Promotion of Para Athlete Well-being (PROPEL II): A Cross-sectional Study of Sleep in Para Athletes Across Two Nations.

OBJECTIVE: Limited research exists on the sleep profiles of South African Para athletes. The aims of this study are to describe sleep quality, day-time sleepiness, and chronotype of South African Para athletes and to compare the relationship between sleep-related outcomes and demographic factors to athletes from a higher-resource country. DESIGN: A descriptive, cross-sectional survey was conducted. Sleep-related characteristics were assessed with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Morningness-Eveningness Questionnaire. Multiple regression models were run with and without country as independent variable. RESULTS: One hundred twenty-four South African athletes and 52 Israeli athletes were included. Thirty percent of South African athletes presented with excessive daytime sleepiness, 35% slept 6 hrs or less per night, and 52% reported poor sleep quality. Thirty-three percent of Israeli athletes reported excessive daytime sleepiness, 29% slept 6 hrs or less, and 56% reported poor sleep quality. Chronotype was the only variable that differed significantly between countries (overrepresentation of morning types in South African athletes, and intermediate types in Israeli athletes). Intermediate chronotypes had significantly greater odds of excessive daytime sleepiness ( P = 0.007) and poor sleep quality ( P = 0.002) than morning types, irrespective of country. CONCLUSIONS: The high prevalence of poor sleep among both South African and Israeli Para athletes warrants further investigation.

Challenges and opportunities in wheelchair basketball classification- A Delphi study.

The International Paralympic Committee (IPC) mandates Paralympic Sports to develop evidence-based classification systems that allocate athletes into 'classes' according to the impact of their impairment on sport-specific performance. In wheelchair-basketball, a panel of classifiers assesses athlete's performance through observation. One key barrier to evidence-based classification is the absence of defined eligible impairments, including clear guidelines on how to assess them and their impact on wheelchair basketball performance. This study aims to reach expert consensus on issues specific to wheelchair basketball that can benefit from evidence-based classification. It offers recommendations for refining the classification manual, thus improving adherence to the IPC classification code. A three-round Delphi study was conducted with 29 experts in wheelchair basketball. The experts agreed with the new definition for the aim of wheelchair basketball classification, which is in line with the IPC code. Cases identified as having the highest risk for disagreement between classifiers included classifying players with upper limb deficiency or with impaired coordination. The panel failed to agree on changing the classification procedures and on defining the eligible impairment list. This study identifies issues specific to wheelchair basketball classification to be addressed in future research. Additional discussions need to take place to promote further resolution.

Wheelchair skills performance between discharge and one year after inpatient rehabilitation in hand-rim wheelchair users with spinal cord injury.

OBJECTIVE: To study possible changes in wheelchair skills in participants with spinal cord injury between discharge and 1 year after rehabilitation, and to determine whether changes in wheelchair skills performance are related to lesion and personal characteristics, self-efficacy, and wheelchair satisfaction. STUDY DESIGN: Prospective cohort study. SETTING: Eight rehabilitation centres with spinal cord injury units in the Netherlands. METHODS: A total of 111 participants performed the Wheelchair Circuit twice: at discharge (t1) and 1 year after discharge (t2). Personal/lesion characteristics, self-efficacy, and wheelchair satisfaction were measured. Normalized ability score and performance time score were analysed with a linear multilevel regression analysis for possible associations with wheelchair skills. RESULTS: No statistically significant changes were found in the ability and performance time scores of the Wheelchair Circuit over the first year after discharge. Younger persons, those with paraplegia, and those with a better self-efficacy score showed higher ability scores and faster performance time scores on both test occasions. CONCLUSION: Wheelchair skills performance, measured with the Wheelchair Circuit, did not change during the first year after discharge from inpatient rehabilitation. Wheelchair skills performance was associated with age, lesion level and self-efficacy perceptions.

Test of Wheeled Mobility (TOWM) and a short wheelie test: a feasibility and validity study.

OBJECTIVE: To assess the feasibility and validity of both the Test of Wheeled Mobility (TOWM) and a wheelie test. DESIGN: Cross-sectional study. SETTING: KU Leuven gymnasium. SUBJECTS: Thirty male manual wheelchair users (age range 23-53 years) with spinal cord injury. INTERVENTIONS: Participants preformed both tests after completing a personal information form and a 'Perceived self-efficacy in WM' scale. The TOWM consists of 30 tasks reflecting functional wheeled mobility. The wheelie test consists of eight tasks measuring the ability to perform a 'wheelie' in challenging situations. MAIN MEASURE: Ability, performance time, qualitative and anxiety scores were assessed. Convergent validity was tested by correlating the TOWM and the wheelie test scores. Construct validity was assessed by testing whether the four scores of both tests are significantly related to perceived self-efficacy in wheeled mobility, time since injury and sport participation. RESULTS: TOWM average total testing time was 24.7 minutes (±5.93) and the wheelie test was 12.62 minutes (±5.08). Convergent validity was confirmed by the positive correlation between the TOWM and wheelie test total ability scores (r = 0.84; P < 0.001), quality scores (r = 0.88) and anxiety scores (r = 0.66). Moderate correlations were found between the total time scores of the TOWM and wheelie test (r = 0.47). Construct validity was confirmed by fair to moderate correlations between both test's scores with time since injury, self-efficacy and sport participation after injury. CONCLUSION: The TOWM and the wheelie tests are feasible and valid instruments for assessing manual wheelchair mobility in persons with spinal cord injury.

Reliability and validity of perceived self-efficacy in wheeled mobility scale among elite wheelchair-dependent athletes with a spinal cord injury.

PURPOSE: To study the reliability and validity of the perceived self-efficacy in wheeled mobility scale among elite athletes with a spinal cord injury (SCI). METHOD: During the Beijing Paralympics, 79 participants with SCI completed the SCI Exercise Self-Efficacy Scale (ESES), the revised Self-Efficacy in Wheeled Mobility scale (SEWM) and the perceived wheeled mobility (WM) at present Visual Analog Scale (VAS). Sample included athletes from 18 countries and subcategorized by gender, lesion level/completeness and type of sports. Reliability and concurrent validity were determined. RESULTS: SEWM Cronbach's α was 0.905. High internal consistency was confirmed in Split-half correlation coefficient (r = 0.87). Validity was supported by significant correlations between SWEM and ESES total scores (r = 0.64, p < 0.05), and between SEWM and WM VAS scores (r = 0.60; p < 0.001). Subgroups analyses showed that athletes with tetraplegia showed significantly lower WM self-efficacy levels than those with paraplegia. There was a significant difference in perceived WM self-efficacy between athletes who participated in dynamic wheelchair sports and those who participated in non-wheelchair sports (p < 0.03). CONCLUSIONS: The SEWM is a reliable and valid scale among Paralympic athletes with SCI. Findings confirmed a significantly higher perception of self-efficacy in WM among athletes who participated in dynamic wheelchair sports. IMPLICATIONS FOR REHABILITATION: • Increased self-efficacy in wheeled mobility (WM) may encourage wheelchair users with spinal cord injury (SCI) to approach, persist, and persevere at WM related tasks that were previously avoided. • The perceived self-efficacy in WM scale (SEWM), which is available on-line in five different languages, may find clinical applications for people with SCI in different countries. • The SEWM can be applied to the assessment of progress in WM levels during the acute rehabilitation phase, and also in structured WM workshops conducted after discharge from the hospital.

Reliability of the test of wheeled mobility (TOWM) and the short Wheelie test.

OBJECTIVE: To assess the reliability of the Test of Wheeled Mobility (TOWM) and the Wheelie test. DESIGN: Cohort study. SETTING: Gymnasium. PARTICIPANTS: Manual wheelchair users (N=30, age 23-53y) with a spinal cord injury. INTERVENTION: Participants performed the 30 skills of the TOWM and the 8 skills of the Wheelie test twice. Ability, time, and anxiety scores were assessed on field. Quality scores were assessed by video analysis. MAIN OUTCOME MEASURES: Test-retest reliability was evaluated for the ability, time, anxiety, and quality scores of both tests. Intrarater and interrater reliability were determined on the basis of quality scores of 20 participants. Intraclass coefficient and nonparametric statistics were applied, as well as standard error of measurement, method error (ME), coefficient variation of ME, minimal detectable change (95% confidence), and technical error of measurement. RESULTS: Test-retest reliability: no significant differences between t1 and t2 in the ability, quality, and time scores, except for anxiety scores. Standard error of measurement, ME, coefficient variation of ME, and minimal detectable change (95% confidence) values were low for the ability and quality total score and higher for the time and anxiety total score. Intrarater and interrater reliability interclass correlation coefficients of both tests ranged between .91 and .99. Interrater relative technical error of measurement for the TOWM and the Wheelie test total quality score was 3.7% and 6.3%, respectively, and intrarater relative technical error of measurement was 4.3% and 6.1%, respectively. Interclass correlation coefficients per individual tasks ranged between .88 and 1.00, except for "level propulsion forward," which showed low interclass correlation coefficient scores (interrater: .49; intrarater: .44; test-retest: .43). CONCLUSIONS: Based on ability and quality total scores, the TOWM and the Wheelie test are reliable when assessing the wheeled mobility of manual wheelchair users with spinal cord injury. The quality criteria of 1 task from the TOWM and 3 tasks from the Wheelie test need to be refined.

Most essential wheeled mobility skills for daily life: an international survey among paralympic wheelchair athletes with spinal cord injury.

OBJECTIVES: To create a hierarchical list of the most essential wheeled mobility (WM) skills for everyday life of wheelchair users with a spinal cord injury (SCI), and to compare perceptions of WM gained during and after clinical rehabilitation. DESIGN: Cross-sectional study using survey questionnaires. SETTING: The Beijing Paralympic games, at the international zone of the Olympic village and in different sports venues. PARTICIPANTS: A sample of men (N=49) and women (N=30) elite manual wheelchair user athletes with SCI (paraplegia, n=64; tetraplegia, n=15). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: A survey with 24 predefined skills was distributed during the Beijing Paralympic games. Respondents were asked to rate the essentiality of each skill (1, not essential; 5, extremely essential); to state where, when, and with whom they have learned to perform each skill; and to mark the level of WM, which they gained during and after clinical rehabilitation, on 3 different WM visual analog scales (scores 1-10). RESULTS: Rated as the most essential skill was transfer into and out of a car (mean ± SD, 4.7±0.7). Rated as the least essential skill was the 1-handed wheelie (mean ± SD, 1.9±1.3). Of the respondents, 57% have learned the most essential skills in clinical rehabilitation, while 40% claimed to have learned those skills afterward in a community setting. Three percent have never learned to perform the most essential skills. Of the very essential skills, 40% were self-taught. Mean score ± SD for the extent to which WM skills were gained in rehabilitation was 5.4±2.5. CONCLUSIONS: The main survey outcome is a sorted list of WM skills according to their essentiality for daily life of hand-rim wheelchair users with SCI. It is recommended to incorporate the skills that were graded as very essential and extremely essential during inpatient rehabilitation and in postrehabilitation WM workshops.

Development of a new scale for perceived self-efficacy in manual wheeled mobility: a pilot study.

OBJECTIVE: To study the psychometric qualities of a perceived self-efficacy in wheeled mobility scale. DESIGN: Questionnaires. SUBJECTS: Forty-seven wheelchair basketball players with spinal cord injury (elite n=25, recreational n=22, from 6 different countries). METHOD: Based on the literature, and expert's and wheelchair user's comments, a new Self-Efficacy in Wheeled Mobility Scale (SEWM)1 was developed. Internal consistency (split-half and Cronbach's alpha) and concurrent validity (correlating the Self-Efficacy in Wheeled Mobility Scale with the Generalized Perceived Self-efficacy Scale (GSE) and the spinal cord injury Exercise Self-Efficacy Scale (ESES)) were assessed. To evaluate the construct validity, age, lesion level and completeness and time since injury between groups of participants and their total scores were compared statistically. RESULTS: Cronbach's alpha for the SEWM was 0.91, internal consistency was r=0.90. Significant correlations between pairs of scales of the entire sample (SEWM-ESES: 0.60; SEWM-GSE: 0.50 (p<0.05; n= 47, 2-tailed) and of the sub-group comparison (SEWM-ESES recreational r=0.61; elite r=0.73), demonstrated fair construct and concurrent validity of the SEWM. CONCLUSION: The SEWM was found to be reliable and valid in active spinal cord injury. A larger more diverse sample is needed to support the psychometric qualities of the SEWM scale.

A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure.

OBJECTIVE: To review, analyse, evaluate and critically appraise available wheelchair skill tests in the international literature and to determine the need for a standardized measurement tool of manual wheeled mobility in those with spinal cord injury. DATA SOURCES: A systematic review of literature (databases PubMed, Web of Science and Cochrane Library (1970-December 2009). SUBJECTS: Hand rim wheelchair users, mainly those with spinal cord injury. REVIEW METHODS: Studies' content and methodology were analysed qualitatively. Study quality was assessed using the scale of Gardner and Altman. RESULTS: Thirteen studies fell within the inclusion criteria and were critically reviewed. The 13 studies covered 11 tests, which involved 14 different skills. These 14 skills were categorized into: wheelchair manoeuvring and basic daily living skills; obstacle-negotiating skills; wheelie tasks; and transfers. The Wheelchair Skills Test version 2.4 (WST-2.4) and Wheelchair Circuit tests scored best on the Gardner and Altman scale, the Obstacle Course Assessment of Wheelchair User Performances (OCAWUP) test was found to be the most relevant for daily needs in a wheelchair. The different tests used different measurement scales, varying from binary to ordinal and continuous. Comparison of outcomes between tests was not possible because of differences in skills assessed, measurement scales, environment and equipment selected for each test. A lack of information regarding protocols as well as differences in terminology was also detected. CONCLUSION: This systematic review revealed large inconsistencies among the current available wheelchair skill tests. This makes it difficult to compare study results and to create norms and standards for wheelchair skill performance.

Effects of short-term awareness interventions on children's attitudes toward peers with a disability.

The purpose of this study was to explore the effect of two awareness activities on children's attitudes towards peers with a disability. The Children's Attitudes towards Peers with Disability scale including cognitive, behavioral and emotional subscales was administered before and after two types of short-term interventions. The first included 75 children from grades 7-9, who actively participated in the workshop simulating movement activities. The second intervention included 121 students of the 10th grade, who observed their peers participating in a wheelchair-basketball activity together with elite wheelchair-basketball players. Results indicated significant effects in the cognitive and behavioral domains. Post-test findings confirmed that intervention bridged the difference in the cognitive domain observed between those with and without previous contact at pretest.

Relation of functional physical impairment and goal perspectives of wheelchair basketball players.

This study examined the relation of functional classification in wheelchair basketball and its relation to the theory of psychological goal perspectives for 59 adult male competitive players. Participants completed the 13-item Task and Ego Orientation in Sport Questionnaire designed for wheelchair basketball players. Analyses indicated that Flemish wheelchair basketball players were similar in their goal perspectives to able-bodied athletes. The present sample was predominantly task-oriented. No significant differences were found between high-point and low-point players in their goal perspectives, indicating that players can be severely or minimally disabled and still share the same goal perspective and the same motivational profile. These findings are not consistent with the hypothesis that severity of disability is associated with the motivation profile of disabled athletes.