Gaps in Wheelchair Skills Training: Clinician Confidence, Capacity, and Service Provision in US Rehabilitation Practice.

BACKGROUND

Clinician ability to teach wheelchair skills varies widely and has not been characterized in the US. Identifying gaps in clinician capacity is integral to improving service provision and client outcomes.

OBJECTIVES

To describe clinicians' capacity and confidence in performing and teaching wheelchair skills in the US.

METHODS

This was a cross-sectional survey conducted as part of a larger trial. A convenience sample of 234 rehabilitation therapists was surveyed. Measures included the Self-Efficacy for Assessing, Training, and Spotting Test for Manual Wheelchairs (SEATS), the Wheelchair Skills Test Questionnaire 5.1 (WST-Q), and data on training quantity (number of trainees, duration) and quality (skills trained, trainee skill mastery).

RESULTS

Over a 6-month period, clinicians trained a median of 2 people for 60 minutes on 2 skills per trainee, predominantly in inpatient settings (P < .001). For advanced skills, most clinicians reported being "not at all" confident in teaching. The number of trainees and trainee skill mastery were low across all skills and were nearly absent for community/advanced skills. SEATS scores for training (45%) were lower (P < .001) compared to spotting (68%) and assessing (57%). Clinicians' WST-Q capacity (33%) and confidence (30%) scores were low. Years of practice did not influence outcomes. Correlations were strong within WST-Q domains (R = 0.904) and SEATS domains (R = 0.707 to 0.724) and moderate between number of skills trained and SEATS training (R = 0.569).

CONCLUSION

Clinicians lack confidence and infrequently train users, focusing mostly on basic skills. Higher clinician competency correlates with greater confidence and a wider variety of skills taught.