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Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

, 103, 4, 798–806


Objective: To test the hypotheses that remote training improves trainer confidence and when these trainers train others the capacity and confidence of the trainees improves.

Design: Cohort study with pre- vs posttraining comparisons.

Setting: Four spinal cord injury model systems centers.

Participants: Convenience sample of 7 clinician trainers and 19 able-bodied trainees (N=26).

Interventions: Part 1 focused on trainer skill acquisition with self-study of the Wheelchair Skills Program Manual and instructional videos focused on motor learning, spotting, and 10 intermediate and advanced wheelchair skills. Trainers practiced in pairs, receiving asynchronous feedback on video recordings from a remote instructor. Part 2 included additional video modules targeted at "how to" assess and train others in 4 wheelchair skills: gets over obstacle, ascends low curb, ascends high curb with caregiver assistance, and performs stationary wheelie. Upon completion, the trainers each provided 1:1 in-person training for 2-3 trainees.

Main outcome measures: Trainer confidence was assessed using the Self-Efficacy on Assessing, Training, and Spotting Test for Manual Wheelchairs. Trainee capacity ("Can you do it?") and confidence ("How confident are you?") were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q).

Results: Trainer confidence increased for assessment (P=.003) and training (P=.002) but not spotting (P=.056). Trainee 4-item median (interquartile range) WST-Q scores significantly increased with training for capacity (13% [6-31] to 88% [75-88], P<.001) and confidence (13% [0-31] to 88% [81-100], P<.001).

Conclusions: Remote training improves trainers' confidence with respect to wheelchair skills testing and training and the wheelchair skills capacity and confidence of their trainees.


Lynn A Worobey, R Lee Kirby, Rachel E Cowan, Trevor A Dyson-Hudson, Mary Shea , Allen W Heinemann, Jessica Presperin Pedersen, Michael L Boninger

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