title: Impact of a wheelchair education protocol based on practice guidelines for preservation of upper-limb function: a randomized trial.
abstract: OBJECTIVE
  To determine if strict use of the Paralyzed Veterans of America's Clinical Practice Guidelines for Preservation of Upper Limb Function affects wheelchair setup, selection, propulsion biomechanics, pain, satisfaction with life, and participation of individuals with new spinal cord injuries (SCIs).
  
  
  METHODS
  Single blinded, randomized controlled trial.
  
  
  METHODS
  Model SCI systems rehabilitation facility and community.
  
  
  METHODS
  Volunteer sample of manual wheelchair users with new SCIs (N=37).
  
  
  METHODS
  The intervention group was strictly educated on the clinical practice guideline by a physical therapist and an occupational therapist in an inpatient rehabilitation facility. The standard of care group received standard therapy services.
  
  
  METHODS
  Comparison of wheelchair setup, selection, propulsion biomechanics, pain, and Satisfaction With Life Scale and Craig Handicap Assessment and Reporting Technique scores at the time of discharge from inpatient rehabilitation and at 6 months and 1 year postdischarge.
  
  
  RESULTS
  Participants in the intervention group pushed on tile with significantly lower push frequency (P=.02) at the discharge visit. On the ramp, the intervention group used a significantly larger push length (P=.03) across all time points. No significant differences were found between groups related to wheelchair setup, selection, pain, satisfaction with life, and participation.
  
  
  CONCLUSIONS
  The intervention group showed better skills on key wheelchair propulsion biomechanics variables related to upper-limb health. Use of a structured education program may be an effective method of educating new manual wheelchair users to prevent the development of upper-limb impairments in an inpatient setting. Additional follow-up testing is necessary to determine whether the differences seen in propulsion skills translate into decreased pain and improved quality of life in the long term.
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL. Electronic address: ricela@illinois.edu.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Rice
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Ian
authors.initials: I
authors.lastname: Smith
authors.affiliation: Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Annmaire R
authors.initials: AR
authors.lastname: Kelleher
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Karen
authors.initials: K
authors.lastname: Greenwald
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA; Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D010549:Personal Satisfaction; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D058992:Social Participation; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D034941:Upper Extremity / Q000502:physiology*; D014910:Wheelchairs
keywords: CPG; DC; IG; MWC; Medical education; NRS; Rehabilitation; SCG; SCI; Spinal cord injuries; WUSPI; Wheelchair; Wheelchair Users Shoulder Pain Index; clinical practice guideline; discharge study visit; intervention group; manual wheelchair; numeric rating scale; spinal cord injury; standard of care group