Clinical trial NCT04009187: A Wheelchair Propulsion Training Program
Official title: Efficacy of a Wheelchair Propulsion Training Program for Manual Wheelchair Users: a Pilot Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Spinal Cord Injuries
Multiple Sclerosis
Amputation
Spina Bifida
Keywords: manual wheelchair
wheelchair propulsion
motor learning
Lead sponsor: Washington University School of Medicine
Sponsor class: OTHER
First posted: 2019-07-05
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The overall purpose of this project is to test the feasibility of a manual wheelchair propulsion program which aims to reduce the chance of development of upper limbs pain and injury.

Detailed description: The purpose of this project is to develop a feasible wheelchair propulsion training that can fit into an in-patient rehabilitation schedule, and determine the effectiveness of the training protocol. This project consists of a randomized control trial (RCT) for manual wheelchair users (MWUs) that examines the number of manual wheelchair propulsion repetitions required to produce change. For the RCT, we will recruit twenty individuals who use manual wheelchairs as their primary means of mobility and who do not follow the recommended clinical guidelines for propulsion. Participants will be randomized into two independent groups: motor learning repetitions overground (Training Group; n =10), and general education on recommended propulsion techniques (Education Group; n =10). Demographics, cognition, shoulder strength, participation, and wheelchair seating may only be assessed at baseline. Participants then may be assessed from the kinematics of their wheelchair performance overground and on a motorized treadmill. Participants may be tested on their wheelchair propulsion techniques in and outside of the lab, upper extremity pain at baseline, post-intervention, and three-week follow-up; participants may also be asked qualitative questions regarding the intervention experience, the experience with the equipment and the laboratory research, the monitoring setting, and the general experience with the research study.

The primary research question is that will repetition of proper propulsion technique practiced overground result in improved manual wheelchair propulsion biomechanics?

Eligibility criteria: Inclusion Criteria:

* 18-65 years of age
* have a mobility limitation requiring the use of a manual wheelchair (MWC)
* be able to self-propel a MWC bilaterally with their upper extremities
* plan to use a MWC for at least 75% of their activities throughout the day
* live in the community
* understand English at a sixth-grade level or higher
* can follow multi-step instructions
* able to provide informed consent independently
* able to tolerate propelling their wheelchair independently for 10m
* be willing to participate in three assessments and six training sessions at the Enabling Mobility in the Community Laboratory (EMC Lab).

Exclusion Criteria:

* maneuver their MWC with their lower extremities or with only one upper extremity
* display the proper wheelchair propulsion techniques during the screening process
* MWC position inhibits them from following the CPGs
* bilateral incoordination
* upper extremity strength inequalities resulting in a 12-inch deviation from a marked pathway
* surgeries compromising the integrity of the upper extremities
* cardiovascular complications within the past year
* upper extremity or overall bodily pain is rated 8/10 or higher per the Wong-Baker FACES Numeric Pain Scale (FACES)
* currently receiving medical treatment for an acute upper extremity injury
* have a Stage IV pressure injury or are currently hospitalized

Primary outcomes:
measure: Motion capture - changes in push angle
timeFrame: Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
measure: Motion capture - changes in hand-axle distance
timeFrame: Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
measure: Wheelchair Propulsion Test (WPT) - changes in effectiveness
timeFrame: Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
measure: Wheelchair Propulsion Test (WPT) - changes in cadence
timeFrame: Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
measure: Wheelchair Propulsion Test (WPT) - changes in propulsion pattern
timeFrame: Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
measure: Outdoor propulsion - ratio of efficient propulsion pattern
timeFrame: Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
Secondary outcomes:
Other outcomes:
Locations:
city: Saint Louis
country: United States
facility: Washington University School of Medicine
state: Missouri
Study officials:
affiliation: Washington University School of Medicine
name: Kerri Morgan, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Boninger ML, Souza AL, Cooper RA, Fitzgerald SG, Koontz AM, Fay BT. Propulsion patterns and pushrim biomechanics in manual wheelchair propulsion. Arch Phys Med Rehabil. 2002 May;83(5):718-23. doi: 10.1053/apmr.2002.32455.
citation: Morgan KA, Tucker SM, Klaesner JW, Engsberg JR. A motor learning approach to training wheelchair propulsion biomechanics for new manual wheelchair users: A pilot study. J Spinal Cord Med. 2017 May;40(3):304-315. doi: 10.1080/10790268.2015.1120408. Epub 2015 Dec 16.
citation: Will, K., Engsberg, J. R., Foreman, M., Klaesner, J., Birkenmeier, R., & Morgan, K. A. (2015). Repetition based training for efficient propulsion in new manual wheelchair users. Journal of Physical Medicine, Rehabilitation & Disabilities, 1(001), 1-9.
citation: Morgan KA, Engsberg JR, Gray DB. Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives. Disabil Rehabil Assist Technol. 2017 Jan;12(1):28-38. doi: 10.3109/17483107.2015.1063015. Epub 2015 Jul 3.
citation: Paralyzed Veterans of America Consortium for Spinal Cord Medicine. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005;28(5):434-70. doi: 10.1080/10790268.2005.11753844. No abstract available.
citation: Sawatzky B, DiGiovine C, Berner T, Roesler T, Katte L. The need for updated clinical practice guidelines for preservation of upper extremities in manual wheelchair users: a position paper. Am J Phys Med Rehabil. 2015 Apr;94(4):313-24. doi: 10.1097/PHM.0000000000000203.
citation: Askari S, Kirby RL, Parker K, Thompson K, O'Neill J. Wheelchair propulsion test: development and measurement properties of a new test for manual wheelchair users. Arch Phys Med Rehabil. 2013 Sep;94(9):1690-8. doi: 10.1016/j.apmr.2013.03.002. Epub 2013 Mar 14.
citation: MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil. 2004 Jan;85(1):41-50. doi: 10.1016/s0003-9993(03)00364-2.
citation: Axelson, P., Chesney, D. Y., Minkel, J., & Perr, A. (1996). The manual wheelchair training guide. Santa Cruz, CA: Pax Press,1996.
citation: Kirby RL, Dupuis DJ, Macphee AH, Coolen AL, Smith C, Best KL, Newton AM, Mountain AD, Macleod DA, Bonaparte JP. The wheelchair skills test (version 2.4): measurement properties. Arch Phys Med Rehabil. 2004 May;85(5):794-804. doi: 10.1016/j.apmr.2003.07.007.
citation: Rice IM, Pohlig RT, Gallagher JD, Boninger ML. Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback. Arch Phys Med Rehabil. 2013 Feb;94(2):256-63. doi: 10.1016/j.apmr.2012.09.014. Epub 2012 Sep 26.
citation: DeGroot KK, Hollingsworth HH, Morgan KA, Morris CL, Gray DB. The influence of verbal training and visual feedback on manual wheelchair propulsion. Disabil Rehabil Assist Technol. 2009 Mar;4(2):86-94. doi: 10.1080/17483100802613685.
citation: Rice LA, Smith I, Kelleher AR, Greenwald K, Boninger ML. Impact of a wheelchair education protocol based on practice guidelines for preservation of upper-limb function: a randomized trial. Arch Phys Med Rehabil. 2014 Jan;95(1):10-19.e11. doi: 10.1016/j.apmr.2013.06.028. Epub 2013 Jul 13.
citation: Klaesner J, Morgan KA, Gray DB. The development of an instrumented wheelchair propulsion testing and training device. Assist Technol. 2014 Spring;26(1):24-32. doi: 10.1080/10400435.2013.792020.