| Institution: | 1. Occupational Therapy Department, Alfred Health, Caulfield Hospital, Melbourne, Australia;2. Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia;3. Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia;4. School of Allied Health (Occupational Therapy), La Trobe University, Melbourne, Australia;5. Occupational Therapy Department, Alfred Health, Melbourne, Australia;6. College of Nursing and Health Sciences, Flinders University, Adelaide, Australia;1. Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL;2. College of Applied Health Sciences, Center on Health, Aging, and Disability, Champaign, IL;3. Department of Kinesiology, Inha University, Incheon, Korea;4. Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS;5. Virginia Crawford Research Institute, Shepherd Center, Atlanta, GA;7. Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL |
| Abstract: | ObjectiveTo evaluate the effect of an mHealth wheelchair skills training program on clinical outcomes among older adult manual wheelchair users.Design2×2 factorial randomized controlled trial.SettingCommunity setting in 2 Canadian cities.ParticipantsConvenience 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.InterventionsAll 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 MeasuresThe primary outcome was wheelchair skill capacity. Secondary outcomes included safety, self-efficacy, activity participation, mobility, divided-attention, and health-related quality of life.ResultsData 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.ConclusionEnhancing 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. |
