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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 20, 2019
Footnotes
Supported by the Canadian Institutes of Health Research (grant no. MOP-123240).
Clinical Trial Registration No.: NCT01740635.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
