Kirby R Lee, Swuste Janneke, Dupuis Debbie J, MacLeod Donald A, Monroe Randi
Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
Arch Phys Med Rehabil. 2002 Jan;83(1):10-8. doi: 10.1053/apmr.2002.26823.
To evaluate the practicality, safety, reliability, validity, and usefulness of a new Wheelchair Skills Test (WST).
A pilot study with within-subject comparisons.
Rehabilitation center.
Twenty-four wheelchair users (11 with amputations, 4 with stroke, 3 with musculoskeletal disorders, 3 with spinal cord injury, 3 with neuromuscular disorders).
The WST.
Subjects were videotaped while performing 33 skills twice (>10d apart). Their ability to perform each skill was rated on a 3-point ordinal scale. The test-retest, intra-, and interrater reliabilities were determined. Each subject's occupational therapist completed a visual analog scale (VAS), reflecting a global rating of the subject's manual wheelchair skills. We assessed validity by evaluating whether the WST detected expected changes (construct validity) and how well the total WST scores correlated with the occupational therapists' global ratings (concurrent validity). Each occupational therapist also used a VAS to quantify the usefulness of the WST.
The mean time required to administer the WST was 29 minutes. There were no adverse incidents. For the test-retest, intra-, and interrater reliabilities, the correlations for the total scores were .65 (P =.001), .96 (P <.001), and .95 (P <.001), respectively. The 9 therapists unanimously endorsed 30 (91%) of the 33 WST skills. The correlation between the mean changes in the WST and global rating scores was .45 (P <.05). There was a slight negative relationship between total WST score and age (P <.05). There were no significant differences related to the diagnoses accounting for wheelchair use. Wheelchair users with more than 3 weeks of experience with their wheelchairs scored higher than those with less experience (P =.0085). The correlations between the WST and global rating scores ranged from .40 to .54 (P <.05). Through Rasch analysis, we eliminated 6 skills, with the remaining skills comprising a unidimensional screening test of wheelchair ability. The mean VAS score for perceived usefulness was 59%.
The WST is practical, safe, well tolerated, exhibits good to excellent reliability, excellent content validity, fair construct and concurrent validity, and moderate usefulness. This pilot study makes an important contribution toward meeting the need for a well-validated outcome measure of manual wheelchair ability.
评估一种新型轮椅技能测试（WST）的实用性、安全性、可靠性、有效性和实用性。
一项进行受试者自身对照的初步研究。
康复中心。
24名轮椅使用者（11名截肢者、4名中风患者、3名肌肉骨骼疾病患者、3名脊髓损伤患者、3名神经肌肉疾病患者）。
WST。
受试者在两次执行33项技能（间隔>10天）时进行录像。每项技能的执行能力按3分等级量表进行评分。确定重测信度、组内信度和组间信度。每位受试者的职业治疗师完成一份视觉模拟量表（VAS），反映对受试者手动轮椅技能的总体评分。我们通过评估WST是否能检测到预期变化（结构效度）以及WST总分与职业治疗师的总体评分之间的相关性（同时效度）来评估有效性。每位职业治疗师还使用VAS来量化WST的实用性。
实施WST所需的平均时间为29分钟。未发生不良事件。对于重测信度、组内信度和组间信度，总分的相关性分别为0.65（P = 0.001）、0.96（P < 0.001）和0.95（P < 0.001）。9名治疗师一致认可3项WST技能中的30项（91%）。WST平均变化与总体评分之间的相关性为0.45（P < 0.05）。WST总分与年龄之间存在轻微负相关（P < 0.05）。与导致使用轮椅的诊断无关的显著差异。使用轮椅经验超过3周的轮椅使用者得分高于经验较少者（P = 0.0085）。WST与总体评分之间的相关性在0.40至0.54之间（P < 0.05）。通过Rasch分析，我们剔除了6项技能，其余技能构成了一项关于轮椅能力的单维度筛查测试。感知实用性的VAS平均得分为59%。
WST实用、安全、耐受性良好，具有良好至优秀的可靠性、优秀得内容效度、尚可的结构效度和同时效度以及中等实用性。这项初步研究为满足对手动轮椅能力进行有效验证的结果测量需求做出了重要贡献。
