Original research| Volume 100, ISSUE 11, P2159-2166, November 2019

Effect of an mHealth Wheelchair Skills Training Program for Older Adults: A Feasibility Randomized Controlled Trial



      To evaluate the effect of an mHealth wheelchair skills training program on clinical outcomes among older adult manual wheelchair users.


      2×2 factorial randomized controlled trial.


      Community setting in 2 Canadian cities.


      Convenience sample of manual wheelchair users 50 years and older living in the community who were able to self-propel with both hands and communicate in English. Participants (N=18) were randomized into either a mHealth treatment (n=10) or tablet gaming control (n=8) group.


      All participants received 2 in-person sessions with their trainer and engaged in a 4-week monitored home training program with a computer tablet. The Enhancing Participation In the Community by improving Wheelchair Skills program provided wheelchair skills training; the control program included 9 dexterity and cognitive training games.

      Main Outcome Measures

      The primary outcome was wheelchair skill capacity. Secondary outcomes included safety, self-efficacy, activity participation, mobility, divided-attention, and health-related quality of life.


      Data collection was blinded to group allocation. Capacity improved by 2 skills but with no statistically significant between-group difference. The mHealth training program had a significant effect on participation (P=.03) and self-efficacy (P=.06) with large effect sizes (ηp2=0.22-0.29). Mobility, safety with skill performance, and divided attention measures demonstrated medium effect size changes, but only safety with skill performance was statistically significant. The program was more beneficial for participants with <1 year of wheelchair experience.


      Enhancing Participation In the Community by improving Wheelchair Skills participants demonstrated good program adherence and clinical benefits were evident in community participation and wheelchair self-efficacy. Wheelchair safety and mobility were positively affected, while skill capacity showed a small, nonsignificant improvement. Future study should investigate benefit retention over time.


      List of abbreviations:

      ANCOVA (analysis of covariance), ICC (intraclass correlation coefficient), ITT (intention-to-treat), LSA (Life-Space Assessment), MWC (manual wheelchair), PP (per protocol), RCT (randomized controlled trial), WhOM (Wheelchair Outcome Measure), WST (Wheelchair Skills Test)
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        • 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
        • World Health Organization
        Guidelines on the provision of manual wheelchairs in less resourced settings.
        World Health Organization, Geneva, Switzerland2008
        • Giesbrecht E.M.
        • Smith E.M.
        • Mortenson W.B.
        • Miller W.C.
        Needs for mobility devices, home modifications and personal assistance among Canadians with disabilities.
        Health Rep. 2017; 28: 9-15
        • Kirby R.L.
        • Smith C.
        • Parker K.
        • et al.
        The Wheelchair Skills Program Manual.
        Dalhousie University, Halifax, NS2016
        • Walker K.A.
        • Morgan K.A.
        • Morris C.L.
        • DeGroot K.K.
        • Hollingsworth H.H.
        • Gray D.B.
        Development of a community mobility skills course for people who use mobility devices.
        Am J Occup Ther. 2010; 64: 547-554
        • Best K.L.
        • Routhier F.
        • Miller W.C.
        A description of manual wheelchair skills training: current practices in Canadian rehabilitation centers.
        Disabil Rehabil. 2015; 10: 393-400
        • Kirby R.L.
        • Keeler L.
        • Wang S.
        • Thompson K.
        • Theriault C.
        Proportion of wheelchair users who receive wheelchair skills training during an admission to a Canadian rehabilitation center.
        Top Geriatr Rehabil. 2015; 31: 58-66
        • Giesbrecht E.M.
        • Miller W.C.
        • Mitchell I.M.
        • Woodgate R.L.
        Development of a wheelchair skills home program for older adults using a participatory action design approach.
        Biomed Res Int. 2014; 2014: 172434
        • World Health Organization
        mHealth: new horizons for health through mobile technologies.
        World Health Organization, Geneva, Switzerland2011
        • Thirumalai M.
        • Rimmer J.H.
        • Johnson G.
        • et al.
        TEAMS (Tele-Exercise and Multiple Sclerosis), a tailored telerehabilitation mHealth app: participant-centered development and usability study.
        JMIR Mhealth Uhealth. 2018; 6e10181
        • Hamine S.
        • Gerth-Guyette E.
        • Faulx D.
        • Green B.B.
        • Ginsburg A.S.
        Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review.
        J Med Internet Res. 2015; 17: e52
        • Dicianno B.E.
        • Parmanto B.
        • Fairman A.D.
        • et al.
        Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation.
        Phys Ther. 2015; 95: 397-405
        • Whyte J.
        • Gordon W.
        • Rothi L.J.
        A phased developmental approach to neurorehabilitation research: the science of knowledge building.
        Arch Phys Med Rehabil. 2009; 90: S3-10
        • Giesbrecht E.M.
        • Miller W.C.
        A randomized control trial feasibility evaluation of an mHealth intervention for wheelchair skill training among middle-aged and older adults.
        PeerJ. 2017; 5: e3879
        • Dalhousie University
        Wheelchair Skills Program 2012.
        (Available at:)
        • Kilkens O.J.
        • Post M.W.
        • Dallmeijer A.J.
        • Seelen H.A.
        • van der Woude L.H.
        Wheelchair skills tests: a systematic review.
        Clin Rehabil. 2003; 17: 418-430
        • Kirby R.L.
        • Swuste J.
        • Dupuis D.J.
        • MacLeod D.A.
        • Monroe R.
        The Wheelchair Skills Test: a pilot study of a new outcome measure.
        Arch Phys Med Rehabil. 2002; 83: 10-18
        • Kirby R.L.
        • Dupuis D.J.
        • Macphee A.H.
        • et al.
        The wheelchair skills test (version 2.4): measurement properties.
        Arch Phys Med Rehabil. 2004; 85: 794-804
        • Sakakibara B.M.
        • Miller W.C.
        • Souza M.
        • Nikolova V.
        • Best K.L.
        Wheelchair skills training to improve confidence with using a manual wheelchair among older adults: a pilot study.
        Arch Phys Med Rehabil. 2013; 94: 1031-1037
        • Sakakibara B.M.
        • Miller W.C.
        Prevalence of low mobility and self-management self-efficacy in manual wheelchair users and the association with wheelchair skills.
        Arch Phys Med Rehabil. 2015; 96: 1360-1363
        • 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
        • Mortenson W.B.
        • Miller W.C.
        • Miller-Pogar J.
        Measuring wheelchair intervention outcomes: development of the wheelchair outcome measure.
        Disabil Rehabil Assist Technol. 2007; 2: 275-285
        • Baker P.S.
        • Bodner E.V.
        • Allman R.M.
        Measuring life-space mobility in community-dwelling older adults.
        J Am Geriatr Soc. 2003; 51: 1610-1614
      1. Giesbrecht EM, Miller WC. Development of the Wheeling While Talking test. Paper presented at: 33rd Annual Conference of the Rehabilitation Engineering Society of North America. June 20-24, 2013; Bellevue, WA

        • 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
        • MacPhee A.H.
        • Kirby R.L.
        • Coolen A.L.
        • Smith C.
        • MacLeod D.A.
        • Dupuis D.J.
        Wheelchair skills training program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation.
        Arch Phys Med Rehabil. 2004; 85: 41-50
        • Drummond M.
        Introducing economic and quality of life measurements into clinical studies.
        Ann Med. 2001; 33: 344-349
        • Jones C.A.
        • Feeny D.
        • Eng K.
        Test-retest reliability of health utilities index scores: evidence from hip fracture.
        Int J Technol Assess Health Care. 2005; 21: 393-398
        • Giesbrecht E.M.
        • Miller W.C.
        • Eng J.J.
        • Mitchell I.M.
        • Woodgate R.L.
        • Goldsmith C.H.
        Feasibility of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) program: study protocol for a randomized controlled trial.
        Trials. 2013; 14: 350
        • Dimitrov D.M.
        • Rumrill Jr., P.D.
        Pretest-posttest designs and measurement of change.
        Work. 2003; 20: 159-165
        • Lakens D.
        Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs.
        Front Psychol. 2013; 4: 863
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        3rd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988
        • Miller W.C.
        • Garden J.
        • Mortenson W.B.
        Measurement properties of the wheelchair outcome measure in individuals with spinal cord injury.
        Spinal Cord. 2011; 49: 995-1000
        • Bandura A.
        Self-efficacy: the exercise of control.
        W.H. Freeman and Company, New York1997
        • Sakakibara B.M.
        • Miller W.C.
        • Eng J.J.
        • Backman C.L.
        • Routhier F.
        Preliminary examination of the relation between participation and confidence in older manual wheelchair users.
        Arch Phys Med Rehabil. 2013; 94: 791-794
        • Miller W.C.
        • Sakakibara B.M.
        • Rushton P.W.
        The prevalence of low confidence with using a wheelchair and its relationship to wheelchair skills.
        Gerontologist. 2012; 52
        • Smith E.M.
        • Sakakibara B.M.
        • Miller W.C.
        A review of factors influencing participation in social and community activities for wheelchair users.
        Disabil Rehabil Assist Technol. 2016; 11: 361-374
        • Kammerlind A.S.
        • Fristedt S.
        • Ernsth Bravell M.
        • Fransson E.I.
        Test-retest reliability of the Swedish version of the Life-Space Assessment Questionnaire among community-dwelling older adults.
        Clin Rehabil. 2014; 28: 817-823
        • Nelson A.L.
        • Groer S.
        • Palacios P.
        • et al.
        Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study.
        Arch Phys Med Rehabil. 2010; 91: 1166-1173
        • Kumar S.
        • Nilsen W.J.
        • Abernethy A.
        • et al.
        Mobile health technology evaluation: the mHealth evidence workshop.
        Am J Prev Med. 2013; 45: 228-236