Manual Wheelchair Skills Training: Lessons Learned in Long-Term Care

Cher Smith, BScOT, R. Lee Kirby, MD, Lynn Brown, BScOT, Laura Smith, BASc

Division of Physical Medicine and Rehabilitation, Department of Medicine (Kirby, Smith L) and School of Health and Human Performance (Smith C), Dalhousie University; and Department of Occupational Therapy (Brown), Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.


The objective of this study was to evaluate, in a Veterans’ long-term care setting, the efficacy of the Wheelchair Skills Training Program with manual wheelchair users. A randomized controlled trial with 24 participants, stratified for dementia as a primary diagnosis, was planned. After 15 months of data collection the study was stopped due primarily, to issues of recruitment and retention. Wheelchair Skills Test data was collected on 13 participants as was information on wheelchair specifications, use, satisfaction, goals and training history. During data collection barriers such as shortening lengths of stay, influenza quarantines, recreation activities, wheelchair provision and fluctuating health status all had an impact on participation. In spite of the challenges, participants reported benefits. Further research in the area is needed.


wheelchair; long-term care; training


Life expectancies in industrialized countries are on the rise (1). Along with this increase comes the expectation of a greater number of individuals living with disabilities (2). The combination of an aging population and greater disability has created a greater number of people needing to reside in long-term care (LTC) facilities. With an estimate of over 2M wheelchair users in the United States, many LTC residents are wheelchair users (3).

Although the mobility benefits of wheelchair use are not debatable, there are also problems associated with the use of wheelchairs. Overuse injuries, tips and falls (4), improper wheelchair components, setup and use lead to increased mobility limitations (5). Often wheelchairs are provided with little or no instruction on how to safely use the device in various situations and environments that users can expect to encounter. In the case of LTC residents, these environments may include a single wing of the facility or the entire facility and its immediate community. The Wheelchair Skills Program (WSP) has been shown to be a safe and efficacious training program for wheelchair users [(6), (7)]. Although it has been used successfully in a number of communities and with varied populations, its efficacy in the LTC setting has not be thoroughly explored. The objective of this study was to evaluate, in the long-term-care setting, the efficacy of the Wheelchair Skills Training Program (WSTP) with respect to manual wheelchair users.


This study was to be a randomized controlled trial with 24 manual wheelchair users residing in a Veterans’ long-term care facility. The participants were to be randomly allocated into training and control groups with stratification for dementia as the primary diagnosis. All participants were to complete a baseline Wheelchair Skills Test Version 4.1 (WST) (8). The treatment group was to then receive up to 8 WSTP training sessions. Four weeks following completion of the WSTP sessions, a second WST was to be administered. Information on demographics, wheelchair specifications, use, satisfaction, goals and training history was also to be collected.


After 15 months of data collection the study was stopped due primarily, to issues of recruitment and retention. Thirty-two manual wheelchair users were willing to be in the study. Nineteen completed consent and had physician approval to participant. Thirteen participants provided WST data with 9 having completed the WST and 4 having partially completed the WST.


The 15 months of data collection provided an enhanced understanding of the changing climate of wheelchair users living in LTC facilities. The experience indicated that the availability of participants was much more reduced than in other environments such as rehabilitation centres or in the community. Multiple visits on multiple days were required to complete a small amount of data collection. As expected, it required longer to complete each test, often multiple sessions, and the length of sessions were generally required to be very brief. The excellent Recreation Department provided plenty of opportunities for participants to be at garden parties or engaging in other regularly scheduled activities which added to challenges with scheduling. The number of co-morbidities of the participants also impacted their ability to participate. There was rapid fluctuation in health status that extended participants’ enrollment in the study over months instead of the intended 4 weeks. Some participants who were quite able to participate at the beginning of the study experienced rapid declines in health and were forced to drop out. As well, influenza quarantines were placed on different units preventing all of the units’ residents from participating for weeks at a time. The number of manual wheelchairs in the facility was a limitation that was also underestimated. As the funding for seating equipment is quite accessible, a much higher percentage of the residents used powered wheelchairs in the test facility than is believed to be representative of other Nova Scotia facilities.

With the presentation of the barriers came a better understanding of the changing needs of wheelchair users in LTC facilities. Although the study was stopped, while participants were in the study there were reports by the wheelchair users that participation was a positive experience; a type of challenge that was needed. Given the observations and participant feedback, future efforts may incorporate skills training into existing activities and recreation programs to create more succinct and meaningful training opportunities. To better meet the wheelchair skills training needs of LTC residents, further research is needed to identify the most beneficial skills and the appropriate contexts for providing positive mobility experiences.


  1.  Abbott A, Wellmann A. Growing old gracefully. Nature 2004;428:116-8.
  2. Statistics Canada - Health Indicators. [Online databases] Data report; November 2003, Available from: URL:
  3. Jones M, Sanford JA. People with mobility impairments in the United States today and in 2010.  Assist Technol 1996;8:43-53.
  4. Ummat S, Kirby RL. Nonfatal wheelchair-related accidents reported to the national electronic injury surveillance system. Am J Phys Med Rehab 1994;73:163-7.
  5. Aissaoui R, Arabi H, Lacoste M, Zalzal V, Dansereau J. Biomechanics of mechanical wheelchair propulsion in elderly: system tilt and back recline angles. Am J Phys Med Rehabil 2002;81:94-100.
  6. MacPhee, A.H., Kirby, R.L., Coolen, A.L., Smith, C., MacLeod, D.A., Dupuis, D.J. (2004). Wheelchair skills training program: a randomized clinical trial on wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil, 85, 41-50.
  7. Best, K.L., Kirby, R.L., Smith, C., MacLeod, D.A. (2005). Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil, 86, 2316-23.
  8. Wheelchair Skills Program.

Correspondence to:

Cher Smith, Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Occupational Therapy Dept., 1341 Summer Street, Halifax, NS, Canada B3H 4K4. E-mail: