with spinal cord injury, amputation, stroke-related paralysis, and other conditions affecting their ability to walk. He has served in numerous clinical, education and research roles with Dalhousie University as well as many national and international agencies. Dr. Kirby has been involved in wheelchair research program for over 40 years at Dalhousie University and the Nova Scotia Rehabilitation Centre. In that time, he and his collaborators developed, evaluated and refined the Wheelchair Skills Program to help people learn to safely navigate over and around obstacles that would otherwise confine them. This program has been translated into French and implemented in various parts of the world.

Laura Hurd

Dr. Laura Hurd is a Professor in the School of Kinesiology at the University of British Columbia. Dr. Hurd’s research examines how older adults’ perceptions and experiences of their aging bodies are influenced by age, gender, and health norms. In particular, her work has considered the impact of ageism, ableism, gender ideals, healthism, heterosexism, and social class on older women’s beauty and weight management practices, older men’s engagement in physical activity, older adults’ perceptions of and responses to masculinity and femininity ideals, the self-care and health promotion practices of older adults, older adults’ use of technologies such as power wheelchairs and scooters, sexuality and body image in later life, and media representations of aging.

Sandra Hobson

Sandra Hobson is an occupational therapist with a BSc (OT) from Queen’s University and a Master in Adult Education from Saint Francis Xavier University. For 23 years she taught occupational therapy at the University of Western Ontario, with primary teaching responsibilities in fieldwork courses and courses in assistive devices and technology and environmental modification and rehabilitation of physical disabilities, including return to work and work accommodation strategies. Sandra Hobson has research interests relating to older adults, including occupational patterns across the lifespan, caregiving, falls and fear of falling, and Alzheimer’s and related dementias. She is also interested in professional education, including entry-to-practice and continuing professional education, as well as interdisciplinary education.

Richelle Emery

Richelle Emery graduated from the University of British Columbia with a Bachelor’s Degree in Occupational Therapy in 2001. Richelle has worked with adults, geriatric clientele and palliative clients with physical, cognitive (stroke), psychological and psychosocial impairments through the Home Health Program for the Vancouver Coastal Health Authority. She has extensive experience conducting home safety assessments and providing recommendations for equipment, home modifications and renovations.

W. Ben Mortenson

Dr. Ben Mortenson is an Associate Professor in the Department of Occupational Science and Occupational Therapy in the Faculty of Medicine at the University of British Columbia. He completed his B.Sc. in Occupational Therapy at the University of Alberta, followed by his M.Sc. and Ph.D. in Rehabilitation Science at the University of British Columbia. He completed his post-doctoral fellowship at the University of Montreal, funded by a CIHR grant, and a post-doctoral fellowship at the Simon Fraser University, funded by a Banting Postdoctoral Fellowship Award. His early career work was supported by a CIHR New Investigator award. Dr. Mortenson’s research is concerned with four overlapping areas: assistive technology, social participation, caregiving and outcome measurement. His work is centered on four main populations: assistive technology users, informal and formal caregivers, individuals with spinal cord injury and residents in long-term care.