The impact of trunk impairment on performance of wheelchair activities with a focus on wheelchair court sports: a systematic review.
Trunk impairment seems to impact significantly on performance in wheelchair court sports, but evidence to support this impression has never been systematically assessed. The objective of this study is to systematically review, describe and synthesise the literature investigating the impact of trunk impairment on wheelchair activities in court sports.



This systematic review was performed according to the consensus statement for the meta-analysis of observational studies in epidemiology (MOOSE). The search strategy for original articles comprised Medline (1950- November 2014), Cinahl (1981-November 2014), and Embase (1980- November 2014), using the search terms: trunk, trunk muscles, postural balance, posture and wheelchair. Eligibility criteria for further review were 1) participants included experienced wheelchair users, 2) comparisons were made between a) participants with different levels of trunk impairment or b) between able bodied participants and participants with trunk impairment, or c) between participants with trunk impairment with and without compensatory equipment, and 3) outcome measures were quantitative data on wheelchair activities. For methodological quality assessment, the STROBE (Strengthening the reporting of observational studies in epidemiology) checklist was used.



After assessment of 358 potentially relevant studies for the eligibility criteria, 25 studies were appropriate for methodological assessment. Twelve articles fulfilled the predetermined minimum of 15 reported items on the 22-item STROBE checklist. These studies were limited to observational studies with small populations. All but one study were restricted to patients with spinal cord injury (SCI).



Limited evidence was found about the impact of trunk impairment on wheelchair activities. Reach to the front and multidirectional reach was further in able bodied persons than in persons with SCI. In a perturbation that equals deceleration in wheelchair court sports, able bodied persons maintain balance, whereas persons with SCI lose balance. No evidence was found to support a difference in acceleration between persons with partial trunk muscle strength and persons with full trunk muscle strength. For future research, there is a need for a test that includes all types of trunk impairment and identification of activities that determine performance in wheelchair court sports. Furthermore, populations of athletes with all trunk impairment types should be included.
Rehabilitation Centre, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
Viola C
VC
Altmann
Department of Physical Therapy and Athlete Training, Northern Arizona University, Flagstaff, Arizona USA.
Anne L
AL
Hart
Department of Rehabilitation sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Yves C
YC
Vanlandewijck
Achmea Health Insurance Company, Amersfoort, The Netherlands.
Jacques
J
van Limbeek
Sint Maartenskliniek, Research, Nijmegen, The Netherlands.
Miranda L
ML
van Hooff