Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review

Objective: To comprehensively assess the effectiveness and safety of wheelchair skills training program in improving wheelchair skills capacity. Data sources: PubMed, OVID, EBSCO, ScienceDirect, Web of Science, CINAHL, Cochrane Library, Google Scholar, and China Knowledge Resource Integrated Database were searched up to March 2017. Methods: Controlled clinical trials that compared a wheelchair skills training program with a control group that received other interventions and used the wheelchair skills test scores to evaluate wheelchair skills capacity were included. Two authors independently screened articles, extracted data, and assessed the methodological quality using the Cochrane risk-of-bias tool in randomized controlled trial (RCT) and methodological index for non-randomized studies. The data results of wheelchair skills test scores were extracted. Results: Data from 455 individuals in 10 RCTs and from 140 participants in seven non-randomized studies were included for meta-analysis using Stata version 12.0 (Stata Corporation, College Station, TX, USA). In the short term (immediately to one week) post-intervention, relative to a control group, manual wheelchair skills training could increase the total wheelchair skills test scores by 13.26% in RCTs (95% confidence interval (CI), 6.19%-20.34%; P<0.001) and by 23.44% in non-randomized studies (95% CI, 13.98%-32.90%; P<0.001). Few adverse events occurred during training; however, compared with a control group, evidence was insufficient to support the effectiveness of powered wheelchair skills training and the long-term (3-12months) advantage of manual wheelchair skills training (P=0.755). Conclusion: The limited evidence suggests that wheelchair skills training program is beneficial in the short term, but its long-term effects remain unclear.