Validity of a Wheelchair Perceived Exertion Scale (Wheel Scale) for Arm Ergometry Exercise in People with Spina Bifida

Abstract

This study assessed the concurrent and construct validity of the Borg 6-20 Scale and WHEEL Scale during arm ergometry exercise stress testing in (n = 24) adolescents and adults with spina bifida. Significant, moderate, positive correlations were observed between power output and relative heart rate and power output to relative VO2peak. Further, a moderate, significant correlation between physiologic criterion variables and the rating of perceived exertion derived from the Borg Scale and the WHEEL Scale was found. Concurrent validity was supported by the following findings: (1) relative heart rate was significantly correlated with the Borg (Kendall's τ = .41) and WHEEL Scales (τ = .44), and relative VO2 was significantly correlated with the Borg (τ = .46) and WHEEL Scales (τ = .47); (2) content validity was supported by the finding that the Borg and WHEEL Scales shared significant variance (τ = .70), demonstrating internal consistency. The WHEEL Scale shows strong potential for use in this cohort subsequent to further testing and validation.

Exercise Prescription Using a Group‐Normalized Rating of Perceived Exertion in Adolescents and Adults With Spina Bifida

“…As such, physical therapists and exercise physiologists can prescribe a target RPE that can be employed by individuals with SB to self‐regulate exercise intensity using either scale. As determined in the parent study for this investigation, the WHEEL Scale is a valid tool to assess perceived exertion in adolescents and adults with SB [29]. The WHEEL Scale was designed [29] for individuals with complex neuromuscular disabilities who use wheelchairs.…”

“…People were excluded if they had a history of cardiac conditions or upper body injuries or surgeries or other medical conditions that would contraindicate arm exercise stress testing. Additional details may be found in the parent manuscript and associated publications derived from the parent investigation [21,29]. Written medical clearance from each participant's primary care physician was required before their participation in the study.…”

“…Testing followed the American College of Sports Medicine Guidelines and was conducted in a temperature‐controlled laboratory with standardized calibration of equipment and instrumentation [11]. The arm ergometer test protocol is described in detail in another study [29]. An auditory cue signaled by a metronome and visual cue signaled by the speed display on the Saratoga Silver Arm Ergometer (Rand‐Scot Inc) were provided to help participants maintain a hand crank rate of 70 rpm throughout the test.…”

“…Linear regression analysis was conducted with Borg (6‐20) RPE as the conditional variable and WHEEL RPE as the criterion variable (Aim 1b). Regarding validity, the criterion variable is recognized as the “reference standard.” The WHEEL Scale was chosen as the criterion variable because it was previously validated in a cohort of adolescents and adults with SB who had mobility impairment [29]. No such concurrent validation of the Borg (6‐20) Scale for individuals with SB is available, making this a conditional metric for the target cohort.…”

“…In a cohort of individuals with SB, both concurrent and construct validity have been confirmed by using responses from the WHEEL Scale [29]. The WHEEL Scale was designed for wheelchair users with SB and features color photos paired with verbal descriptors and numerical categories [29]. However, the group‐normalized RPE equivalent to the Vpt for people with SB who are wheelchair users has not yet been determined.…”