RESNA 27th International Annual Confence
Wheelchair Skills Training Program: Community-Based Training of Junior Occupational Therapy Students by More Senior Students
The hypothesis was tested that 2 nd year undergraduate occupational therapy (OT) students, who were taught by 3 rd year OT students using the Wheelchair Skills Training Program (WSTP) in a campus-community environment, would improve their abilities to perform wheelchair skills. After an average of 3 training sessions of about one hour each, the 46 2 nd year OT students' overall percentage scores on Wheelchair Skills Test 2.4 improved by a mean of 10.4 (SD7.9)% (p=0.000, 95 th percentile CI 8.2, 12.9). Skills in the Advanced Skill Level improved the most. This method of training was demonstrated to be a practical, effective and potentially sustainable means of wheelchair skills training for OT students.
Rehabilitation; training; occupational therapy; wheelchair; Wheelchair Skills Test; Wheelchair Skills Training Program
The wheelchair is a common and essential assistive device for individuals with severe movement limitations. However, proper training in the use of the wheelchairs is necessary for safe and efficient use. The Wheelchair Skills Training Program (WSTP 2.4) is a training protocol comprised of 50 wheelchair skills that vary in complexity and are categorized into Indoor, Community and Advanced Skill Levels. The WSTP has been shown to be a safe and effective method of training wheelchair users (1) and caregivers (2) to perform wheelchair skills.
Coolen et al (3) found that a brief formalized period of wheelchair skills training, added to the standard undergraduate occupational therapy (OT) curriculum, resulted in significantly greater overall improvements in wheelchair skills than a standard undergraduate OT curriculum alone. Training was provided to the students by research assistants using a standardized obstacle course. Given the success of the training in the undergraduate program, we felt that the means of making the training sustainable needed to be investigated. As a result, this study explored two main issues, the person providing the training and the location of the training.
The objective of this study was to test the hypothesis that 2 nd year undergraduate OT students, who were taught by their 3 rd year OT student peers using the WSTP within a campus-community environment, will improve their abilities to perform wheelchair skills.
We studied 46 of a possible 47 2 nd year OT students who had not yet received any wheelchair skills-related training from their undergraduate program. Forty-four of their peers in their 3 rd year of OT schooling provided the testing and training using the Wheelchair Skills Test (WST 2.4) and the WSTP 2.4 (4). The measurement properties of the WST have been reported (5). Forty-one (93%) of the 3rd year OT students had either participated in WST testing and/or WSTP training in the previous school year. The 3 rd year students also received a 2-hour refresher lecture prior to training the 2 nd year students. This lecture briefly reviewed the principles, skills and scoring of the WST and WSTP. Greater detailed information was made available electronically to all of the 3 rd year OT students in the form of the WSTP manual (4). The 3 rd year students were also encouraged to practice the skills before teaching them.
Testing and training of the skills was completed on the university's campus. As the WSTP is based on commonly found environmental barriers, on-campus locations were identified and descriptions and photos of the barriers were made available to the 3 rd year students. The obstacle specifications were adhered to as closely as possible. When deviations were necessary, we erred on the side of caution, making the skills more challenging. The most extreme deviations were that a hallway used was 10cm narrower and a portion of a slope was 3.1 degrees steeper than the WSTP specifications.
The 2nd year students were paired with their 3 rd year peers using 8 groups that were pre-assigned by the OT program. The groups were encouraged to further divide themselves and were directed to the WSTP manual for suggested trainer:trainee ratios. The students were asked to document comments, training ratios and the number and length of the sessions. Each group was given use of a conventional-weight folding wheelchair with a sling back and foam cushion. Each group was also provided with a spotter strap for use during training. The integrated testing and training protocol was used. Paired t tests were used to compare the total WST pre and post-test scores with a significance value of p<0.05.
The 3 rd year OT students trained the 2 nd year OT students over a mean of 5.6 (SD 2.2) days, in an average of 3 sessions. On average, the sessions lasted 58.8 minutes and the travel time across campus to the various training areas averaged 13 minutes per session. Trainer:trainee ratios varied from 1:1 to 3:3. On a few occasions trainers incorrectly failed or passed their trainees.
The 2 nd year OT students' overall WST percentage scores improved by an average of 10.4 (SD 7.9)% (p=0.000, 95 th percentile CI 8.2, 12.9). Improvements from pre to post-test scores were observed in all three skill levels, particularly in the Advanced Skills Level.
Overall, the training provided by the 3 rd year OT students improved the wheelchair skills of the 2 nd year students and feedback indicated that the protocol would be appropriate and sustainable with some modifications to address scoring errors. A possible solution for these problems would be to provide examples of the common scoring errors in the 2-hour refresher and have a printed version of the scoring criteria available for each group to refer to during testing and training sessions.
The locations were spread across the campus to enhance the students' appreciation of the accessibility of the school grounds. Although the average travel time per session was 13 minutes, students recommended that the training areas be located closer to each other to reduce the overall time required to complete the testing and training.
One limitation of the study is that it was completed within only one school's undergraduate program; however, the Dalhousie University program has been shown to be representative of other North American OT programs (3). Another limitation is that some of the skill areas were outdoors; weather may limit the seasons during which the protocol could be used. Finally, although the majority of the 3 rd year OT students were familiar with the WSTP, one cannot conclude that they all prepared themselves to be competent, confident testers and trainers. However, despite these limitations, significant improvements were observed in the total percentage WST scores.
The method of training junior OT students by more senior students, in a community setting, is a practical, effective and potentially sustainable means of wheelchair skills training for OT students.
This study was funded by the Canadian Institutes of Health Research and the Queen Elizabeth II Health Sciences Centre Research Fund. We thank Krista Best for her assistance.
Cher Smith BSc, Occupational Therapist,
Queen Elizabeth II Health Sciences
Centre,
Nova Scotia Rehabilitation Centre Site,
1341 Summer Street,
Halifax,
NS, Canada B3H 4K4.
Phone: (902) 473-3834;
E-mail: cher.smith@cdha.nshealth.ca.