Sensitivity to change of the field-based Wheelchair Mobility Performance Test in wheelchair basketball


de Witte, A.M.H.; Sjaarda, F.S.F.; Helleman, J.; Berger, M.A.M.; van der Woude, L.H.V.; Hoozemans, M.J.M.

Journal of Rehabilitation Medicine 50(6): 556-562

2018


The Wheelchair Mobility Performance (WMP) test is a reliable and valid measure to assess mobility performance in wheelchair basketball. The aim of this study was to examine the sensitivity to change of the WMP test by manipulating wheelchair configurations. Sixteen wheelchair basketball players performed the WMP test 3 times in their own wheelchair: (i) without adjustments ("control condition"); (ii) with 10 kg additional mass ("weighted condition"); and (iii) with 50% reduced tyre pressure ("tyre condition"). The outcome measure was time (s). If paired t-tests were significant (p < 0.05) and differences between conditions were larger than the standard error of measurement, the effect sizes (ES) were used to evaluate the sensitivity to change. ES values ≥0.2 were regarded as sensitive to change. The overall performance times for the manipulations were significantly higher than the control condition, with mean differences of 4.40 s (weight - control, ES = 0.44) and 2.81 s (tyre - control, ES = 0.27). The overall performance time on the WMP test was judged as sensitive to change. For 8 of the 15 separate tasks on the WMP test, the tasks were judged as sensitive to change for at least one of the manipulations. The WMP test can detect change in mobility performance when wheelchair configurations are manipulated.

J
Rehabil
Med
2018;
50:
556-562
ORIGINAL
REPORT
Check
for
updates
SENSITIVITY
TO
CHANGE
OF
THE
FIELD-BASED
WHEELCHAIR
MOBILITY
PERFORMANCE
TEST
IN
WHEELCHAIR
BASKETBALL
Annemarie
M.
H.
DE
WITTE,
MSc
1,2
,
Fleur
S.
F.
SJAARDA,
MSc
2
,
Jochem
HELLEMAN,
MSc
2
,
Monique
A.
M.
BERGER',
Lucas
H.
V.
VAN
DER
WOUDE
3,4
and
Marco
J.
M.
HOOZEMANS
2
From
the
'The
Hague
University
of
Applied
Sciences,
The
Hague,
2
Department
of
Human
Movement
Sciences,
Vrije
Universiteit
Amsterdam,
Amsterdam
Movement
Sciences,
Amsterdam,
3
Centre
for
Human
Movement
Sciences
and
4
Centre
for
Rehabilitation,
University
Medical
Centre
Groningen,
University
of
Groningen, Groningen,
The
Netherlands
Objective:
The
Wheelchair Mobility
Performance
(WMP)
test
is
a
reliable
and
valid
measure
to
assess
mobility
performance
in
wheelchair
basketball.
The
aim
of
this
study
was
to
examine
the
sensitivity
to
change
of
the
WMP
test
by
manipulating
wheelchair
configurations.
Methods:
Sixteen
wheelchair
basketball
players
per-
formed
the
WMP
test
3
times
in
their
own
wheel-
chair:
(i)
without
adjustments
("control
condition");
(ii)
with
10
kg
additional
mass
("weighted
condi-
tion");
and
(iii)
with
50%
reduced
tyre
pressure
("tyre
condition").
The
outcome
measure
was
time
(s).
If
paired
t-tests
were
significant
(p
<
0.05)
and
differences
between
conditions
were
larger
than
the
standard
error
of
measurement,
the
effect
sizes
(ES)
were
used
to
evaluate
the
sensitivity
to
change.
ES
values
z0.2
were
regarded
as
sensitive
to
change.
Results:
The
overall
performance
times
for
the
manipulations
were
significantly
higher
than
the
control
condition,
with
mean
differences
of
4.40
s
(weight
-
control,
ES=
0.44)
and
2.81
s
(tyre
-
con-
trol,
ES=
0.27).
The
overall
performance
time
on
the
WMP
test
was
judged
as
sensitive
to
change.
For
8
of
the
15
separate
tasks
on
the
WMP
test,
the
tasks
were
judged
as
sensitive
to
change
for
at
least
one
of
the
manipulations.
Conclusion:
The
WMP
test
can
detect
change
in
mo-
bility
performance
when
wheelchair
configurations
are
manipulated.
Key
words:
wheelchair
configurations;
athletic
performance;
Paralympics.
Accepted
Mar
7,
2018;
Epub
ahead
of
print
May
8,
2018
J
Rehabil
Med
2018;
50:
556-562
Correspondence
address:
Annemarie
M.
H.
de
Witte,
Faculty
of
Health,
Nutrition
&
Sport,
The
Hague
University
of
Applied
Sciences,
Meester
P.
Droogleever
Fortuynweg
22,
NL-2533
SR
Den
Haag,
The
Netherlands.
E-mail:
a.m.h.dewitte@hhs.nl
I
n
wheelchair
basketball,
the
interaction
between
the
player,
the
wheelchair
and
the
environment
deter-
mines
overall
performance.
More
specifically,
and
in
agreement
with
several
other
studies
(1,
2),
all
actions
a
wheelchair
basketball
player
can
perform
using
the
wheelchair,
such
as
turning,
blocking,
stopping
and
accelerating,
are
considered
to
be
part
of
mobility
performance.
In
order
to
repeatedly
monitor
athletes'
mobility
performance,
standardized
field-based
tests
1-
MAIN
MESSAGE
In
this
study
we
measured
the
performance
times
on
the
Wheelchair
Mobility
Performance
(WMP)
test
during
different
test
conditions
to
see
if
the
performance
times
changed
when
wheelchair
settings
were
changed.
The
overall
performance
time
on
the
WMP
test
increased
when
the
tire
pressure
was
reduced
and
also
when
extra
mass
was
attached
to
the
wheelchair.
It
can
be
concluded
that
the
WMP
test
is
sensitive
to
changes
in
wheelchair
settings.
It
is
recommended
to
use
this
field-
based
test
in
further
research
to
investigate
the
effect
of
`wheelchair
settings
on
mobility
performance
time.
}
are
informative
and
helpful
(3,
4).
Recently,
de
Witte
et
al.
(5)
developed
a
standardized
field-based
Wheelchair
Mobility
Performance
(WMP)
test
to
assess
mobi-
lity
performance
in
wheelchair
basketball.
Extensive
analyses
of
matches
with
elite
wheelchair
basketball
athletes
were
performed
in
order
to
determine
the
most
common
wheelchair
handling
activities
and
their
cha-
racteristics
(1,
5,
6).
These
characteristics
were
combi-
ned
in
a
test-circuit
consisting
of
15
specific
wheelchair
basketball
mobility
performance
tasks
(Appendix
SP).
The
WMP
test
covers
the
full
range
of
relevant
mobility
performance
tasks
in
wheelchair
basketball,
meaning
that
all
aspects
of
an
athlete's
mobility
performance
can
be
assessed
in
a
single
standardized
test.
The
reliability
and
construct
validity
of
the
WMP
test
has
been
determined
previously
(5).
The
reliability
of
the
WMP
test
for
overall
performance
outcome
was
found
to
be
excellent
(intraclass
correlation
coefficient
(ICC)
=
0.95)
(5).
Furthermore,
the
construct
validity
of
the
WMP
test
was
confirmed
by
showing
that
it
can
de-
tect
differences
in
mobility
performance
between
athle-
tes
who
were
expected
to
differ
in
terms
of
their
level
of
physical
capacity
(7,
8).
In
line
with
expectations,
men
performed
better
than
women
and
international
male
athletes
performed
better
than
national
male
athletes
on
the
WMP
test.
A
borderline
significant
difference
in
mobility
performance
was
found
between
low
classifica-
tion
(1.0-2.5)
and
high
classification
(3.0-4.5)
athletes.
It
was
concluded
that
the
WMP
test
was
reliable
and
valid
and
could
be
used
to
assess
the
capacity
of
mobi-
lity
performance
of
elite
wheelchair
basketball
players.
Ittp://www.medicaljournals.se/jrnilcontentndoi=10.2340/16501977-2341
This
is
an open
access
article
under
the
CC
BY-NC
license.
www.medicaljournals.se/jrm
doi:
10.2340/16501977-2341
Journal
Compilation
©
2018
Foundation
of
Rehabilitation
Information.
ISSN
1650-1977
Sensitivity
to
change
of
the
Wheelchair
Mobility
Performance
test
in
wheelchair
basketball
557
In
addition
to
being
reliable
and
valid,
the
WMP
test
should
also
be
sensitive
to
change
in
order
to
apply
the
test
in
sports
practice
and
research
(9).
Sensitivity
to
change
can
be
defined
as
the
ability
of
a
test
to
detect
change
in
its
outcome
when
it
has
occurred
(10-12).
In
elite
sports,
differences
in
performance
are
very
small
and,
therefore,
it
is
important
to
be
able
to
detect
changes
in
the
determinants
of
performance
(13).
If
the
WMP
test
is
sensitive
to
change,
the
change
or
dif-
ference
in
performance
time
assessed
using
the
test
can
be
truly
attributed
to
a
systematic
change
in
mobility
performance
in-person
and
not
to
noise
or
random
error.
The
psychometric
characteristic
sensitivity
to
change
of
the
WMP
test
can
be
studied
by
such
manipulation
of
the
mobility
performance,
for
which
it
can
be
ex-
pected
that
the
WMP
test
is
able
to
detect
the
change
in
mobility
performance.
Potential
manipulations
that
can
be
studied
to
explore
the
sensitivity
to
change
of
the
WMP
test
are:
configuration
of
the
wheelchair
(e.g.
wheel
diameter,
mass),
characteristics
of
the
athlete
(e.g.
body
weight),
or
manipulations
in
the
interface
between
wheelchair
and
athlete
(e.g.
seat
height).
If
the
WMP
test
is
able
to
detect
a
change
in
performance
time
when
the
wheelchair,
athlete
or
interface
configurations
are
ma-
nipulated,
it
is
justified
to
use
the
test
in
practice
and
in
research.
The
test
can
be
used,
for
instance,
to
optimize
the
design
of
the
wheelchair
in
wheelchair
basketball.
Therefore,
the
objective
of
the
present
study
was
to
examine
the sensitivity
to
change
of
the
standardized
field-based
WMP
test
in
wheelchair
basketball
by
sys-
tematically
manipulating
the
wheelchair
configuration.
METHODS
Participants
Sixteen
wheelchair
basketball
players
(15
men,
1
woman)
with
a
mean
age
of
23.5
years
(standard
deviation
(SD)
8.4),
a
mean
5
4
'a'
3
E
2
I
1
1 I
0
1
1.5
2
2.5
3.5
4
4.5
Classification category
Fig.
1.
Overview
of
the
classification
categories
for
16
wheelchair
basketball
players.
To
assess
the
level
of
impairment,
an
internationally
accepted
classification
system
is
used
in
which
8
classes
are
defined
-
ranging
from
1.0-4.5
-
with
1.0
being
the
most
limiting
impairment.
During
a
game
for
the
5
players
on
court
the
sum
of
classification
points
may
not
exceed
14
(International
Wheelchair
Basketball
Federation.
Incheon,
Korea,
2014).
body
weight
of
71.1
kg
(SD
21.4)
and
7.8
years
(SD
6.6)
of
experience
in
wheelchair
basketball
volunteered
to
participate
in
this
study.
All
participants
trained
at
least
twice
a
week
and
played
in
the
B-
or
C-division
of
the
Dutch
wheelchair
basketball
competition.
An
overview
of
their
classification
is
shown
in
Fig.
1.
Prior
to
participation,
all
participants
were
informed
about
the
study
objectives
and
procedures,
and
signed
an
informed
consent
form.
The
study
was
approved
by
the
ethics
committee
of
the
Faculty
of
Behavioural
and
Movement
Sciences,
Vrije
Universiteit
Amsterdam
(VCWE
2016-091).
Procedure
The
WMP
test
consists
of
15
sport-specific
tasks
based
on
extensive
observation
of
wheelchair
basketball
matches
(5)
(see
Appendix
SI
for
a
description
of
the
test).
The
test-retest
reliability
of
the
WMP
test
was
excellent
(ICC
=0.95)
for
the
overall
performance
time
and
the
WMP
test
is
a
valid
tool
to
as-
sess
mobility
performance
in
wheelchair
basketball
players
(5).
The
participants
performed
the
WMP
test
3
times
in
their
own
wheelchair:
(i)
in
the
"control
condition"
(CC)
participants
performed
the
test
with
normal
tyre
pressure
(standardized
at
7
bar)
and
with
no
extra
mass
attached
to
the
wheelchair;
(ii)
in
the
"weighted
condition"
(WC)
participants
performed
the
test
with
normal
tyre
pressure,
but
with
an
additional
mass
of
10
kg
attached
to
the
wheelchair
(distributed
over
the
wheelchair
frame
using
5
masses
of
2
kg
(Fig.
2);
(iii)
in
the
"tyre
condition"
(TC)
participants
performed
the
test
in
their
own
wheelchair
with
the
tyre
pressure
reduced
by
50%
(3.5
bar)
and
with
no
additional
mass
attached
to
the
wheelchair.
Tyre
pressure
was
determined
using
a
high-pressure
pump
(LezyneAlloy
Drive
SE
Floor
Pump).
Prior
to
the
WMP
tests,
verbal
instructions
were
given
to
the
participants
about
the
test
procedure,
and
participants
had
to
practice
the
WMP
test
tasks
in
the
presence
of
a
researcher
who
gave
verbal
instructions
for
each
task.
After
being
given
the
instructions,
the
participants
completed
a
form
concerning
general
information:
age,
body
weight,
type
of
impairment,
years
of
experience
in
wheelchair
basketball,
and
classification.
After
a
self-selected
warm-up,
the
participants
performed
the
3
experimental
conditions
of
the
WMP
tests
in
a
randomized
and
counterbalanced
order
to
avoid
learning
effects.
All
standardized
tasks
of
the
WMP
test
were
carried
out
in
succession
in
a
fixed
sack
F
rant
Fig.
2.
Birds-eye
view
of
the
distribution
of
10
kg
mass
(5x2
kg)
on
the
wheelchair
frame.
Rehabil
Med
50,
2018
Differences
Tyre
condition
-
Control
condition
Differences,
s
Effect
95%
CI
of
the
Sensitive
Mean
(SD)
p-values
size
effect
size
to
change?
0.40
(1.16)
0.185
0.17
-0.52
0.03
(0.29)
0.732
0.10
-0.60
0.20
(0.15)
0.000*
0.41
-0.30
0.09
(0.50)
0.486
0.15
-0.55
0.24
(0.46)a
0.057
0.30
-0.41
0.03
(0.39)
0.785
0.07
-0.63
0.35
(0.47)a
0.010*
0.37
-0.34
0.21
(0.55)
0.150
0.20
-0.50
0.34
(0.32)
0.001*
0.40
-0.31
0.05
(0.22)
0.420
0.12
-0.57
0.17
(0.53)
0.226
0.17
-0.52
0.11
(0.83)
0.618
0.07
-0.62
0.26
(1.06)
0.332
0.16
-0.54
0.07
(0.30)
0.379
0.16
-0.54
0.28
(0.57)
0.070
0.19
-0.51
2.81
(2.25)
a
<0.001*
0.27
-0.43
0.86
0.79
1.10
0.84
0.99
0.76
1.06
0.89
1.08
x
0.82
0.86
0.76
0.85
0.85
-
0.88
-
0.96
x
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Table
I.
Mean
(standard
deviation;
SD)
performance
times
(s)
for
each
task
and
overall
performance
time
(s)
for
the
Wheelchair
Mobility
Performance
test
for
the
control
condition
and
the
manipulation
conditions
(weighted
and
tyre
conditions).
The
mean
differences
between
the
manipulation
conditions
and
control
condition,
p-values,
Cohen's
d
effect
sizes,
95%
confidence
intervals
(95%
CI)
of
the
effect
size
and
the
standard
error
of
measurement
retrieved
from
the
study
of
de
Witte
et
al.
(5)
are
shown
Control
condition,
s
Mean
(SD)
Weighted
condition,
s
Mean
(SD)
Tyre
condition,
s
Mean
(SD)
SEM,
s
Differences
Weighted
condition
-
Control
condition
Differences,
s
Mean
(SD)
p-values
Effect
95%
CI
of
the
Sensitive
size
effect
size
to
change?
1.
Tik-Tak
box
8.26
(2.06)
8.79
(2.46)
8.66
(2.54)
-
0.53
(0.80)
0.017*
0.24
-0.47
0.92
x
2.
180°
turn
on
the
spot
(left)
1.22
(0.29)
1.35
(0.31)
1.24
(0.23)
0.10
0.13
(0.24)a
0.050*
0.43
-0.28
1.12
x
3.
12-m
sprint
5.37
(0.48)
5.63
(0.51)
5.57
(0.48)
0.24
0.26
(0.17)a
<0.001*
0.51
-0.21
1.20
x
4.
12-m
rotation
(right)
6.92
(0.61)
7.08
(0.50)
7.01
(0.57)
0.16
0.17
(0.41)a
0.130
0.30
-0.41
0.99
-
5.
12-m
rotation
(left)
6.85
(0.65)
7.01
(0.59)
7.08
(0.92)
0.22
0.16
(0.43)
0.147
0.26
-0.44
0.95
-
6.
180°
turn
on
the
spot
(right)
1.29
(0.40)
1.30
(0.23)
1.32
(0.40)
0.10
0.01
(0.29)
0.878
0.03
-0.66
0.73
-
7.
3-3-6-m
sprint
8.19
(0.90)
8.50
(1.08)
8.54
(1.00)
0.28
0.31
(0.57)a
0.048*
0.31
-0.39
1.00
x
8.
3-3-6-m
rotation
(left)
9.08
(1.00)
9.39
(1.03)
9.29
(1.04)
0.26
0.32
(0.68)a
0.085
0.31
-0.39
1.00
-
9.
3-3-6-m
rotation
(right)
8.93
(0.80)
9.36
(0.91)
9.28
(0.93)
0.37
0.43
(0.47)a
0.002*
0.50
-0.21
1.19
x
10.
90°-
90°
turn
on
the
spot
with
stop
(left)
1.99
(0.35)
2.07
(0.30)
2.04
(0.38)
0.14
0.08
(0.18)
0.093
0.25
-0.46
0.94
-
11.
12-m
dribble
6.84
(0.83)
7.18
(1.09)
7.01
(1.06)
0.31
0.34
(0.57)a
0.031*
0.35
-0.35
1.04
x
12.
12-m
rotation
dribble
(right)
9.32
(1.34)
9.35
(1.38)
9.43
(1.60)
0.56
0.03
(1.00)
0.919
0.02
-0.67
0.71
-
13.
12-m
rotation
dribble
(left)
9.40
(1.98)
10.01
(1.58)
9.67
(1.38)
0.51
0.60
(0.87)a
0.014*
0.34
-0.37
1.03
x
14.
90°-
90°
turn
on
the
spot
with
stop
(right)
2.03
(0.30)
2.03
(0.28)
2.09
(0.49)
0.11
0.00
(0.24)
0.992
0.00
-0.69
0.70
-
15.
Combination
15.90
(1.42)
16.94
(1.95)
16.18
(1.58)
0.34
1.04
(0.78)
a
<0.001*
0.61
-0.12
1.30
x
Overall
performance
time
(sum
tasks
1-15)
101.59
(9.63)
105.99
(10.52)
104.39
(11.03)
0.98
4.40
(2.05)
a
<0.001*
0.44
-0.28
1.13
x
*Significant
effect
of
manipulation
condition
(p
<0.05)
in
performance
time
compared
with
control
condition.
a
Difference
between
manipulation
condition
and
control
condition
larger
than
standard
error
of
measurement.
x:
standard
error
of
measurement
not
available.
SEM:
Standard
error
of
measurement.
135
S
(a)
A
125
115
8
105
0
.............................
.................................
......
..
....
.
..
.......
.........
.
.....
....
....
4
.................
..
..„„„
..................
.........
:
..
......
95
........
4.
1
1
1
.
...............
I
................
85
................................
85
135
(b)
......
..........
125
.............
........
.
..........
105
........
...
..
..
95
.............
....
..
115
.............................
cc
cc
Jou
rna
l
o
f
Re
ha
bilita
t
ion
cc
Sensitivity
to
change
of
the
Wheelchair
Mobility
Performance
test
in
wheelchair
basketball
559
Sensitivity
to
change
For
assessment
of
sensitivity
to
change
of
the
WMP
test,
a
significant
difference
in
performance
time
must
be
detected
between
the
manipulation
conditions
(WC
and
TC)
and
CC.
Furthermore,
the
observed
differences
between
both
conditions
must
be
larger
than
the
SEM.
greem
If
the
results
met
both
'
re-
quirements,
the
ES
was
used
to
evaluate
the
magnitude
of
the
differences
between
the
manipulated
and
control
conditions.
Cohen's
d
cut-off
points
for
ES
values
were:
trivial
(d<0.2),
small
(0.2
5
d
<0.5),
moderate
(0.5
5
d<
0.8)
and
large
(d>0.8)
(16).
In
our
case,
the
WMP
test
was
judged
not
sensitive
to
change
for
ES
values
lower
than
0.2,
while
values
equal
to
or
higher
than
0.2
were
judged
as
sensitive
to
change.
RESULTS
The
mean
overall
performance
time
on
the
WMP
test
for
the
CC
was
101.59
(SD
9.63)
s,
for
the
WC
105.99
(SD
10.52)
s
and,
for
the
TC,
104.39
(SD
11.03)
s
(Ta-
ble
I).
The
overall
performance
time
for
the
WC
and
TC
was
significantly
higher
than
for
the
CC
(p
<
0.05).
The
observed
overall
differences
between
the
manipu-
lated
and
control
conditions
(AWC—CC
=
4.40+2.05
s,
ATC—CC
=
2.81
+2.25
s)
were
larger
than
the
reported
standard
error
of
measurement
(SEM)
(>0.98).
The
ES
for
the
WC—CC
was
0.44
and
for
the
TC—CC
0.38.
Therefore,
the
overall
performance
time
was
judged
as
sensitive
to
change
(ES
>0.20).
The
individual
dif-
ferences
in
the
overall
performance
times
between
the
different
conditions
per
wheelchair
basketball
player
are
shown
in
Fig.
3.
For
the
performance
times
of
the
separate
tasks,
only
the
3-3-6-m
sprint,
for
both
WC
and
TC
condi-
tion,
was
sensitive
to
change
(ES:
WC—CC
=
0.31,
TC—CC
=
0.37).
In
the
WC,
performance
times
for
7
out
of
the
15
WMP
tests
tasks
were
significantly
dif-
ferent
from
those
in
the
CC,
while
at
the
same
time
the
differences
were
larger
than
the
SEM.
The
tasks
75 75
0
0
Control
Weighted
Control
Condition
Condition
Condition
180°
turn
on
the
spot
left
(ES
=
0.43),
12-m
sprint
(ES
=0.51),
3-3-6-m
sprint
(ES
=0.31),
3-3-6-m
rota-
tion
to
the
right
(ES
=0.50),
12-m-dribble
(ES
=0.35),
12-m-rotation
dribble
to
the
left
(ES
=0.34),
and
the
combination
task
(ES
=0.61)
were
judged
sensitive
to
change.
For
the
TC,
as
indicated
above,
only
the
performance
time
on
the
3-3-6-m
sprint
(ES
=0.37)
and
the
overall
performance
time
(ES
=0.27)
were
significantly
different
from
the
CC.
DISCUSSION
This
study
determined
the
sensitivity
to
change
of
the
standardized
field-based
WMP
test,
in
order
to
assess
whether
the
WMP
test
can
detect
changes
in
mobility
performance
in
wheelchair
basketball
players.
The
mean
total
performance
times
for
the
10
kg
extra
mass
condition
and
the
reduced
tyre
pressure
condition,
were
significantly
more
than
for
the
control
condition.
The
overall
performance
time
of
the
WMP
test
was
judged
sensitive
to
change.
It
can,
therefore,
be
concluded
that
the
WMP
test
can
detect
changes
in
mobility
performance
when
wheelchair
configurations
are
ma-
nipulated.
The
separate
tasks
of
the
WMP
test
showed
different
levels
of
sensitivity
to
change
dependent
on
the
manipulation
condition.
For
8
of
the
15
separate
tasks
on
the
WMP
test,
the
tasks
were
judged
sensitive
to
change
for
at
least
one
of
the
manipulations.
Sensitivity
to
change
In
the
present
study
sensitivity
to
change
was
investi-
gated
in
order
to
determine
whether
the
WMP
test
can
detect
changes
in
mobility
performance.
The
term
"sensitivity
to
change"
is
generally
used
as
a
common
measure
to
detect
change
when
it
has
occurred
(11,
12,
17).
The
cause
of
the
change
may
vary;
for
instance,
as
to
the
topic
of
the
present
study,
because
of
changes
in
wheelchair
configuration,
but
also
because
of
changes
over
time.
However,
the
term
responsive-
ness
is
also
used
in
the
literature,
specifi-
cally
when
it
concerns
changes
over
time
in
the
construct
to
be
measured
(9,
18).
As
the
aim
of
this
study
was
to
investigate
whether
the
WMP
test
is
able
to
detect
changes
in
mobility
performance
due
to
changes
in
wheelchair
configuration,
we
decided
to
use
the
term
"sensitivity
Tire
to
change".
This
does
not
mean
that
the
Condition
WMP
test
is
not
sensitive
to
changes
in
mobility
performance
over
time.
The
test
was
shown
to
be
able
to
detect
manipu-
lated
changes
in
mobility
performance,
Fig.
3.
Differences
in
total
performance
time
(ins)
on
the
Wheelchair
Mobility
Performance
test
per
wheelchair
basketball
player
between:
(a)
the
Control
Condition
and
Weighted
Condition
(10
kg
extra
mass);
and
between
the
(b)
Control
Condition
and
50%
reduced
pressure
Tyre
Condition.
Rehabil
Med
50,
2018
cc
cc
and
we
expect
the
test
to
be
able
to
detect
change
in
mobility
performance
over
time
due
to
training
or
injury.
Change
should,
however,
be
beyond the
limits
of
agreement
described
in
the
validity
and
reliability
study
of
the
WMP
test
(5).
Furthermore,
De
Vet
et
al.
(9)
state
that
responsiveness
is
relevant
to
measurement
instruments
used
in
evaluative
applications,
and
that
if
an
instrument
is
used only
for
discrimination
between
patients
at
1
time-point,
then
responsiveness
is
not
an
issue.
According
to
Deyo
&
Centor
(19),
responsive-
ness
relates
to
a
true
change
in
clinical
(health)
status
over
time.
This
means
that
the
outcome
measure
must
remain
stable
when
no
(clinical)
change
has
occurred
(specificity)
and
it
must
detect
meaningful
(clinical)
change
when
it
has
occurred
(sensitivity).
However,
in
the
present
study,
differences
in
performance
times
on
the
WMP
test
between
conditions
are
assumed
to
be
caused
by
the
manipulations
in
wheelchair
configura-
tion.
In
order
to
measure
whether
change
occurred
and
the
magnitude
of
that
change,
the
current
study
used
sensitivity
to
change.
Conditions
Sensitivity
to
change
was
examined
by
manipulating
wheelchair
configuration,
which
can
have
a
significant
impact
on
mobility
performance
(20).
Other
manipu-
lations
could
have
been
chosen
to
study
sensitivity
to
change.
For
example,
manipulation
of
the
athlete
or
the
wheelchair-athlete
interaction
could
change
mobility
performance,
e.g.
by
limiting
trunk
function,
the
move-
ment
of
the
trunk
will
be
limited
and
performance
may
decrease.
In
this
study,
a
10
kg
extra
mass
and
a
50%
reduced
tyre
pressure
were
used
to
examine
sensitivity
to
change.
These
manipulations
were
chosen because
they
were
relatively
easy
to
apply
to
the
athlete's
own
wheelchair
(CC)
and
they
clearly
increase
the
external
work
required,
and
thus
reduce
mobility
performance.
The
magnitude
of
the
manipulations
was
chosen
in
agreement
with
previous
studies
(21-24).
Beekman
et
al.
(21)
found
that,
in
a
wheelchair
that
was
7.8
kg
lighter,
the
speed
and
distance
travelled
were
greater
than
for
a
heavier
wheelchair.
Cowan
et
al.
(23)
found
that
velocity
decreased
as
the
weight
of
the
wheelchair
increased
by
with
9.05
kg.
Therefore,
we
used
10
kg
additional
mass
in
the
weight
condition.
Booka
et
al.
(22)
and
de
Groot
et
al.
(24)
stated
that
a
lower
tyre
pressure
needs
more
work,
even
on
a
hard
level
surface.
To
increase
the
work,
the
tyre
pressure
was
reduced
to
50%
in
this
study.
In
both
manipulated
conditions,
the
power
output
was
increased,
while
this
may
not
impact
the
skill
of
mobility
performance
because
the
wheelchair-athlete
settings
have
remained
unchanged.
Performance
times
In
the
weighted
condition,
all
tasks
that
were
not
judged
sensitive
were
related
to
rotational
tasks.
In
this
study,
the
masses
(5
x
2
kg)
were
attached
on
the
outside
of
the
frame
(Fig.
2).
It
could
be
that
the
weight
distribution
had
less
effect
on
the
performance
time
for
the
rotatio-
nal
tasks
compared
with
translation
tasks,
or
that
the
amount
of
weight
had
less
effect
on
rotational
tasks.
Moreover,
the
extra
mass
was
10
kg
for
all
participants,
which
may
mean
that
the
relative
weight
gain
was
dif-
ferent
between
participants.
This
may
have
led
to
an
overestimation
of
the
results.
If
the
amount
of
additio-
nal
mass
is
determined
relative
to
the
total
mass
of
the
athlete
and
wheelchair,
the
disadvantage
of
extra
mass
is
the
same
for
all
the
athletes.
Based
on
this
study,
it
can
be
concluded
that
mass
influences
performance
times,
but
this
does
not
provide
insight
into
to
what
extent
mass
influences
performance
time.
To
research
that
relationship,
future
studies
should
examine
the
effect
of
relative,
not
absolute,
additional
mass.
In
the
TC,
only
the
performance
on
the
3-3-6-m
sprint
and
the
performance
time
on
the
entire
WMP
test
were
judged
sensitive
to
change.
A
recent
study
by
Leboeuf
et
al.
(25)
showed
that
a
lower
tyre
pressure
(5
compared
with
9
bar)
only
decreases
sprint
perfor-
mance
in
a
straight
line
and
not
when
other
movements
are
included,
such
as
stops
and
half-turns.
This
is
in
line
with
the
results
of
the
present
study.
It
could
be
that
the
differences
between
the
conditions
on
the
separate
tasks
were
too
small
to
appear
as
sensitive
to
change,
but
the
sum
of
the
separate
tasks
was
large
enough
to
appear
as
sensitive
to
change.
Another
explanation
could
be
that
the
tyres
deformed
during
changes
in
directions
and
stops.
By
inflating
the
tyres
as
much
as
possible,
the
friction
between
the
ground
and
the
tyres
reduces,
which
may
result
in
skidding.
Skidding
leads
to
loss
of
grip
and
thus
waste
of
time.
This
can
be
an
explanatory
hypothesis
for
the
comparable
time
between
the
tyre
pressure
conditions.
In
the
present
study,
outcome
measure
time
(in
s)
was
used,
which
can
be
assessed
using
a
timer
or,
as
in
the
present
study,
video.
Therefore,
the
test
is
easy
to
use
in
practice
to
determine
changes
in
performance.
However,
information
about
kinematic
outcomes,
such
as
(rotational)
acceleration,
could
provide
additional
information
and
can
be
measured
with
inertial
sensors
on
the
wheelchair
(6,
26).
The
use
of
additional
kine-
matic
outcome
measures
could
provide
more
in-depth
information
about
sensitivity
to
change.
However,
specific
knowledge
and
equipment,
such
as
inertial
sensors,
are
required
and
this
is
therefore
more
difficult
in
practice.
For
research
purposes,
it
is
recommended
www.medicaljournals.se/jrm
2
cc
—)
2
cc
—)
o
f
Re
ha
bilita
t
ion
N
0
2
Sensitivity
to
change
of
the
Wheelchair
Mobility
Performance
test
in
wheelchair
basketball
561
that
additional
kinematic
outcomes
are
used
to
analyse
sensitivity
to
change.
Wheelchair
Mobility
Performance
test
The
WMP
test
was
developed
to
assess
the
capacity
of
mobility
performance
of
wheelchair
athletes
in
wheel-
chair
basketball.
For
research
purposes,
Mason
et
al.
(20)
recommended
that
a
standardized
field-based
test
can
be
used
to
examine
the
impact
of
different
wheelchair
configurations
on
mobility
performance.
However,
the
test
should
be
reliable,
valid
and
sensitive
to
change.
A
previous
study
determined
the
reliability
and
construct
validity
of
the
WMP
test
(5)
and
the
present
study
de-
termined
sensitivity
to
change.
Together,
these
2
studies
included
2
analyses
concerning
sensitivity
to
change
(tyre
pressure
and
weight),
a
reliability
analysis
and
3
analyses
of
construct
validity
(sex,
playing
standard,
and
classification)
in
order
for
the
WMP
test.
The
authors
decided
that
the
reliability
must
have
an
ICC
>
0.70
(indicated
as
satisfactory)
and
that
a
minimum
of
4
of
the
5
remaining
analyses
must
meet
the
requirements
in
order
for
the
WMP
test
to
be
judged
as
valid
and
sensitive
to
change.
Based
on
this
requirement,
it
can
be
concluded
that
the
WMP
test
is
reliable,
valid
and
sensitive
to
change
for
the
3-3-6-m
sprint
task,
the com-
bination
task
(sprint,
turn,
slalom,
turn),
and
the
overall
performance
time.
If
the
cut-off
was
set
at
the
level
that
all
analysis
must
meet
the
requirements,
than
only
the
3-3-6-m
sprint
task
and
the
overall
performance
time
appear
to
be
useful
outcome
measures.
The
sensitivity
to
change
of
the
combination
task
in
the
tyre
pressure
manipulation
was
borderline
significant
(p=
0.07).
The
selected
measurement
outcomes
provide
an
overview
of
the
mobility
performance
capacity
of
a
wheelchair
basketball
athlete.
The
WMP
test
is
not
able
to
detect
change
in
separate
tasks
in
a
reliable,
valid
and
sensitive
way.
Further
research
is
needed,
focussing
on
the
3
des-
cribed
performance
outcomes
(3-3-6-m
sprint,
combina-
tion
task
and
overall
performance
outcome),
in
order
to
draw
a
conclusion
on
mobility
performance
capacity.
Implications
of
the
Wheelchair
Mobility
Performance
test
The
WMP
test
can
be
used
in
a
reliable
and
valid
way
to
assess
the
capacity
of
mobility
performance
of
elite
wheelchair
athletes
in
wheelchair
basketball
(5).
The
test
can
be
used
in
a
reliable
and
valid
way
to
periodi-
cally
monitor
the
capacity
of
the
mobility
performance
of
an
athlete,
to
detect
the
strengths
and
limitations
of
an
athlete,
to
detect
talented
athletes,
and
to
examine
whether
an
athlete
is
sufficiently
recovered
from
an
injury.
Furthermore,
the
selected
outcomes
are
sensitive
to
change
and
can
be
used
to
assess
differences
in
per-
formance
time
when
wheelchair-athlete
configurations
are
changed.
The
difference
should,
however,
be
larger
than
the
limits
of
agreement
as
reported
in
the
reliability
and
validity
study
(5)
.
The
test
is
easy
to
perform
for
athletes,
little
material
is
required
and
measuring
time
(in
s)
does
not
require
specific
knowledge.
In
addition
to
the
applications
mentioned
above,
the
test
can
be
used
to
optimize
the
wheelchair-athlete
configuration
or
wheelchair
design.
The
selected
parts
of
the
WMP
test
showed
that
performance
time
was
sensitive
to
change
when
configuration
settings
were
changed,
and
this
can
be
used
in
further
research.
However,
as
mentioned
earlier,
performance
time
is
one
outcome
measure.
Kinematic
outcomes
such
as
(rotational)
acceleration
could
provide
more
in-depth
information
about
the
ef-
fects
of
configurations
on
mobility
performance.
Study
limitations
A
limitation
of
this
study
was
that
the
test
was
not
blin-
ded.
The
sequence
of
test
conditions
was
randomized,
but
the
participants
could
see
or
hear
the
manipulations
being
applied
to
their
wheelchairs.
This
may
have
biased
the
results,
but
it
is
unknown
to
what
extent
this
affected
the
test
results.
Future
research
must
take
into
account
this
potential
effect.
Furthermore,
in
the
weighted
condition,
for
all
participants,
10
kg
extra
mass
was
attached
to
the
wheelchair.
The
magnitude
of
the
effect
was
different
for
all
participants,
which
may
have
affected
the
measurements.
It
is
possible
that
the
results
were
overestimated
because
the
relative
weight
gain
was
not
the
same
for
all
participants.
In
future
research
a
relative
value
should
be
determined
so
that
the
effect
is
the
same
for
all
participants.
An-
other
limitation
of
the
WMP
test
is
that
not
all
separate
tasks
can
be
used
to
analyse
mobility
performance.
For
example,
the
single
rotational
tasks
could
not
be
used
in
assessing
mobility
performance.
Conclusion
The
WMP
test
can
detect
changes
in
mobility
perfor-
mance;
for
instance,
when
the
wheelchair
configuration
is
manipulated.
Taking
into
account
the
results
of
the
current
study
together
with
those
of
the
reliability
and
construct
validity
study,
it
is
recommended
that
perfor-
mance
on
the
3-3-6-m
sprint
(task
7),
the
combination
(task
15),
and
the
entire
WMP
test
are
monitored
in
future
research
and
practice.
ACKNOWLEDGEMENTS
The
authors
would
thank
the
students
Josi
Klomp
and
Chloe
Bras
(Vrije
Universiteit
Amsterdam)
for
their
assistance
with
data
collection.
This
work
was
supported
by
the
Taskforce
for
3
Rehabil
Med
50,
2018
O
C
'5
O
lo
2
C
:a
.c
O
CC
O
Ts
C
O
Jou
rna
l
o
f
Re
ha
bilita
t
ion
Me
di
Applied
Research
(part
of
the
Netherlands
Organization
for
Scientific
Research).
The
authors
have
no
conflicts
of
interest
to
declare.
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