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Effectiveness of a Web-Based Direct-to-User Transfer Training Program: A Randomized Controlled Trial

  • Stephanie K. Rigot
    Affiliations
    Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA

    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
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  • Kaitlin M. DiGiovine
    Affiliations
    Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA

    Department of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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  • Michael L. Boninger
    Affiliations
    Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA

    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
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  • Rachel Hibbs
    Affiliations
    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
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  • Ian Smith
    Affiliations
    Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
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  • Lynn A. Worobey
    Correspondence
    Corresponding author Lynn A. Worobey, PhD, DPT, ATP, Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA 15213.
    Affiliations
    Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA

    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
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      Abstract

      Objective

      To determine the effectiveness of a web-based, direct-to-user transfer training program in improving transfer quality and maintaining improvements for up to 1 month after training as compared with a control group.

      Design

      Randomized controlled trial with participants randomized to an immediate intervention group (IIG) or waitlist control group (WLCG) that received the training after a 6-month delay.

      Setting

      Wherever the participants accessed the web-based training, likely the home environment.

      Participants

      Convenience sample of full-time wheelchair users (N=72; IIG, n=34; WLCG, n=38 for between-group analysis, n=48 for combined within-group analysis) with spinal cord injury or disorder who were able to independently perform a lateral scoot transfer.

      Interventions

      Self-paced, web-based transfer training module.

      Main Outcome Measures

      Transfer Assessment Instrument Questionnaire (TAI-Q) score at baseline, 1 month, and 6 months postbaseline (WLCG only), immediately posttraining, and 1 month posttraining. The TAI-Q is an 18-item self-assessment that covers several aspects of a quality transfer.

      Results

      The IIG significantly increased particpants’ baseline TAI-Q score from 6.91±0.98 to 7.79±1.12 (P<.001) by 1 month posttraining. The WLCG also increased from baseline to the 1-month postbaseline assessment (from 6.52±1.13 to 7.00±1.09; P=.014), potentially from learning effects secondary to self-assessment with the TAI-Q. The extent of change over time did not differ significantly between the IIG and WLCG from baseline to 1 month (P=.169). However, significant improvements in TAI-Q scores were still evident after the training for the WLCG (P<.001). Those with a lower pretraining TAI-Q score and more shoulder pain were most likely to benefit from the training.

      Conclusions

      Repeated TAI-Q self-assessments likely contributed to improved transfer quality, with web-based training having an additive effect. Wheelchair users are likely to benefit from transfer training and self-assessment of transfer quality in their home environments. This has the potential to decrease injury risk while avoiding barriers to in-person training.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), IIG (immediate intervention group), MDC (minimum detectable change), SCI (spinal cord injury), TAI-Q (Transfer Assessment Instrument Questionnaire), WLCG (waitlist control group), WUSPI (Wheelchair User's Shoulder Pain Index)
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