Wheelchair pushing (v no intervention) on cardiorespiratory fitness in people with SCI who are wheelchair dependent | SCI Physiotherapy Clinical Practice Guidelines

	Wheelchair pushing (v no intervention) on cardiorespiratory fitness in people with SCI who are wheelchair dependent
P	People with SCI who are wheelchair dependent	Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence.		Weak opinion statement FOR Wheelchair pushing may be provided to improve cardiorespiratory fitness in people with SCI who are wheelchair dependent. Clinical note: Wheelchair pushing for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse.
I	Wheelchair pushing
C	No intervention	Consensus-based opinion statement Weak for (83%)
O	Cardiorespiratory Fitness (Vo2 peak)	Consensus-based opinion statement Weak for (83%)
	SUMMARY	1 RCT (see reference)		Mean Difference (95% CI) 0 (-0.2 to 0.1)
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision Very serious	Indirectness Serious	Publication bias Serious

WHEELCHAIR PUSHING ON CARDIORESPIRATORY FITNESS: GRADE Evidence to Decision
PROBLEM	No	Probably no	Probably yes	Yes		Don't know
DESIRABLE EFFECTS	Trivial	Small	Moderate	Large		Don't know
UNDESIRABLE EFFECTS	Large	Moderate	Small	Trivial		Don't know
CERTAINTY OF EVIDENCE	Very low	Low	Moderate	High		No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME	Important uncertainty or variability	Possibly important uncertainty or variability	Probably no important uncertainty or variability	No important uncertainty or variability
BALANCE OF EFFECTS	Favours the Control	Probably favours the Control	Does not favour either the intervention (I) or the comparison (C)	Probably favours the I	Favours the I	Don't know
RESOURCES REQUIRED	Large costs	Moderate costs	Negligible costs and savings	Moderate savings	Large savings	Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES	Very low	Low	Moderate	High		No included studies
COST EFFECTIVENESS	Favours the comparison	Probably favours the comparison	Does not favour either the intervention or the comparison	Probably favours the intervention	Favours the intervention	No included studies
EQUITY	Reduced	Probably reduced	Probably no impact	Probably increased	Increased	Don't know
ACCEPTABILITY	No	Probably no	Probably yes	Yes		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes		Don't know

WHEELCHAIR PUSHING ON CARDIORESPIRATORY FITNESS: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
VAN DER SCHEER 2016	Wheelchair treadmill propulsion V No intervention	Wheelchair treadmill propulsion, twice a week (30 mins) for 16 weeks (30-40% HRR)	C4 to L5 SCI	12/13	Vo2 Peak	Some Concerns of Risk of Bias PEDro = 7

The Australian and NZ SCI Physiotherapy guideline committee recommends wheelchair pushing to improve cardiorespiratory fitness in people with SCI who are wheelchair dependent. This is a consensus-based opinion statement supported by the opinions of the experts. There are no randomized controlled trials on this topic. The guideline states:

Wheelchair pushing may be provided to improve cardiorespiratory fitness in people with SCI who are wheelchair dependent.

This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend wheelchair pushing to improve cardiorespiratory fitness in people with SCI who are wheelchair dependent based on opinion.

To learn more about this recommendation go to the research summary.

Van der Scheer JW, de Groot S, Tepper M, Faber W; ALLRISC group, Veeger DH, van der Woude LH. Low-intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels. J Rehabil Med. 2016 Jan;48(1):33-42.