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)To read this article in full you will need to make a payment
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References
- Most essential wheeled mobility skills for daily life: an international survey among paralympic wheelchair athletes with spinal cord injury.Arch Phys Med Rehabil. 2012; 93: 629-635
- Upper limb function in persons with long term paraplegia and implications for independence: part I.Paraplegia. 1994; 32: 211-218
- Americans with disabilites: 2014.US Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, Washington (DC)2018
- Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives.Disabil Rehabil Assist Technol. 2017; 12: 28-38
- Scapular kinematics during transfers in manual wheelchair users with and without shoulder impingement.Clin Biomech (Bristol, Avon). 2005; 20: 32-40
- Upper extremity pain after spinal cord injury.Spinal Cord. 1999; 37: 191-195
- Biomechanics of sitting pivot transfers among individuals with a spinal cord injury: a review of the current knowledge.Top Spinal Cord Inj Rehabil. 2009; 15: 33-58
- Upper limb kinetic analysis of three sitting pivot wheelchair transfer techniques.Clin Biomech (Bristol, Avon). 2011; 26: 923-929
- The weight-bearing shoulder.J Am Acad Orthop Surg. 2018; 26: 3-13
- Shoulder pain in persons with thoracic spinal cord injury: prevalence and characteristics.J Rehabil Med. 2008; 40: 277-283
- Concurrent validity and reliability of the transfer assessment instrument questionnaire as a self-assessment measure.Arch Rehabil Res Clin Transl. 2020; 2100088
- Reliability and validity of the revised transfer assessment instrument.Top Spinal Cord Inj Rehabil. 2018; 24: 217-226
- Ultrasonographic median nerve changes after repeated wheelchair transfers in persons with paraplegia: relationship with subject characteristics and transfer skills.PM R. 2016; 8: 305-313
- Transfer technique is associated with shoulder pain and pathology in people with spinal cord injury: a cross-sectional investigation.Arch Phys Med Rehabil. 2016; 97: 1770-1776
- Cross-sectional investigation of acute changes in ultrasonographic markers for biceps and supraspinatus tendon degeneration after repeated wheelchair transfers in people with spinal cord injury.Am J Phys Med Rehabil. 2016; 95: 818-830
- Annual report on people with disabilities in America.Institute on Disability, Durham2018
- Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial.Arch Phys Med Rehabil. 2005; 86: 2316-2323
- Inpatient and postdischarge rehabilitation services provided in the first year after spinal cord injury: findings from the SCIRehab study.Arch Phys Med Rehabil. 2011; 92: 361-368
- Outpatient spinal cord injury rehabilitation: managing costs and funding in a changing health care environment.Disabil Rehabil. 2007; 29: 1525-1534
Office of Disease Prevention and Health Promotion. Access to health services. Available at:https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Access-to-Health-Services. Accessed April 1, 2020.
- Geographic variation in outpatient health care service utilization after spinal cord injury.Arch Phys Med Rehabil. 2017; 98: 341-346
- Barriers, facilitators, and access for wheelchair users: substantive and methodologic lessons from a pilot study of environmental effects.Soc Sci Med. 2002; 55: 1435-1446
- 2020 annual statistical report for the Spinal Cord Injury Model Systems.National Spinal Cord Injury Statistical Center, Birmingham2020
- Transfer component skill deficit rates among veterans who use wheelchairs.J Rehabil Res Dev. 2016; 53: 279-294
- Upper-limb biomechanical analysis of wheelchair transfer techniques in two toilet configurations.Clin Biomech (Bristol, Avon). 2018; 55: 79-85
- Immediate biomechanical implications of transfer component skills training on independent wheelchair transfers.Arch Phys Med Rehabil. 2016; 97: 1785-1792
- Activity restriction among wheelchair users.J Am Geriatr Soc. 2003; 51: 1244-1251
- Nonfinancial barriers and access to care for U.S. adults.Health Serv Res. 2012; 47: 462-485
- Internal and external indicators of virtual learning success: a guide to success in K-12 virtual learning.Distance Learning. 2012; 9: 21-28
- Investigating the efficacy of web-based transfer training on independent wheelchair transfers through randomized controlled trials.Arch Phys Med Rehabil. 2018; 99: 9-16.e10
- Short-term influence of transfer training among full time pediatric wheelchair users: a randomized trial.J Spinal Cord Med. 2017; 40: 396-404
- Development of the Wheelchair User's Shoulder Pain Index (WUSPI).Paraplegia. 1995; 33: 290-293
- Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI).Paraplegia. 1995; 33: 595-601
- Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users.Spinal Cord. 1999; 37: 421-429
- Clinimetrics: the Wheelchair User's Shoulder Pain Index (WUSPI).J Physiother. 2019; 65: 55
- Quantification of reaction forces during sitting pivot transfers performed by individuals with spinal cord injury.J Rehabil Med. 2008; 40: 468-476
- The relationship between independent transfer skills and upper limb kinetics in wheelchair users.Biomed Res Int. 2014; 2014984526
- Paralyzed Veterans of America Consortium for Spinal Cord Medicine. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals.J Spinal Cord Med. 2005; 28: 434-470
- Statistical power analysis for the behavioral sciences.Academic Press, London, UK2013
- Effectiveness of the wheelchair skills training program: a systematic review and meta-analysis.Disabil Rehabil Assist Technol. 2019; 14: 391-409
- Changes in internet use over time among individuals with traumatic spinal cord injury.Arch Phys Med Rehabil. 2021 May 29; ([Epub ahead of print])
- Impact of length or relevance of questionnaires on attrition in online trials: randomized controlled trial.J Med Internet Res. 2011; 13: e96
- Methodological challenges in online trials.J Med Internet Res. 2009; 11: e9
Article info
Publication history
Published online: June 03, 2021
Accepted:
May 21,
2021
Received in revised form:
May 19,
2021
Received:
April 6,
2021
Footnotes
Presented in a platform presentation to the Academy of Spinal Cord Injury Professionals, September 6-9, 2020, virtual.
Supported by the Paralyzed Veterans of America Research Foundation, National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant nos. 90SI5014, 90DP0078) and the National Institute of Child Health and Human Development (NICHD) (grant no. K23HD096134).
Disclosures: none.
Clinical Trial Registration No.: NCT03164278.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
