WHEEL-I: development of a wheelchair propulsion laboratory for rehabilitation.

Objective: To describe the enabling factors and barriers experienced in the Wheelchair Expert Evaluation Laboratory implementation (WHEEL-i) project, in which scientific knowledge, tools and associated systematic analyses of hand-rim wheelchair propulsion technique, user's wheelchair propulsion capacity, wheelchair-user interface, and wheelchair mechanics were implemented in 2 rehabilitation centres. Design: Implementation project. Patients: Spinal cord injury. Methods: In this implementation project standardized tests were performed: wheelchair skills tests, 2 questionnaires, and a steady-state exercise test on a treadmill in which propulsion technique (forces and torques) and physical strain (oxygen uptake, heart rate and mechanical efficiency) were measured. Results: Good interpretation of the test outcomes was the most important barrier. In order to discuss individual wheelchair performance results with patients and clinicians, reference data were developed, smallest detectable differences were calculated and software was developed to simultaneously show video recordings and force and torque signals. Conclusion: Based on pilot results, the greatest barrier to systematic monitoring of the individual wheelchair fitting and learning process in rehabilitation with, among others, instrumented measurement wheels, was interpretation of outcomes. For proper interpretation of individual outcomes, the availability of reference data, smallest detectable differences and visualization of outcomes is of utmost importance.