Advertisement

Extent to Which Caregivers Enhance the Wheelchair Skills Capacity and Confidence of Power Wheelchair Users: A Cross-Sectional Study

Published:January 03, 2018DOI:https://doi.org/10.1016/j.apmr.2017.11.014

      Highlights

      • Caregivers significantly enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance.
      • The nature and benefits of the caregivers' assistance could be summarized in 7 themes, for instance caregiver provides verbal support (eg, by cueing, coaching, or reporting about the environment).
      • These findings have significance for wheelchair skills assessment and training and for the planning of posthospital care.

      Abstract

      Objective

      To test the hypothesis that caregivers enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance, and to describe the nature of that assistance.

      Design

      Multicenter cross-sectional study.

      Setting

      Rehabilitation centers and communities.

      Participants

      Participants (N=152) included caregivers (n=76) and wheelchair users (n=76).

      Interventions

      None.

      Main Outcome Measures

      Version 4.3 of the Wheelchair Skills Test (WST) and the Wheelchair Skills Test-Questionnaire (WST-Q). For each of the 30 individual skills, we recorded data about the wheelchair user alone and in combination (blended) with the caregiver.

      Results

      The mean total WST capacity scores ± SD for the wheelchair users alone and blended were 78.1%±9.3% and 92.4%±6.1%, respectively, with a mean difference of 14.3%±8.7% (P<.0001). The mean WST-Q capacity scores ± SD were 77.0%±10.6% and 93.2%±6.4%, respectively, with a mean difference of 16.3%±9.8% (P<.0001). The mean WST-Q confidence scores ± SD were 75.5%±12.7% and 92.8%±6.8%, respectively, with a mean difference of 17.5%±11.7% (P<.0001). The mean differences corresponded to relative improvements of 18.3%, 21.0%, and 22.9%, respectively. The nature and benefits of the caregivers' assistance could be summarized in 7 themes (eg, caregiver provides verbal support [cueing, coaching, reporting about the environment]).

      Conclusions

      Caregivers significantly enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance, and they do so in a variety of ways. These findings have significance for wheelchair skills assessment and training.

      Keywords

      List of abbreviations:

      WST (Wheelchair Skills Test), WST-Q (Wheelchair Skills Test-Questionnaire)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smith E.M.
        • Giesbrecht E.M.
        • Mortenson W.B.
        • Miller W.C.
        Prevalence of wheelchair and scooter use among community-dwelling Canadians.
        Phys Ther. 2016; 96: 1135-1142
        • Auger C.
        • Demers L.
        • Gelinas I.
        • Jutai J.
        • Fuhrer M.J.
        • DeRuyter F.
        Powered mobility for middle-aged and older adults: systematic review of outcomes and appraisal of published evidence.
        Am J Phys Med Rehabil. 2008; 87: 666-680
        • Davies A.
        • De Souza L.H.
        • Frank A.O.
        Changes in the quality of life in severely disabled people following provision of powered indoor/outdoor chairs.
        Disabil Rehabil. 2003; 25: 286-290
        • Mortenson W.
        • Miller W.
        • Boily J.
        • et al.
        Perceptions of power mobility use and safety within residential facilities.
        Can J Occup Ther. 2005; 72: 142-152
        • Pettersson I.
        • Ahlström G.
        • Törnquist K.
        The value of an outdoor powered wheelchair with regard to the quality of life of persons with stroke: a follow-up study.
        Assist Technol. 2007; 19: 143-153
        • Brandt A.
        • Iwarsson S.
        • Stahle A.
        Older people's use of powered wheelchairs for activity and participation.
        J Rehabil Med. 2004; 36: 70-77
        • Evans R.
        The effect of electrically powered indoor/outdoor wheelchairs on occupation: a study of users' views.
        Br J Occup Ther. 2000; 63: 547-553
        • Taylor D.H.
        • Hoenig H.
        The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement.
        J Am Geriatr Soc. 2004; 52: 72-79
        • Frank A.O.
        • Ward J.
        • Orwell N.J.
        • McCullagh C.
        • Belcher M.
        Introduction of a new NHS electric powered indoor/outdoor chair (EPIOC) service: benefits, risks and implications for prescribers.
        Clin Rehabil. 2000; 14: 665-673
        • Guerette P.
        • Tefft D.
        • Furumasu J.
        Pediatric powered wheelchairs: results of a national survey of providers.
        Assist Technol. 2005; 17: 144-158
        • Reid D.
        • Laliberte-Rudman D.
        • Hebert D.
        Impact of wheeled seated mobility devices on adult users' and their caregivers' occupational performance: a critical literature review.
        Can J Occup Ther. 2002; 69: 261-280
        • Mortenson W.B.
        • Demers L.
        • Fuhrer M.J.
        • Jutai J.W.
        • Lenker J.
        • DeRuyter F.
        How assistive technology use by individuals with disabilities impacts their caregivers: a systematic review of the research evidence.
        Am J Phys Med Rehabil. 2012; 91: 984-998
        • Mortenson W.B.
        • Demers L.
        • Fuhrer M.J.
        • Jutai J.W.
        • Lenker J.
        • DeRuyter F.
        Development and preliminary evaluation of the Caregiver Assistive Technology Outcome Measure.
        J Rehabil Med. 2015; 47: 412-418
        • Kairy D.
        • Rushton P.W.
        • Archambault P.
        • et al.
        Exploring intelligent power wheelchair use: the users' and caregivers' perspective.
        Int J Environ Res Public Health. 2014; 11: 2244-2261
        • Rushton P.W.
        • Kairy D.
        • Archambault P.
        • et al.
        The potential impact of intelligent power wheelchair use on social participation: perspectives of users, caregivers, and clinicians.
        Disabil Rehabil Assist Technol. 2015; 10: 191-197
        • Thompson Jr., E.H.
        • Futterman A.M.
        • Gallagher-Thompson D.
        • Rose J.M.
        • Lovett S.B.
        Social support and caregiving burden in family caregivers of frail elders.
        J Gerontol. 1993; 48: S245-S254
        • Grigorovich A.
        • Forde S.
        • Levinson D.
        • Bastawrous M.
        • Cheung A.M.
        • Cameron J.I.
        Restricted participation in stroke caregivers: who is at risk?.
        Arch Phys Med Rehabil. 2015; 96: 1284-1290
        • Hagberg L.
        • Hermansson L.
        • Fredriksson C.
        • Pettersson I.
        Cost-effectiveness of powered mobility devices for elderly people with disability.
        Disabil Rehabil Assist Technol. 2017; 12: 115-120
        • Frank A.
        • Neophytou C.
        • Frank J.
        • de Souza L.
        Electric-powered indoor/outdoor wheelchairs (EPIOCs): users' views of influence on family, friends and carers.
        Disabil Rehabil Assist Technol. 2010; 5: 327-338
        • Rushton P.W.
        • Labbe D.
        • Demers L.
        • Miller W.C.
        • Mortenson W.B.
        • Kirby R.L.
        Understanding the burden experienced by caregivers of older adults who use a powered wheelchair: a cross-sectional study.
        Gerontol Geriatr Med. 2017; 3: 1-8
        • Roberts J.
        • Young H.
        • Andrew K.
        • McAlpine A.
        • Hogg J.
        The needs of carers who push wheelchairs.
        J Integr Care. 2012; 20: 23-34
        • Hall K.
        • Partoy J.
        • Tenenbaum S.
        • Dawson D.R.
        Power mobility driving training for seniors: a pilot study.
        Assist Technol. 2005; 17: 47-56
        • Mountain A.
        • Kirby R.L.
        • Smith C.
        • Eskes G.
        • Thompson K.
        Powered wheelchair skills training for persons with stroke: a randomized controlled trial.
        Am J Phys Med Rehabil. 2014; 93: 1031-1043
        • Kirby R.L.
        • Miller W.C.
        • Routhier F.
        • et al.
        Effectiveness of a wheelchair skills training program for powered wheelchair users: a randomized controlled trial.
        Arch Phys Med Rehabil. 2015; 96: 2017-2026.e3
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        BMJ. 2007; 335: 806-808
        • Kilkens O.J.
        • Post M.W.
        • Dallmaijer A.J.
        • Seelen H.A.
        • van der Woude L.H.
        Wheelchair skills tests: a systematic review.
        Clin Rehabil. 2003; 17: 418-430
        • Letts L.
        • Dawson D.
        • Bretholz I.
        • et al.
        Reliability and validity of the power-mobility community driving assessment.
        Assist Technol. 2007; 19: 154-163
        • Fliess-Douer O.
        • Vanlandewijck Y.C.
        • Manor G.L.
        • van der Woude L.H.
        A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure.
        Clin Rehabil. 2010; 24: 867-886
        • Rushton P.W.
        • Kirby R.L.
        • Routhier F.
        • Smith C.
        Measurement properties of the Wheelchair Skills Test - Questionnaire for powered wheelchair users.
        Disabil Rehabil Assist Technol. 2016; 11: 400-406
        • Dalhousie University, Faculty of Medicine, Wheelchair Skills Program
        Wheelchair Skills Test dynamic link.
        (Available at:)
        • Kirby R.L.
        • Smith C.
        • Parker K.
        • et al.
        Wheelchair Skills Program (WSP) manual: version 4.3.1.
        (Available at:)
        • Kirby R.L.
        Wheelchair skills assessment and training.
        CRC Press, Florida2016
        • Rushton P.W.
        • Miller W.C.
        • Kirby R.L.
        • Eng J.J.
        • Yip J.
        Development and content validation of the Wheelchair Use Confidence Scale: a mixed-methods study.
        Disabil Rehabil Assist Technol. 2011; 6: 57-66
        • Hosseini S.M.
        • Oyster M.L.
        • Kirby R.L.
        • Harrington A.L.
        • Boninger M.L.
        Manual wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 2237-2243
        • Kirby R.L.
        • Worobey L.A.
        • Cowan R.
        • et al.
        Wheelchair skills capacity and performance of manual wheelchair users with spinal cord injury.
        Arch Phys Med Rehabil. 2016; 97: 1761-1769
        • Kirby R.L.
        • Mitchell D.
        • Sabharwal S.
        • McCranie M.
        • Nelson A.L.
        Manual wheelchair skills training for community-dwelling veterans with spinal cord injury: a randomized controlled trial.
        PLoS One. 2016; 11: e0168330
        • Dalhousie University, Faculty of Medicine, Wheelchair Skills Program
        Wheelchair Skills Training Program dynamic link.
        (Available at:)
        • Tu C.J.
        • Liu L.
        • Wang W.
        • et al.
        Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review.
        Clin Rehabil. 2017; 31: 1573-1582
        • Kirby R.L.
        • Mifflen N.J.
        • Thibault D.L.
        • et al.
        The wheelchair-handling skills of caregivers and the effect of training.
        Arch Phys Med Rehabil. 2004; 85: 2011-2019
        • Hoenig H.
        • Landerman L.R.
        • Shipp K.M.
        • et al.
        A clinical trial of rehabilitation expert clinician versus usual care for providing manual wheelchairs.
        J Am Geriatr Soc. 2005; 53: 1712-1720
        • Kilkens O.J.
        • Post M.W.
        • Dallmeijer A.J.
        • van Asbeck F.W.
        • van der Woude L.H.
        Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation.
        J Rehabil Res Dev. 2005; 42: 65-74
        • van Zeltzen J.M.
        • de Groot S.
        • Post M.W.
        • Slootman J.R.
        • van Bennekom C.A.
        • van der Woude L.H.
        Return to work after spinal cord injury.
        Am J Phys Med Rehabil. 2009; 88: 47-56
        • Lemay V.
        • Routhier F.
        • Noreau L.
        • Phang S.H.
        • Ginis K.A.
        Relationships between wheelchair skills, wheelchair mobility and level of injury in individuals with spinal cord injury.
        Spinal Cord. 2012; 50: 37-41
        • Mortenson W.B.
        • Miller W.C.
        • Backman C.L.
        • Oliffe J.L.
        Predictors of mobility among wheelchair using residents in long-term care.
        Arch Phys Med Rehabil. 2011; 92: 1587-1593
        • Krause J.
        • Carter R.E.
        • Brotherton S.
        Association of mode of locomotion and independence in locomotion with long-term outcomes after spinal cord injury.
        J Spinal Cord Med. 2009; 32: 237-248
        • Phang S.H.
        • Martin Ginis K.A.
        • Routhier F.
        • Lemay V.
        The role of self-efficacy in the wheelchair skills-physical activity relationship among manual wheelchair users with spinal cord injury.
        Disabil Rehabil. 2012; 34: 625-632
        • Borg J.
        • Larsson S.
        • Ostergren P.O.
        • Rahman A.S.
        • Bari N.
        • Khan A.H.
        User involvement in service delivery predicts outcomes of assistive technology use: a cross-sectional study in Bangladesh.
        BMC Health Serv Res. 2012; 12: 330
        • Boaventura L.C.
        • Borges H.C.
        • Ozaki A.H.
        [Assessment of the burden of adult wheelchair-bound patients with neurological disabilities on the caregiver].
        Cien Saude Colet. 2016; 21 ([Portuguese]): 3193-3202
      1. Routhier F, Kirby RL, Demers L. Translation of the wheelchair skills program into Canadian-French: an internationalization experience. In: Proceedings of the 21st World Congress of Rehabilitation International; 2008 Aug 25-28; Québec City (Canada). New York: Rehabilitiation International; 2008.

        • Dalhousie University, Faculty of Medicine, Wheelchair Skills Program
        Programme d'habiletés en fauteuil roulant.
        (Available at:)
        • Perneger T.V.
        What is wrong with Bonferroni adjustments.
        BMJ. 1998; 136: 1236-1238