Psychometric properties of the International Society of Wheelchair Professionals' basic manual wheelchair-service-provision knowledge Test Version 1 and development of Version 2.

INTRODUCTION: Valid and reliable scores from measurement tools to test competency in basic manual wheelchair-service-provision are needed to promote good practice and support capacity building. The International Society of Wheelchair Professionals' (ISWP) Basic Test Version 1 in English, launched in 2015, is the most frequently used outcome measure tool to test basic manual wheelchair-service-provision knowledge and is part of an international certification process. Despite the wide acceptance and use of the test, its psychometric properties have not yet been established. The objectives of this study were 1) to evaluate the test's psychometric properties, 2) to develop the test's Version 2, and 3) to evaluate the content validity of the new version. METHODS: For Objective 1, methods from the Classical Test Theory were used to obtain items' difficulty, item discrimination index and domains' reliability. For Objective 2, a team of experts in wheelchair service delivery and education conducted a systematic qualitative review of the questions' text and answers and updated them using evidence-based guidelines. For Objective 3, an external team reviewed the clarity, relevance and domain allocation of the developed items using a 4-point Likert scale. Descriptive statistics were used to describe and characterize the results for each objective. Item-content (I-CVI) and Scale-content (S-CVI) validity indexes were calculated to compute content validity. RESULTS: For Objective 1, all domains in the test were below the threshold for acceptable internal consistency reliability; 80% of the total test pool (116 items from the total pool of 145) did not meet the thresholds for item difficulty and index of discrimination suggested in the literature. Of the items in the Test, 78% could be responded to intuitively and 66% did not distinguish between test-takers who were knowledgeable in the content area and those who were not. For Objective 2, experts found concerns such as items being grouped in the wrong domain, being repeated, not using person-first language, and using terms inconsistently. Thirty-four (23.4%) items were dropped and 111 (76.5%) were updated. In addition, 61 new items were developed. Members re-categorized the items and proposed a new classification of subdomains. For Objective 3, good agreement between subject-matter experts was found; the S-CVI calculated using the I-CVIs related to item clarity was 84% while using the I-CVIs related to item relevance was 98%. Only 7 items (4.1%) were deemed to be in the wrong domain and 4 items (2.3%) were considered irrelevant and dropped. CONCLUSION: The psychometric evidence in support of ISWP Basic Test Version 1 in English is suboptimal. A new set of items developed by experts in the field has shown excellent content validity. Ongoing assessments will be needed as ISWP Basic Test Version 2 is implemented and monitored.

Exercise perceptions among people with stroke: Barriers and facilitators to participation.

BACKGROUND/AIMS: People with stroke continue to lead sedentary lives despite the multiple benefits of exercise. Knowledge regarding stroke survivors' conception of exercise, which is essential for a thorough understanding of the barriers and facilitators to exercise, is lacking. This study aims to explore the perceptions of exercise among stroke survivors, including their concepts and definitions of exercise, as well as their perceptions of barriers and facilitators to exercise. METHODS: This study utilized a qualitative exploratory design. Focus groups were conducted with 11 community dwelling participants with stroke (mean 8 ± 3 years post stroke). Data was analysed using content analysis methods. FINDINGS: Six themes that provided information regarding participants' perceptions of exercise were identified: mobility, balance, self-efficacy, outcomes, support, and exercise as part of an active or healthy lifestyle. Although participants internalized specific benefits of exercise, they did not demonstrate an internalized link between exercise and stroke risk. Low self-efficacy was identified as a barrier to participating in exercise, whereas, support to exercise (e.g., external encouragement, qualified personnel) was identified as a facilitator. CONCLUSION: These findings may provide insight when developing exercise interventions which optimize adherence for people with stroke.

Feasibility of a 6-month exercise and recreation program to improve executive functioning and memory in individuals with chronic stroke.

BACKGROUND: Physical activity is beneficial for improving cognitive function in healthy older adults. However, research results on the benefits of physical activity on cognitive performance after stroke are limited. OBJECTIVE: To determine if a combined exercise and recreation program can improve the executive functioning and memory of individuals with chronic stroke. METHODS: In all, 11 ambulatory participants with chronic stroke (mean age 67 ± 10.8 years) participated in a 6-month program of exercise for 2 hours and recreation for 1 hour weekly. Executive functions and memory were assessed at baseline and at 3 and 6 months by a battery of standard neuropsychological tests, including response inhibition, cognitive flexibility, dual task (motor plus cognitive), and memory. Motor ability was also assessed. Nonparametric statistics were used to obtain the differences between the 3 assessments. RESULTS: At baseline, substantial deficits in all aspects of executive functioning were revealed. From baseline to 3 months, the mean improvement was 10% ± 14% for the dual task (Walking While Talking), -3% ± 22% (χ(2) = 2.4; P > .05) for response inhibition (Stroop Test), and 61% ± 69% for memory (Rey Auditory Verbal Learning Test-long delay). From baseline to 6 months, the mean improvement was 7% ± 7.5% for response inhibition (Stroop Test). In addition, knee strength and walking speed improved significantly at 3 months. CONCLUSIONS: This pilot study suggests that exercise and recreation may improve memory and executive functions of community-dwelling individuals with stroke. Further studies require a larger sample size and a control group.

Aerobic exercise during early rehabilitation for cervical spinal cord injury.

BACKGROUND AND PURPOSE: People with spinal cord injuries (SCIs), particularly those with injuries causing tetraplegia, are at risk for cardiovascular illnesses. There is a compelling need to address poor cardiovascular health as early as possible after cervical SCI. The purpose of this case report is to illustrate the process of aerobic exercise prescription during inpatient rehabilitation for cervical SCI. CASE DESCRIPTION: The patient was a 22-year-old man who had sustained a complete C5 SCI during a swimming accident 12 weeks before he participated in an aerobic exercise program. The program was developed to facilitate aerobic capacity while minimizing muscular fatigue. The patient attended 18 sessions over a 2-month period. OUTCOMES: The patient's exercise tolerance increased in terms of both exercise duration and exercise intensity. Measurements of cardiovascular health, taken before and after training, revealed substantial increases in peak oxygen uptake (20%) and orthostatic tolerance over the course of the program. DISCUSSION: The patient experienced typical complications associated with acute SCI (eg, orthostatic hypotension, urinary tract infections). He exhibited several signs of improved exercise tolerance and wheelchair mobility during the 2-month program, indicating potential cardiovascular and functional improvements from the exercise training.

Screening and habituation of functional electrical stimulation-leg cycle ergometry for individuals with spinal cord injury: a pilot study.

OBJECTIVES: To document the screening process and develop the habituation procedures prior to commencing a functional electrical stimulation leg cycle ergometry (FES-LCE) exercise program for individuals with spinal cord injury (SCI). DESIGN: This was a prospective descriptive study of screening and habituation for FES-LCE exercise for people with chronic SCI (injury duration longer than one year). SETTING: : Tertiary rehabilitation center. PARTICIPANTS: Thirteen subjects with SCI (mean years since injury, 7; mean age, 34.8 years; injury range, C4-T10; 7 males). MAIN OUTCOME MEASURES: Time to attain target cycle speed for 30 continuous minutes. RESULTS: Six of the 13 subjects were not eligible to start the FES-LCE habituation program because of previous fragility fracture, excessive spasticity, pain, autonomic dysreflexia, or lack of electrical stimulation response because of lower motor neuron damage in individuals with low thoracic injuries (T11-12). Time to attain target cycle speed for 30 continuous minutes ranged from 30 to 779 minutes (1-31 training sessions). CONCLUSIONS: Almost half of the individuals interested in participating in the FES-LCE exercise program did not pass the screening phase. Although the habituation phase was time-consuming for most of the participants who were able to use the FES-LCE, all reported few adverse effects to using the device once they completed this phase of training.