BACKGROUND

The Wheelchair Skills Program (WSP) is an integrated system that includes the Wheelchair Skills Test (WST) (1), the questionnaire version of the WST (WST-Q) (2), and the Wheelchair Skills Training Program (WSTP) (3-5). Version 3.2 of the WST allows one to test, with a 2-point scale (pass or fail), 57 representative skills objectively, simply and inexpensively (www.wheelchairskillsprogram.ca). The WSP was, until recently, only available in English. However, there are over 80 million people worldwide for whom French is their mother tongue. French is a language used in more than 50 countries, throughout North America (e.g. Canada), Europe (e.g. France, Belgium), Africa (e.g. Senegal, Maroc), Asia (e.g. Vietnam, Laos), and the Caribbean (e.g. Haiti). The WSP (Version 3.2) was translated into French-Canadian (www.wheelchairskillsprogram.ca/fre/) using methodological guidelines usually applied to the translation and trans-cultural adaptation of questionnaires (6,7). A series of iterative steps that met language, clinical, scientific and socio-cultural objectives were applied to produce French-Canadian versions of the WSP (WSP-F) and its components (i.e. the WST-F, WST-Q-F and WSTP-F) (8-10). Because the validity of the WSP-F may be limited to the Province of Quebec (Canada) French-Speaking population, where it was translated, and because translating the WSP into French appears to be an important step in internationalizing it, the general goal of this study is to determine if the WSP-F is linguistically and culturally valid for French-Acadian speaking wheelchair users in the Province of Nova Scotia (Canada). The objective of this study was to document the efficacy and to describe the linguistic and cultural quality of the WSTP-F through French-Acadian speaking wheelchair users of Nova Scotia.

METHODOLOGY

French-Acadian speaking wheelchair users from Nova Scotia were recruited. Wheelchair users recruited met the following general inclusion and exclusion criteria: 1) being a French-Acadian-speaking manual wheelchair user, 2) being eighteen (18) years of age or older, 3) expecting to require his/her wheelchair for more than 4 hours/day, and 4) involving in a rehabilitation process (including training in manual wheelchair use). Participants were recruited using advertising posters, Acadian and/or wheelchair users associations, and word of mouth. They were tested three times (T1, T2 and T3) with the WST-F (Version 3.2) at the Nova Scotia Rehabilitation Centre (Halifax, Canada). A series of 4 to 8 sessions of training of 30-60 minutes each were provided between T1 and T2. T3 tests were conducted approximately 3 months after T2. During the evaluation, no feedback was provided by the tester/trainer to the wheelchair user. After each testing and training sessions, opinions and/or comments of the wheelchair users and of the tester/trainer were also noted regarding his/her comprehension of the language used in the WSTP-F and the WST-F

RESULTS

To date, 2 men have been recruited and completed at least T1 and T2. Two other participants were recruited but did not complete any or only one testing session. Results are reported only for the participants who completed at least T1 and T2. Their sociodemographic data and information related to their wheelchairs are reported in Table 1. Participant #1 was evaluated twice (T1 and T2) only and participant #2 completed the three testing sessions (T1, T2 and T3). Because participant #2 propelled his wheelchair by himself and also with the help/support of his caregiver (his wife), he was tested in these 2 settings. WST-F results are reported at Table 2. Participant #1 did not report any language barrier. Participant #2 and/or his caregiver reported language barriers at 4 times on a total of 9 testing/training sessions and 1 information session (Table 3).

DISCUSSION

Our results show a WST-F relative improvement of +51% of the participant #1 between T1 and T2, results that are approximately twice than previous study on the efficacy of wheelchair skills training with English wheelchair users undergoing initial rehabilitation [4]. However, this improvement was possibly influenced by the fact that this participant changed his wheelchair between T1 and T2 in addition to the effect of training. We were not surprised to get such improvement with a spinal cord wheelchair user who started at a low wheelchair skills level considering his diagnosis (61.4%). So, we can say that the WSTP-F is as efficacious as the English version for this French-Acadian speaking wheelchair user. At the linguistic and cultural level, we can also say that the translation was excellent for this participant because no linguistic barrier was noted.

With participant #2, +6.4% relative improvement was noted between T1 and T2 and a similar diminution (-6.4%) was noted between T1 and T3 when he used his wheelchair by himself. Respective improvements of +13.0% and 2.5% were noted when the caregiver help to propel the wheelchair. We think that the difficulty in retaining information due to the diagnosis of this participant is one of the principal causes of those poorer results. It can suggest that it is important to train wheelchair users and caregivers together when we have a wheelchair user with a diagnosis of traumatic brain injury. Also, because retention at T3 is very low (only +2.5% relative to T1 and -12.1% relative to T2), this results suggest that follow-up training sessions can be needed to keep wheelchair skills. At the linguistic and cultural level, we observed that minor linguistic specifications can be needed. Those specifications do not need very much detailed explanation. It can suggest that even if an “international language” is used, probably that tester/trainer will always need to specify some wordings. Maybe more specifications will be needed if the cultural context is more different (e.g. in developing nations).

Although recruitment was difficult (4 individuals recruited including 2 dropouts over a period of 24 months), at least in a preliminary way, we accomplished our objectives of documenting the efficacy and the linguistic and cultural quality of the WSTP-F through French-Acadian speaking wheelchair users of Nova Scotia,. This observational study suggests that this French-Canadian version of the WSP, the WSP-F version 3.2 (testing and training components), is efficacious and valid for French-Acadian wheelchair users and probably also with other French-Speaking populations with some minor adjustments to the language used.