Kirby RL, Walker R, Smith C, Best K, MacLeod DA, Thompson K. Manual wheelchair-handling skills by caregivers using new and conventional rear anti-tip devices: a randomized controlled trial. OBJECTIVE: To test the hypothesis that, in comparison with caregivers handling manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new design (Arc-RADs) perform relevant wheelchair skills better and as safely. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Caregivers (n=16) and the wheelchair users (n=16) for whom they cared. INTERVENTION: Participants were trained in wheelchair-handling skills for an average of 54 minutes each. MAIN OUTCOME MEASURES: Total percentage score on a set of 20 rear anti-tip device- and caregiver-relevant skills from the Wheelchair Skills Test, version 3.2, administered a minimum of 3 days after training. RESULTS: For the C-RAD and Arc-RAD groups, the mean +/- SD Wheelchair Skills Test scores were 40%+/-0% and 98.8%+/-3.5%, respectively (P<.001). Skills that required the wheelchair to be tipped back extensively (eg, for ascending a 15cm curb) accounted for the differences between the groups. There were no adverse effects in either group. CONCLUSIONS: The Arc-RAD design allows significantly better caregiver wheelchair-handling skills than the conventional design, without compromising safety.