Bridging clinical capacity and functional performance: Clinical predictors of independence in advanced wheelchair skills after spinal cord injury

Context Advanced wheelchair skills (ramp, railing, curb, wheelie) are essential for mobility after spinal cord injury (SCI), but predictors of discharge independence remain unclear.Objective To identify admission predictors of improvement and discharge independence in advanced wheelchair skills after SCI.Methods We retrospectively analyzed 150 inpatients with SCI (2016–2023) at a single rehabilitation hospital with admission and discharge assessments for four advanced wheelchair skills. For each skill, participants were classified as Group 1 (no improvement or decline and remained dependent), Group 2 (improved but remained dependent), or Group 3 (achieved or maintained independence). Admission variables were compared across groups, and multinomial logistic regression used Group 3 as the reference.Results In adjusted models, older age increased the odds of Group 1 and Group 2 classifications compared with Group 3; for wheelie, ORs were 1.08 and 1.09 per year, respectively (both P < 0.001). Greater upper-extremity strength was associated with reduced odds of Group 1 classification for wheelie (OR 0.43, 95% CI 0.21–0.87) and ramp (OR 0.44, 95% CI 0.25–0.78), but not for railing or curb. Longer post-injury duration was associated with lower odds of a dependent outcome for curb (OR 0.998 per day, P < 0.05). In unadjusted comparisons, outcome-group distributions differed by age group, neurological level, and AIS grade.Conclusions Older age was associated with dependent outcomes across skills, whereas upper-extremity strength favored independence in wheelie and ramp only. These findings support incorporating age and task-relevant upper-limb capacity into goal setting and training prioritization; prospective studies should quantify training exposure and goal priorities.