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Efficacy of a Remote Train-the-Trainer Model for Wheelchair Skills Training Administered by Clinicians: A Cohort Study With Pre- vs Posttraining Comparisons

      Abstract

      Objective

      To test the hypotheses that remote training improves trainer confidence and when these trainers train others the capacity and confidence of the trainees improves.

      Design

      Cohort study with pre- vs posttraining comparisons.

      Setting

      Four spinal cord injury model systems centers.

      Participants

      Convenience sample of 7 clinician trainers and 19 able-bodied trainees (N=26).

      Interventions

      Part 1 focused on trainer skill acquisition with self-study of the Wheelchair Skills Program Manual and instructional videos focused on motor learning, spotting, and 10 intermediate and advanced wheelchair skills. Trainers practiced in pairs, receiving asynchronous feedback on video recordings from a remote instructor. Part 2 included additional video modules targeted at “how to” assess and train others in 4 wheelchair skills: gets over obstacle, ascends low curb, ascends high curb with caregiver assistance, and performs stationary wheelie. Upon completion, the trainers each provided 1:1 in-person training for 2-3 trainees.

      Main Outcome Measures

      Trainer confidence was assessed using the Self-Efficacy on Assessing, Training, and Spotting Test for Manual Wheelchairs. Trainee capacity (“Can you do it?”) and confidence (“How confident are you?”) were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q).

      Results

      Trainer confidence increased for assessment (P=.003) and training (P=.002) but not spotting (P=.056). Trainee 4-item median (interquartile range) WST-Q scores significantly increased with training for capacity (13% [6-31] to 88% [75-88], P<.001) and confidence (13% [0-31] to 88% [81-100], P<.001).

      Conclusions

      Remote training improves trainers’ confidence with respect to wheelchair skills testing and training and the wheelchair skills capacity and confidence of their trainees.

      Keywords

      List of abbreviations:

      IQR (interquartile range), OT (occupational therapist), RCT (randomized controlled trial), SCI (spinal cord injury), SEATS (Self-Efficacy on Assessing, Training, and Spotting Test for Manual Wheelchairs), WST-Q (Wheelchair Skills Test Questionnaire)
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