Manual wheelchair skills training (v no intervention) on wheelchair skills in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	Manual wheelchair skills training (v no intervention) on wheelchair skills in people with SCI
P	People with SCI	Evidence recommendation Weak for (95%)		Weak evidence recommendation FOR Evidence recommendation: manual wheelchair skills training may be provided to improve manual wheelchair skills in people with SCI.
I	Manual wheelchair skills training	Evidence recommendation Weak for (95%)
C	No intervention	Consensus-based opinion statement No opinion statements
O	Wheelchair skills	Consensus-based opinion statement No opinion statements
	SUMMARY	4 RCTs (see references)		Standardised Mean difference (95% CI): 0.7 (0 to 1.4) Favours wheelchair skills training
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Very serious	Imprecision Very serious	Indirectness Serious	Publication bias Serious

MANUAL WHEELCHAIR TRAINING FOR WHEELCHAIR SKILLS: 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

MANUAL WHEELCHAIR SKILLS TRAINING FOR WHEELCHAIR SKILLS: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
KIRBY 2016	Wheelchair skills training V Educational Control	Intervention: Five individual training sessions Control: Five education sessions	People with SCI living in community	47/49	Wheelchair skills test	Some concerns about Risk of Bias PEDro = 7/10
RICE 2013	Wheelchair skills training V No Intervention	3 visits of real time feedback from a Smart wheel while pushing	People with SCI living in community SCI<2 years	6/9	Stroke frequency	Some concerns about Risk of Bias PEDro = 4/10
WOROBEY 2016	Wheelchair skills training V Control	Between 2-8, 60–80-minute group training sessions	People with SCI living in community	36/43	Wheelchair skills test	High Risk of Bias PEDro = 7
YEO 2018	Wheelchair skills training V No Intervention	1 hour per day, 3 days/week for 8 weeks	People with tetraplegia living in community	13/11	Wheelchair skills test	Some concerns about Risk of Bias PEDro = 4

The Australian and NZ SCI Physiotherapy guideline committee recommends manual wheelchair skills training to improve manual wheelchair skills in people with SCI. This is an evidence recommendation supported by the results of four randomised controlled trials. The guideline states:

Manual wheelchair skills training may be provided to improve manual wheelchair skills in people with SCI.

This recommendation was formed by considering the results of four randomised controlled trials alongside other factors. The combined trial results indicate that manual wheelchair skills training is better than no manual wheelchair skills training to improve manual wheelchair skills. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.

This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend manual wheelchair skills training to improve manual wheelchair skills in people with SCI. To learn more about this recommendation go to the research summary.

Kirby RL, Mitchell D, Sabharwal S, et al. Manual wheelchair skills training for community-dwelling veterans with spinal cord injury: a randomized controlled trial. PLoS ONE 2016 Dec;11(12):e0168330.
Rice LA, Smith I, Kelleher AR, et al. Impact of the clinical practice guideline for preservation of upper limb function on transfer skills of persons with acute spinal cord injury. Archives of Physical Medicine and Rehabilitation 2013 Jul;94(7):1230-1246.
Yeo SS, Kwon JW. Wheelchair Skills Training for Functional Activity in Adults with Cervical Spinal Cord Injury. International journal of sports medicine 2018; 39: 924-928.
Worobey LA, Kirby RL, Heinemann AW et al Effectiveness of Group Wheelchair Skills Training for People With Spinal Cord Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2016 Oct;97(10):1777-1784.