Keeler Laura, Kirby R Lee, Parker Kim, McLean Katie D, Hayden Jill A
a Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada.
b Division of Physical Medicine and Rehabilitation, Department of Medicine , Dalhousie University , Halifax , NS , Canada.
Disabil Rehabil Assist Technol. 2019 May;14(4):391-409. doi: 10.1080/17483107.2018.1456566. Epub 2018 Apr 4.
To conduct a systematic review synthesizing the evidence for the effectiveness of the Wheelchair Skills Training Program (WSTP).
We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to 10 October 2017.
Randomized controlled trials (RCTs) assessing the effectiveness of the WSTP.
Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane's Risk of Bias Tool.
Meta-analyses (including sub-group analyses) were conducted for the Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen articles (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; p < .0001) compared to no treatment, standard care or educational controls, a relative increase over baseline of 21.2%. Subgroup analyses showed that training was more effective for new wheelchair users. Retention of training effects was suggested by the absence of significant declines between tests post-training and at follow-up. The WSTP was found to have positive effects on some other outcomes. No serious adverse events were reported.
There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes. Implications for rehabilitation A systematic review and meta-analysis of 13 randomized controlled trials on a total of 581 participants, using the Wheelchair Skills Training Program (WSTP) as the intervention, found that the WSTP increased Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores by 21.2% relative to baseline. Subgroup analyses showed that training was more effective for new wheelchair users. The WSTP was found to have positive effects on some other outcomes and no serious adverse events were reported. The WSTP warrants cautious implementation in clinical and educational settings.
进行一项系统综述，综合有关轮椅技能培训计划（WSTP）有效性的证据。
我们检索了截至2017年10月10日的PubMed、Cochrane图书馆、CINAHL和Embase数据库以及灰色文献。
评估WSTP有效性的随机对照试验（RCT）。
两名独立的评审员筛选文章并提取数据。使用Cochrane偏倚风险工具评估方法学质量。
对轮椅技能测试（WST）和WST问卷（WST-Q）的总能力得分进行荟萃分析（包括亚组分析）。我们对保留率、WST/WST-Q小计和个人技能能力得分以及其他确定的结果进行了定性评估。使用推荐分级、评估、制定和评价（GRADE）方法确定证据质量。纳入13篇文章（581名参与者）进行分析。证据水平为中等质量。与未治疗、标准护理或教育对照相比，WSTP使训练后WST/WST-Q的总能力得分提高了14.0%（95%CI：7.4，20.8；p < .0001），相对于基线的相对增幅为21.2%。亚组分析表明，培训对新轮椅使用者更有效。训练后测试与随访之间无显著下降，提示训练效果得以保留。发现WSTP对其他一些结果有积极影响。未报告严重不良事件。
有中等质量的证据表明，WSTP是一种安全的干预措施，对WST/WST-Q能力得分和其他一些结果具有临床意义的影响。对康复的启示一项对总共581名参与者的13项随机对照试验进行的系统综述和荟萃分析，以轮椅技能培训计划（WSTP）作为干预措施，发现WSTP相对于基线使轮椅技能测试（WST）和WST问卷（WST-Q）的总能力得分提高了21.2%。亚组分析表明，培训对新轮椅使用者更有效。发现WSTP对其他一些结果有积极影响，且未报告严重不良事件。WSTP值得在临床和教育环境中谨慎实施。
