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

      Abstract

      Objective

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

      Design

      2×2 factorial randomized controlled trial.

      Setting

      Community setting in 2 Canadian cities.

      Participants

      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.

      Interventions

      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.

      Results

      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.

      Conclusion

      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.

      Keywords

      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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