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.

Ethiopian-born and native Israeli school children have different growth patterns.

OBJECTIVE: Nutrition status of preschool children in Azezo, North West Ethiopia, and Ethiopian-born and native Israeli children aged 7 to 11 y and 12 to 15 y was studied. The aim of the study was to determine the growth patterns of immigrant children after changes in their nutritional habits. METHODS: The Ethiopian-born and native school children were recruited from a caravan-dwelling site and a boarding school and from a town adjacent to the caravan site and a boarding school, respectively. RESULTS: Weight for age was lower than -2 standard deviations of the Z score in 40.5%, 55.6%, 31.9%, and 61% of children aged 1 to 24, 25 to 36, 37 to 48, and 49 to 60 mo, respectively. Similarly, 18.9%, 59.3%, 39.1%, and 19.5% of children aged 1 to 24, 25 to 36, 37 to 48, and 49 to 60 mo had a height for age lower than -2 standard deviations of the Z score. The Ethiopian-born boys aged 7 to 11 y had lower body weight (P < 0.03), mean arm muscle circumference, plasma transthyretin and magnesium (P < 0.0001), and higher triceps skinfold thickness (P < 0.01) compared with the controls. Similarly, the Ethiopian-born girls had lower body weight (P < 0.006), weight-to-height ratio (P < 0.02), mean arm muscle circumference and plasma transthyretin, calcium, and magnesium (P < 0.0001), and higher triceps skinfold thickness (P < 0.0001) than their Israeli counterparts. Weight, weight-to-height ratio, mean arm muscle circumference, plasma calcium and magnesium (P < 0.0001), and transthyretin (P < 0.01) were lower and triceps skinfold thickness (P < 0.0001) was higher in the Ethiopian-born boarding school children than in the native Israelis of the same age range. CONCLUSIONS: The Azezo study confirmed that malnutrition-induced developmental impairment in preschool children is a major problem in Ethiopia. It is a manifestation of a rural economic and educational poverty and cannot be eradicated by palliative short-term nutritional programs. Although ethnicity and prenatal and postnatal malnutrition may have contributed, an insufficiency or imbalance of vital nutrients appeared to be the determinant factor for the lower relative growth of the Ethiopian-born children. The children from Ethiopia may have a propensity to avoid certain foods because of digestive intolerance or early childhood dietary habituation. Parental financial constraint may have been a factor in the younger group. These findings have implications for nutrition and welfare policies for children emigrating from developing countries.