This study is limited in its generalizations in several ways.
First, this study used a convenience volunteer group from
southern California, whichmay ormay not be representative
of people with SCI throughout the country.
Differences in physical environments, weather conditions,
and daily activities may vary depending on the part of the
country. Second, this study had a relatively short follow-up
period after the end of treatment. In retrospect, it might
have been better to have a 12-week follow-up design that
would allow participants more time towork out what patterns
of activities would be best for them and to further
monitor their pain for a longer period. Third, this study
was limited to people with SCI. However, people with
other diagnosis also use manual wheelchairs for their
primary source of locomotion and the sample could be
expanded to include some of these other groups such as
people with post-polio, cerebral palsy, or amputations. A
final limitation of this study was that the treatment
group had one more face-to-face interaction with the
therapists than did the control group. It is difficult to estimate
the effect this may have had on the outcomes of the
study. However, it is hard to imagine that such a limited
contact could have had a substantial effect. For the purposes
of this article, we focused mainly on pain, social
interaction, and QOL. However, more physical measures
were assessed and have been reported on. Those seeking
information about the broader physical outcomes of this
study are referred to that article.9