4 Functional Tasks for Wheelchairs

Last Updated

November 28, 2012

Purpose

The 4FTPSMW quantifies functional ability when manual wheelchair users employ different postural supports.

Link to Instrument

Instrument Details

Acronym 4FTPSMW

Assessment Type

Performance Measure

Cost

Not Free

Wheelchair Usage

Four skills:
1) Timed forward wheeling : distance=23 m plus length of wheelbase.
2) Forward vertical reach: individuals hold a 1 meter measuring stick in both hands with palms facing down, starting position is forearms parallel to thighs and raise the measuring stick up. The distance measure was from the floor to the highest point reached.
3) Ramp ascent (forward wheeling): The ramp was 10.3m long with a grade of 1:13. Participants were given a moving start of 4.5 meters on a level surface. Timing began when the front casters crossed the start line at the beginning of the incline and continued until the most posterior aspect of the rear wheel crossed the finish line at the top of the ramp.
4) One-stroke push: all four wheels positioned on carpet (1.5 cm pile). Participant propelled wheelchair forward by pushing once with maximal effort. Distance was measured by choosing the most posterior point of the rear wheel before and after propulsion.
Individuals use their current wheelchair and back support.
Recommend adequate rest breaks between each skill to avoid upper extremity fatigue.

Number of Items

Stop watch
Tape measure
Meter stick
Ramp (10.3, 1:13 grade)
Carpet (1.5cm pile)
Patient's manual wheelchair

30 minutes

30 Minutes to Complete 2 Trials

Required Training

No Training

Instrument Reviewers

Initially reviewed by Irene Ward, PT, DPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 6/2012.

ICF Domain

Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association��s Multiple Sclerosis Taskforce (MSEDGE), Parkinson��s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:

*Abbreviations:*
HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations for use based on acuity level of the patient:

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

Recommendations based on SCI AIS Classification:

	AIS A/B	AIS C/D
SCI EDGE	NR	NR

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
SCI EDGE	No	No	No	Not reported
TBI EDGE	No	No	No	Not reported

Considerations

This measure lacks rigorous psychometric testing. This review is based off of one article. No information specific to TBI was found in the review process.

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Normative Data

Manual wheelchair users: (May et al, 2003, n=9 for reliability testing, average age=33.1 years, range 23-70 years, male, all had a neurological condition affecting the spinal cord, all but 2 had been wheelchair dependent for less than 2 years)

Forward wheeling (seconds)- trial 1, trial 2
- Average score= 14.7, 14.6
- Standard deviation= 8.2, 7.3
- Minimum=6.9, 6.6
- Maximum= 34.3, 31.0
Forward vertical reach (cm)- trial 1, trail 2
- Average score= 160.7, 160.8
- Standard deviation= 9.1, 10.1
- Minimum=147.4, 145.6
- Maximum= 172.3, 173.6
Ramp ascent (s)- trial 1, trial 2
- Average score= 39.6, 34.4
- Standard deviation= 81.7, 70.1 (one participant need frequent rests)
- Minimum=3.2, 3.2
- Maximum= 255.1, 219.9
One-stroke push (cm)- trial 1, trial 2
- Average score= 102.1, 109.8
- Standard deviation= 38.4, 40.6
- Minimum= 45.7, 47.7
- Maximum= 175.5, 188.7

Test/Retest Reliability

Excellent test-retest reliability of all 4 functional tasks (r=.99, P<.001)

Interrater/Intrarater Reliability

Manual wheelchair users: (May et al, 2003, n=9 for reliability testing, average age=33.1years, range 23-70 years, male, all had a neurological condition affecting the spinal cord, all but 2 had been wheelchair dependent for less than 2 years)

Excellent interrater reliability for three of the four tasks, (ICC=.99, P<.001). The one-stroke push was added to replace one of the original four tasks, the ramp descent. Therefore, the interrater reliability for the one-stroke push was not calculated.

Content Validity

The four functional skills were chosen by a panel of clinicians with more then 5 years of experience, a clinical researcher, and clients.

Bibliography

May, L. A., Butt, C., et al. (2004). "Wheelchair back-support options: functional outcomes for persons with recent spinal cord injury." Arch Phys Med Rehabil 85(7): 1146-1150.

May, L. A., Butt, C., et al. (2003). "Measurement reliability of functional tasks for persons who self-propel a manual wheelchair." Arch Phys Med Rehabil 84(4): 578-583.

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