Janssen Rowie J F, van Dilgt Melle, van Hutten Kim, Vegter Riemer J K, de Groot Sonja, Berger Monique
Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, The Netherlands.
Disabil Rehabil Assist Technol. 2025 Jul 18:1-14. doi: 10.1080/17483107.2025.2531242.
Wheelchair optimisation in clinical settings often relies on expert opinion from static wheelchair seating posture. A wheelchair ergometer provides biomechanical and physiological insights during propulsion. This study assessed the reliability of propulsion technique and physiological parameters in submaximal and sprint tests and used these values to compare two hand rim types.
Nineteen non-wheelchair users completed two exercise blocks per hand rim type (Gekko vs. conventional) on a wheelchair ergometer. Each block included a 4-min submaximal test and a 30 s sprint. The intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were calculated to assess reliability for one to four exercise blocks. Hand rim differences were analysed using a mixed-effects model.
Submaximal propulsion technique showed good to excellent reliability (ICC = 0.75-1.00), while physiological variables and sprint propulsion technique had moderate to excellent reliability (ICC = 0.5-0.95). SDCs ranged from 12 to 29% (submaximal) and 13 to 25% (sprint), except for negative power variables (25-70%). Averaging the two, three or four tests reduced SDCs by 29%, 42% and 50%, respectively, compared to one test. The Gekko rim outperformed the conventional rim in negative power (submaximal) and in distance, velocity and power (sprints).
The submaximal test demonstrated better reliability and lower SDCs than the sprint test. The Gekko rim performed better at group level but not for every individual. Using SDCs instead of group results enhances clinical relevance. Future research should validate these findings in wheelchair users to support evidence-based wheelchair setup recommendations.Implications for rehabilitationThe study showed that submaximal propulsion technique has good-to-excellent reliability, while submaximal physiological parameters and sprint propulsion technique showed moderate-to-excellent reliability. Smallest detectable change (SDC) values varied, with higher values seen in negative power and physiological parameters, and generally higher SDCs in the sprint test.Although group-level statistics showed significant differences in propulsion technique (favouring the Gekko hand rim), individual analysis using SDC cut-offs revealed variations among participants. This highlights that wheelchair adaptations should be evaluated at an individual level, as group results may not capture important differences that matter for specific users.To detect the most meaningful individual differences, it is recommended to average the results of four tests. However, since the most significant reduction in SDCs occurs between one and two tests, at least two tests should be conducted when time or physical capacity is limited.The findings are not only relevant for comparing hand rims. SDC thresholds can be used to assess a wide range of individual factors, such as propulsion technique, fitness or wheelchair features (e.g., seat height). These thresholds can help tailor interventions based on the unique needs of each wheelchair user.
临床环境中的轮椅优化通常依赖于静态轮椅坐姿的专家意见。轮椅测力计可在推进过程中提供生物力学和生理学见解。本研究评估了次最大强度测试和冲刺测试中推进技术和生理参数的可靠性，并使用这些值比较两种手轮类型。
19名非轮椅使用者在轮椅测力计上针对每种手轮类型（壁虎型与传统型）完成了两个运动组块。每个组块包括一个4分钟的次最大强度测试和一个30秒的冲刺。计算组内相关系数（ICC）、测量标准误差（SEM）和最小可检测变化（SDC）以评估一至四个运动组块的可靠性。使用混合效应模型分析手轮差异。
次最大强度推进技术显示出良好至极佳的可靠性（ICC = 0.75 - 1.00），而生理变量和冲刺推进技术具有中等至极佳的可靠性（ICC = 0.5 - 0.95）。SDC范围为12%至29%（次最大强度）和13%至25%（冲刺），负功率变量除外（为25%至70%）。与一次测试相比，将两次、三次或四次测试的结果平均后，SDC分别降低了29%、42%和50%。在负功率（次最大强度）以及距离、速度和功率（冲刺）方面，壁虎型手轮优于传统型手轮。
次最大强度测试显示出比冲刺测试更好的可靠性和更低的SDC。壁虎型手轮在组水平上表现更好，但并非对每个个体都如此。使用SDC而非组结果可增强临床相关性。未来研究应在轮椅使用者中验证这些发现，以支持基于证据的轮椅设置建议。
对康复的启示
该研究表明，次最大强度推进技术具有良好至极佳的可靠性，而次最大强度生理参数和冲刺推进技术显示出中等至极佳的可靠性。最小可检测变化（SDC）值各不相同，在负功率和生理参数中较高，并且在冲刺测试中通常SDC更高。
尽管组水平统计显示推进技术存在显著差异（有利于壁虎型手轮），但使用SDC临界值的个体分析揭示了参与者之间的差异。这突出表明轮椅适配应在个体水平上进行评估，因为组结果可能无法捕捉对特定使用者重要的差异。
为了检测最有意义的个体差异，建议对四次测试的结果进行平均。然而，由于SDC的最大降幅发生在一次和两次测试之间，当时间或身体能力有限时，应至少进行两次测试。
这些发现不仅与比较手轮相关。SDC临界值可用于评估广泛的个体因素，如推进技术、体能或轮椅特征（如座位高度）。这些临界值可帮助根据每个轮椅使用者的独特需求调整干预措施。
