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Influence of Peer-led Wheelchair Training on Wheelchair Skills and Participation in Older Adults: Clinical Outcomes of a Randomized Controlled Feasibility Trial

  • Author Footnotes
    ∗ Miller and Best contributed equally to this work.
    William C. Miller
    Correspondence
    Corresponding author William C. Miller, PhD, FCAOT, Rehabilitation Research Lab, University of British Columbia, Department of Occupational Science and Occupational Therapy, 4255 Laurel St, Vancouver, BC Canada V5Z 2G9.
    Footnotes
    ∗ Miller and Best contributed equally to this work.
    Affiliations
    Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Rehabilitation Research Program, Vancouver Coastal Research Institute, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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  • Author Footnotes
    ∗ Miller and Best contributed equally to this work.
    Krista L. Best
    Footnotes
    ∗ Miller and Best contributed equally to this work.
    Affiliations
    Department of Rehabilitation, Laval University, Quebec City, Quebec, Canada

    Center for Interdisciplinary Research in Rehabilitation and Social Integration, Integrated Health and Social Services Center of the National-Capital, Institute of Rehabilitation in Physical Disability of Quebec, Quebec City, Quebec, Canada
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  • Janice J. Eng
    Affiliations
    Rehabilitation Research Program, Vancouver Coastal Research Institute, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada

    Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • François Routhier
    Affiliations
    Department of Rehabilitation, Laval University, Quebec City, Quebec, Canada

    Center for Interdisciplinary Research in Rehabilitation and Social Integration, Integrated Health and Social Services Center of the National-Capital, Institute of Rehabilitation in Physical Disability of Quebec, Quebec City, Quebec, Canada
    Search for articles by this author
  • Author Footnotes
    ∗ Miller and Best contributed equally to this work.
Published:November 23, 2018DOI:https://doi.org/10.1016/j.apmr.2018.10.018

      Abstract

      Objective

      To estimate treatment effect size of a peer-led Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU) program on objective wheelchair skills (primary); and on perceived wheelchair skills capacity and performance, wheelchair use self-efficacy, satisfaction with participation, life-space mobility, and participation frequency (secondary); and to evaluate retention 6 months later (secondary).

      Design

      Randomized controlled trial.

      Setting

      Rehabilitation centers and communities.

      Participants

      Community-living older adults (N=40).

      Intervention

      WheelSeeU comprised six 90-minute peer-led sessions of customized training (in pairs) according to participants’ goals. A support-trainer provided spotting. The control group comprised six 90-minute professional-led didactic information sessions (in pairs).

      Main Outcome Measures

      The Wheelchair Skills Test (WST), Wheelchair Skills Test Questionnaire (WST-Q), Wheelchair Use Confidence Scale for Manual Wheelchair Users-Short Form (WheelCon-M-SF), Wheelchair Outcomes Measure (WhOM), Life-Space Mobility (LSA), and Late Life Function and Disability Index (LLFDI) were collected at baseline (T1), postintervention (T2), and 6 months postintervention (T3).

      Results

      Of 121 screened, 39 individuals did not meet the inclusion criteria and 41 declined to participate. Forty participants (64.5 years of age; 60% men) were randomized, 38 completed the intervention, and 35 completed T3 assessments. There were no adverse effects. WheelSeeU did not have a statistically significant greater effect on objective WST (primary) or WST-Q capacity, WheelCon, LSA, and LLFDI at T2 compared to the control group. Effect sizes were statistically significant and large for WST-Q performance (Cohen’s d=0.72) and the WhOM (Cohen’s d=0.82) at T2, and effects were retained at T3.

      Conclusion

      Compared to an active control group, WheelSeeU did not have a greater effect on wheelchair skills capacity. However, WheelSeeU should not be prematurely dismissed as an approach to potentially improve wheelchair skills performance and satisfaction with participation in meaningful activities. Sex and depression are important when designing interventions for older adults.

      Keywords

      List of abbreviations:

      ICF (International Classification of Functioning, Disability, and Health), iWheel (Resources for Improving Wheelchair Use), LLFDI (Late Life Function and Disability Index), LSA (Life-Space Assessment), MWC (manual wheelchair), RCT (randomized controlled trial), WheelCon-M-SF (Wheelchair Use Confidence Scale for Manual Wheelchair Users-Short Form), WheelSeeU (Wheelchair Self-Efficacy Enhanced for Use), WhOM (Wheelchair Outcome Measure), WST (Wheelchair Skills Test version 4.1), WST-Q (Wheelchair Skills Test Questionnaire)
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