title: Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise.
abstract: Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents.
  
  
  
  Mixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the 'COnsensus-based Standards for the selection of health Measurement Instruments' (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing.
  
  
  
  Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons.
  
  
  
  The newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice.
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, Utrecht, 3501 AA, The Netherlands. marleen.sol@hu.nl.|Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. marleen.sol@hu.nl.|De Hoogstraat Rehabilitation, Utrecht, The Netherlands. marleen.sol@hu.nl.
authors.forename: Marleen Elisabeth
authors.initials: ME
authors.lastname: Sol
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.|De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: Olaf
authors.initials: O
authors.lastname: Verschuren
authors.affiliation: De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: de Groot
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, Utrecht, 3501 AA, The Netherlands.|Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Janke Frederike
authors.initials: JF
authors.lastname: de Groot
mesh_terms: D004185:Disability Evaluation; D004867:Equipment Design; D006801:Humans; D051346:Mobility Limitation; D009048:Motor Skills / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000523:psychology; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014910:Wheelchairs
keywords: Children; Outcome measure; Wheelchair mobility; Wheelchair mobility skills