Evaluation of the feasibility of an error-minimized approach to powered wheelchair skills training using shared control

BACKGROUND

Powered wheelchairs promote participation for people with mobility limitations. For older adults with cognitive impairment, existing training methods may not address learning needs, leading to difficulty with powered wheelchair skills. Error-minimized training, facilitated by shared control technology, may provide learning opportunities more suited to this population.

OBJECTIVE

The objective of this study was to evaluate the feasibility of an error-minimized approach to powered wheelchair skills training using shared control in residential care. Feasibility indicators were hypothesized a priori to be feasible for use in a definitive RCT.

METHODS

A 2 × 2 factorial RCT compared an error-minimized powered wheelchair skills training program (Co-pilot) to a control intervention at two doses (6 sessions vs. 12 sessions). Data were collected on the feasibility of study processes (e.g., recruitment), resources (e.g., participant time), management (e.g., technology reliability), and training outcomes (e.g., adverse events, clinical outcomes).

RESULTS

Twenty-five older adults with cognitive impairment participated in the study. Technical issues were encountered in 14.5% of training sessions. Participants receiving 6 sessions of training adhered better to the treatment than those receiving 12 sessions. All participants learned the skills required for PWC use with minor errors, regardless of the training method or dose. Co-pilot participants and trainers reported feelings of safety and training benefits with the use of shared control technology.

CONCLUSIONS

Individuals with mild to moderate cognitive impairment are able to learn the skills required to drive a powered wheelchair in as few as six training sessions. Further evaluation of the Co-pilot training program is required.IMPLICATIONS FOR REHABILITATIONShared control teleoperation technology may be used to augment learning in older adults with cognitive impairments.Evaluation of the feasibility of use of novel rehabilitation technologies is critical prior to engaging in large-scale clinical research.Individuals with cognitive impairment are able to learn the required skills for operation of a powered wheelchair.

Integrated Knowledge Translation Guiding Principles for Conducting and Disseminating Spinal Cord Injury Research in Partnership

OBJECTIVE

To address a gap between spinal cord injury (SCI) research and practice by rigorously and systematically co-developing integrated knowledge translation (IKT) guiding principles for conducting and disseminating SCI research in partnership with research users.

DESIGN

The process was guided by the internationally accepted The Appraisal of Guidelines for REsearch & Evaluation (AGREE) II Instrument for evaluating the development of clinical practice guidelines.

SETTING

North American SCI research system (ie, SCI researchers, research users, funders).

PARTICIPANTS

The multidisciplinary expert panel (n=17) and end users (n=35) included individuals from a North American partnership of SCI researchers, research users, and funders who have expertise in research partnerships.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Clarity, usefulness, and appropriateness of the principles.

RESULTS

Data regarding 125 principles of partnered research were systematically collected from 4 sources (review of reviews, scoping review, interviews, Delphi consensus exercise). A multidisciplinary expert panel held a 2-day meeting to establish consensus, select guiding principles, and draft the guidance. The panel reached 100% consensus on the principles and guidance document. The final document includes a preamble, 8 guiding principles, and a glossary. Survey data showed that the principles and guidance document were perceived by potential end users as clear, useful, and appropriate.

CONCLUSIONS

The IKT Guiding Principles represent the first rigorously co-developed, consensus-based guidance to support meaningful SCI research partnerships. The principles are a foundational tool with the potential to improve the relevance and impact of SCI research, mitigate tokenism, and advance the science of IKT.

Older adults' use of an online decision support system: Usability and stability of assistive technology recommendations

Online decision support systems (DSS) may help older adults self-select assistive technology (AT) by offering recommendations. User interactions with DSSs may change the recommendations they receive.

OBJECTIVE

We evaluated recommendations stability and usability of an online DSS.

METHODS

Middle-aged and older adults (n = 43) were observed while using the DSS. The stability of DSS recommendations (ATs and advice) was compared between two time points, using a three-point scale: no, partial, or full agreement. Usability was coded, referencing ISO standards.

RESULTS

Half (51%) of participants received AT recommendations from the DSS in both sessions, with full (14%) or partial (12%) agreement. All but one participant received advice, and almost all of them had full (40%) or partial (56%) agreement between sessions. Many of the usability issues appear to be the result of the users inaccurately measuring their environment, challenges in understanding the questions being asked, and improperly making selections from the system.

DISCUSSION

Strict AT matching rules versus generic advice, and usability issues, likely reduced the matching rate and stability of AT recommendations.

CONCLUSION

It appears that some users may require assistance with the system, and we suggest changes to the DSS format and content to improve stability and usability.

Implementing a self-management mobile app for spinal cord injury during inpatient rehabilitation and following community discharge: A feasibility study

Objective: To determine the feasibility of implementing and evaluating a self-management mobile app for spinal cord injury (SCI) during inpatient rehabilitation and following community discharge. Design: Pilot feasibility study. Setting: Rehabilitation hospital and community. Participants: Inpatients from rehabilitation hospital following admission for their first SCI. Intervention: A mobile app was developed to facilitate self-management following SCI. The app consisted of 18 tools focusing on goal setting, tracking various health aspects, and identifying confidence regarding components of self-management. In-person training and follow-up sessions were conducted during inpatient rehabilitation and follow-up calls were provided after participants were discharged into the community. Main outcome measures: Participants completed outcome measures at baseline, community discharge, and 3-months post discharge. This study focused on feasibility indicators including recruitment, retention, respondent characteristics, adherence, and app usage. Additionally, participants' self-management confidence relating to SCI (e.g. medication, skin, bladder, pain) was evaluated over time. Results: Twenty participants (median age 39, IQR: 31 years, 85% male) enrolled in the study. Participants' Spinal Cord Injury Independence Measure (SCIM-III) median score was 23 and IQR was 33 (range: 7-84), which did not correlate with app usage. Retention from admission to discharge was 85% and 70% from discharge to 3-months post discharge. Individuals in the study who used the app entered data an average of 1.7x/day in rehabilitation (n = 17), and 0.5x/day in the community (n = 7). Participants' bowel self-management confidence improved between admission and discharge (P < 0.01). Conclusions: Feasibility indicators support a larger clinical trial during inpatient rehabilitation; however, there were challenges with retention and adherence following community discharge.

Understanding the task demands for powered wheelchair driving: a think-aloud task analysis

BACKGROUND

Powered wheelchair use promotes participation in individuals with limited mobility, however training is required for safe and effective use. There is limited evidence on the task demands of powered wheelchair use to inform an evidence-based skills training programme.

OBJECTIVE

To conduct a systematic exploration of the task demands of indoor powered wheelchair use to identify frequently used skills, abilities, and knowledge.

METHODS

We used a two-phased think aloud process to conduct a task analysis of powered wheelchair use with experienced powered wheelchair users (n = 5) and expert clinicians (n = 5). Participants completed seven indoor driving tasks while speaking aloud (concurrent think aloud) and subsequently engaged in a structured qualitative interview to discuss skills, abilities, and knowledge used across each of the seven tasks (retrospective think aloud). We used directed content analysis to map the skills and abilities to the ICF framework and conventional content analysis to develop thematic areas of knowledge used while operating a powered wheelchair.

RESULTS

One-hundred and ten (110) distinct skills and abilities were identified and mapped to the ICF; 80 in the Body Structures and Functions domain, and 30 in the Activities and Participation domain. Approximately 50% of skills and abilities were mental functions. Four thematic knowledge domains were identified: knowledge of self, environment, wheelchair, and task.

CONCLUSION

Powered wheelchair use is complex and requires a variety of skills and abilities from all areas of human functioning, in addition to a wide range of knowledge. Training programmes should address a range of areas of skill development.IMPLICATIONS FOR REHABILITATIONPowered wheelchair use is a complex skill; training should develop skills from all.Domains of the ICF, including mental and physical functions.A range of knowledge is used while operating a powered wheelchair; training programs.Should include the development and application of necessary knowledge.Clinicians may consider a range of factors when assessing suitability for powered.Wheelchair user, however should acknowledge that while the range of skills idenotified.May be useful, they may not be critical for success in powered wheelchair use.

Feasibility of a peer-led, manual wheelchair maintenance skills training programme to improve wheelchair efficiency, and knowledge and confidence about wheelchair maintenance: a pre-post study

BACKGROUND

Wheelchair users typically receive little training about wheelchair maintenance. Therefore, we developed a peer-led, manual wheelchair skills maintenance training programme, with the intention of evaluating its efficacy in a future experimental study.

PURPOSE

The purpose of this feasibility study was to examine how well we were able to implement the training programme and to evaluate the feasibility of conducting a larger scale clinical trial.

SETTING

Spinal cord injury research centre.

PARTICIPANTS

Five mentors and fifteen mentees were recruited to complete this feasibility study.

METHOD

We collected information about recruitment capability and sample characteristics, data collection procedure, acceptability of the training programme, resources required, and participants' responses to the intervention. Participants completed all the items and we had little missing data. Participants did not face any difficulty answering the questionnaires or performing the tests. Therefore, we could conclude data collection was feasible moving forward to perform larger efficacy trials. The acceptability of the wheelchair maintenance programme was more than 90%. There was a statistically significant improvement in wheelchair maintenance knowledge test and total rolling resistance. Confidence of mentees increased significantly after the training. Improvements in the 3-cone test and the 6-min push test results were not significant.

CONCLUSIONS

If recruitment and scheduling challenges can be overcome, our data suggested that it is feasible to conduct a larger experimental study to test the efficacy of the programme.Implications for RehabilitationWheelchair maintenance skills are important to help wheelchair users keep their wheelchairs working safely and efficiently.The findings from this study suggest that a peer-led wheelchair maintenance training programme may improve participants' wheelchair maintenance knowledge and maintenance self-confidence.The study also suggests that a peer-led wheelchair maintenance training programme may decrease the rolling resistance of participants' wheelchairs.A larger clinical trial is needed to demonstrate the efficacy of this intervention authoritatively.

The Impact of Peer Mentoring on Loneliness, Depression, and Social Engagement in Long-Term Care

Loneliness, depression, and social isolation are common among people living in long-term care homes, despite the activities provided. We examined the impact of a new peer mentoring program called Java Mentorship on mentees' loneliness, depression, and social engagement, and described their perceptions of the visits. We conducted a mixed-methods approach in 10 homes in Ontario, Canada, and enrolled residents as mentees (n = 74). We used quantitative surveys and qualitative interviews to understand their experience. After 6 months, mentees (n = 43) showed a 30% reduction in depression (p = .02, d = .76), a 12% reduction in loneliness (p = .02, d = .76), and a 60% increase in the number of monthly programs attended (p = .01, d = .37), with small-to-medium effect sizes. The analysis of mentee's interviews revealed positive perceptions. This program offers an innovative, nonpharmacological alternative to the treatment of loneliness and depression.

Examining the Impact of Knowledge Mobilization Strategies to Inform Urban Stakeholders on Accessibility: A Mixed-Methods study

Urban areas offer many opportunities for people with disabilities, but limited accessibility may prevent their full engagement in society. It has been recommended that the experience-based perspective of people with disabilities should be an integral part of the discussion on urban accessibility, complementing other stakeholder expertise to facilitate the design of more inclusive environments. The goals of this mixed-method study were to develop knowledge mobilization (KM) strategies to share experience-based findings on accessibility and evaluate their impact for various urban stakeholders. Using a participatory approach, various KM strategies were developed including videos, a photo exhibit and an interactive game. These strategies were evaluated based on various impact indicators such as reach, usefulness, partnerships and practice changes, using quantitative and qualitative methods. The findings suggested that the KM strategies were effective in raising the awareness of various urban stakeholders and providing information and guidance to urban planning practices related to accessibility.

Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning

IMPORTANCE

The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined.

OBJECTIVE

To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse.

DESIGN

This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B.

SETTING

Rehabilitation hospital.

PARTICIPANTS

Forty-one patients with neurological impairments.

OUTCOMES AND MEASURES

The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion).

RESULTS

The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (r_s = -.436, p = .009) and B (r_s = -.364, p = .029).

CONCLUSIONS AND RELEVANCE

The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments.

WHAT THIS ARTICLE ADDS

This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.

All aboard: users' experiences of adapted paddling programs

PURPOSE

Research has yet to examine the experiences of paddle boarders, or of kayakers with disabilities other than spinal cord injuries. The goal of this study was to explore the experiences of kayakers and paddle boarders in two adaptive paddling programs.

METHOD

Participants were children and adults requiring physical, cognitive, and/or psychosocial supports. Using an ethnographic approach, participant observations (n = 24) and semi-structured interviews (n = 11) were completed. Data were analyzed thematically.

RESULT

We identified three main themes. "Different Strokes" described the personal meaning participants ascribed to aspects of paddling, including valuing fun, exercise and relaxation. "Turning the Tide" illustrated the process of becoming a paddler, from doubting capacity to feeling competent. "Headwinds" explored paddlers' interactions with the broader social, institutional, and economic environments, such as inadequate funding and program aversion to risk.

CONCLUSIONS

Programs offering a variety of adaptive paddle boarding and kayaking configurations enable paddlers to make valued choices about their participation. In addition to providing equipment and support to meet paddlers' functional abilities, program developers and clinicians should also consider individual preferences for exercise, socialization, risk taking, self-presentation of disability, and independence.IMPLICATIONS FOR REHABILITATIONPeople living with physical, cognitive, and/or psychosocial impairments perceive kayaking and paddle boarding as meaningful activities offering opportunities to exercise, have fun, achieve goals, socialize, and/or relax on the water.Kayakers and paddle boarders value equipment options that meet their physical and disability-disclosure preferences.Despite the existence of adaptive paddling programs, participation may be restricted by program availability, risk management policies, and leisure funding.

Outdoor recreation among wheeled mobility users: perceived barriers and facilitators

PURPOSE

Participation in outdoor recreation is associated with improvements in mental, emotional, and physical health. Individuals with impairments affecting mobility, such as wheelchair users, face environmental, physical, and social barriers to participation in outdoor recreation. There is limited research on outdoor recreation participation among wheelchair users, especially concerning informal recreational opportunities. Formal programmes that offer access to outdoor recreation are often oversubscribed and also do not enable opportunities to participate more spontaneously.

OBJECTIVES

(1) To explore the experiences and impact of participation in outdoor recreation activities by wheelchair users, with an emphasis on more informal activities; and (2) to identify perceived barriers and facilitators to participation in outdoor recreation activities.

METHODS

Semi-structured interviews were the main means of data collection in this interpretive description study; this was supplemented by photographs of activity involvement provided by participants. These data were analysed thematically.

RESULTS

Fifteen Canadian wheelchair users participated in the study. Three themes emerged following analysis: (1) Into the Woods explores participants' current outdoor recreation experiences, (2) Ain't No Mountain High Enough looks at the barriers and challenges participants face, and (3) Just Around the Riverbend discusses participants' desired changes to enable their further participation.

CONCLUSIONS

The study highlighted participants' current experiences, their perceived barriers, and several ways to enhance outdoor recreation participation among wheelchair users, including: developing new adaptations, creating policies, increasing access to affordable equipment and programmes, and reducing barriers in built and natural environments.Implications for rehabilitationWheelchair users participate in a wide variety of outdoor activities.Wheelchair users experience various barriers and challenges when participating in outdoor recreation.Despite recent improvements, environmental changes are needed to allow wheelchair users to access outdoor recreation.Further development of adaptive equipment is needed in order for wheelchair users to access their desired outdoor recreation activities.

Changes in residents' seating needs and perception of stakeholders since implementation of a provincial wheelchair program

BACKGROUND

People living in long-term care frequently have inadequate access to properly fitted wheelchairs. This can lead to potential problems with mobility, positioning, comfort, and skin integrity. A provincial programme to provide individually fitted lightweight wheelchairs to residents started in January 2016; however, no research has evaluated programme outcomes.

OBJECTIVES

To identify seating needs of residents before and after implementation of a provincial wheelchair programme at two long term care facilities in Vancouver and to explore stakeholders experiences with this programme.

METHODS

A pre/post study design was used which involved chart reviews to collect Seating Identification Tool (SIT), and interviews with stakeholders having experience with the provincial programme to gather information on their experiences. SIT data were analysed using a Wilcoxon Signed-Rank test and interviews were analysed thematically.

FINDINGS

SIT scores improved by 2 (median) which was statistically significant for the 22 residents with pre/post data available. Prevalence of seating needs decreased on average by 18%. Among the six stakeholders interviewed, themes identified included: wheelchairs/cushions provided addressed many residents' needs; and saved residents and their families money and stress; and there is still ongoing need for more specialised equipment for frail residents (not covered by this programme).

CONCLUSION

This study provides some evidence regarding the benefits of the introduction of this programme in two care homes and identifies potential changes that might improve wheelchair seating among residents with more severe seating needs. Further research is required on how these equipment changes might affect their mobility or participation in activities. Implications for rehabilitationThese findings appear to support the provision of lightweight individually fitted wheelchairs and moderate pressure redistribution cushions by occupational therapists in long-term care through this programme.Regular use of the SIT (i.e., on admission, condition change, annual care conference, and as needed) may be beneficial to ensure residents are properly screened for seating needs.Collaboration with the resident appears to be important to ensure equipment on provision and follow-up are meeting residents' needs.Recommend future research on the use of tilt in space wheelchairs for residents' in long-term care.

Patients' Perspectives on the Usability of a Mobile App for Self-Management following Spinal Cord Injury

With decreasing inpatient lengths of stay following spinal cord injury (SCI), newly injured patients may be discharged into the community without the self-management skills needed to prevent secondary conditions. A mobile app was developed to facilitate self-management skills following SCI in the inpatient rehabilitation and early community settings. The objective of this study was to explore patients' perspectives on the usability of this self-management app. A mixed-methods study design was implemented. The app was trialed at a local rehabilitation centre with 20 inpatient participants who experienced a SCI. They received mobile app training sessions throughout their inpatient rehabilitation. A thematic analysis was performed on qualitative data from post-discharge exit questionnaires and researchers' field notes. Quantitative data (in the form of participants' tool usage data and self-reported system usability scale scores) were collected at discharge and 3 months post-discharge. Three main themes emerged from the qualitative analysis: (1) being accessible to users (i.e., being easy to adopt and compatible with assistive technologies), (2) being intuitive to navigate (i.e., incorporating a simple app layout and a system of alert notifications), and (3) offering users flexibility (i.e., providing users with control over their data). The mobile app received above average mean system usability scale scores, both at discharge (78.1/100) and 3 months post-discharge (71.6/100). Given that participants found the app acceptable for use in inpatient rehabilitation and following discharge into the community, further testing is warranted to explore its efficacy in preventing secondary complications.

“A Chance to Try”: Exploring the Clinical Utility of Shared-Control Teleoperation for Powered Wheelchair Assessment and Training

Importance: Powered wheelchairs provide independence for people with mobility impairments; however, current training practices may not meet the needs of those with cognitive impairments. Shared-control teleoperation may have utility in a clinical setting when developing training suited to this population.

Objective: To explore the clinical utility of a shared-control teleoperation device for powered wheelchair assessment and training.

Design: In this qualitative study, we used two sequential semistructured interviews conducted a minimum of 2 wk apart. Thematic analyses were used with member checking, reflexive journaling, and triangulation of researchers to establish trustworthiness of the data.

Setting: Rehabilitation center and residential care and community settings.

Participants: Using purposive sampling, we recruited occupational therapists and physical therapists who were mostly female and who had a range of practice experience.

Results: Fifteen participants were interviewed, and two primary themes were identified: (1) “A big enabler” described how shared control provides opportunities to train people who may otherwise be denied powered mobility, and (2) “changing the learner experience” described how shared control may promote success in skill development through an alternative learning experience.

Conclusions and Relevance: Shared-control technology may have the potential to broaden the scope of therapeutic intervention by reducing risk to the driver and others in the environment and by facilitating alternative training approaches.

What This Article Adds: Technological advances that allow more control over a powered wheelchair by a clinician, known as shared control, may provide learning opportunities for people who are otherwise denied access to powered mobility. Shared control may also allow the use of new instructional techniques, increase safety in the training process, and reduce anxiety associated with learning.

Visual Field Impairment and Driver Fitness: A 1-Year Review of Crashes and Traffic Violations

IMPORTANCE

Occupational therapists frequently assess the fitness to drive of people with visual field impairment, but the relationship between these assessments and driving performance over time is not well understood.

OBJECTIVE

To determine traffic violation and crash incidence over a 1-yr period for drivers with visual field impairment.

DESIGN

Retrospective review of medical and driving records.

SETTING

British Columbia, Canada.

PARTICIPANTS

Participants (N = 445) were ages 26-74 yr with binocular, corrected visual acuity of ≥20/50. Goldmann visual field tests were reviewed to stratify participants on the basis of visual field impairment and whether impairments exceeded licensing standards.

OUTCOME AND MEASURES

Traffic records were reviewed to determine group-specific traffic violations and crash incidence during the year after the visual field test.

RESULTS

Of 445 participants, 292 held a valid driver's license during the designated period. Participants not meeting the licensing standards were less likely to become licensed than participants who met the standards. The results indicate that drivers with visual field impairment did not have a higher probability of crashes or violations than drivers without visual field impairment.

CONCLUSION

Drivers with visual field impairment who retained a driver's license did not have an increased probability of crashes in the following year. A larger, prospective, mixed methods study of long-term driving behaviors among people with visual field impairment is recommended.

WHAT THIS ARTICLE ADDS

This study provides preliminary data on the 1-yr incidence of traffic violations and crashes among people with visual field impairment.

Comparing Assessments of Physical Functional Independence in Older Adults With Mobility Limitations

OBJECTIVES

The aims of the study were (1) to assess the agreement and correlation between self-reported functional independence and observations of family caregivers in a heterogeneous population of community-dwelling older adults with disabilities and (2) to determine how self-reports and caregiver reports correlate with evaluator rated functional independence over time.

DESIGN

Data were drawn from a larger, randomized controlled trial examining the effects of a caregiver-inclusive intervention on outcomes of care recipients and their family caregivers. Functional independence measures were obtained using a self-report version of the Functional Independence Measure (care recipient self-reported Functional Independence Measure, caregiver self-reported Functional Independence Measure) and the Functional Autonomy Measurement System (evaluator perspective). They were administered at baseline (preintervention) and after the intervention at 6, 22, and 58 wks.

RESULTS

Bivariate correlation analyses of 90 dyads consisting of older care recipients and their family caregivers reported moderate to very strong correlations between the three functional independence measures across all time points (rS = 0.45-0.91, P < 0.01). Bland-Altman analyses revealed a small systematic bias between care recipient and caregiver assessments of functional independence, with participants reporting higher scores across all time points (mean difference = 2.00-2.97).

CONCLUSIONS

There is substantial consistency among the self-assessed, caregiver-assessed, and evaluator assessed functional independence of older adults. Caregivers may be used as proxies for community-dwelling older adults without severe cognitive impairments with functional limitations.

TO CLAIM CME CREDITS

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: After reviewing this article, readers will be able to: (1) Describe the strength of association between self-reported functional independence and observations of family caregivers in a heterogeneous population of community-dwelling older adults with disabilities over time; (2) Describe the level of agreement between self-reported functional independence and observations of family caregivers over time; and (3) Describe the associations among self-reported, caregiver reported and evaluator rated functional independence over time.

LEVEL

Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Feasibility RCT protocol evaluating a powered-wheelchair training program for older adults

Background.

Powered-wheelchair use improves participation for people with mobility limitations; however, many individuals do not receive powered-wheelchair skills training that meets their learning needs.

Purpose.

The aim of this work is to evaluate the feasibility of a powered-wheelchair training program for older adults with cognitive impairment, using errorless learning strategies facilitated by shared control technology.

Method.

A feasibility 2 × 2 factorial randomized controlled trial will recruit 32 older adults in residential care with mild to moderate cognitive impairment who are new powered-wheelchair use. The intervention consists of six or 12 training sessions, facilitated by shared control technology, using errorless learning techniques. Control participants will receive six or 12 training sessions using trial-and-error methods. Feasibility and clinical outcomes data (primary outcome: powered-wheelchair skills) will be collected.

Implications.

Errorless learning facilitated by shared control technology may be an alternative to meet the powered-wheelchair learning needs of older adults with cognitive impairments.

Development of a Self-Management App for People with Spinal Cord Injury

With decreasing inpatient rehabilitation lengths of stay, there may be a greater risk of spinal cord injury (SCI) populations being discharged into the community without the self-management skills needed to prevent secondary complications. Recent advancements in mobile health has made mobile apps a feasible method of delivering population-based, self-management interventions to address SCI-specific secondary complications. The objective of this study is to describe stakeholder perspectives on the development of a functional mobile app to facilitate self-management skills needed to prevent secondary complications following recent SCI during inpatient rehabilitation. A user-centered design approach was used that involved an evolving mobile app and the collection of prospective qualitative data. Stakeholders from three groups were enrolled in the study: individuals admitted for rehabilitation following SCI (n = 20) and informal (n = 7) and formal (n = 48) caregivers. Iterative feedback was gathered from rehabilitation inpatients during ongoing interactions and via post-discharge exit questionnaires, from informal caregivers via one-on-one interviews, and from formal caregivers via series of focus groups at various phases throughout the design process. Three main themes emerged from the analysis: (1) being individualized and user friendly (i.e., developing an app that is simple and easy to use to facilitate universal uptake), (2) targeting goals to promote self-management (i.e., adopting self-management skills relative to personal goals and confidence), and (3) increasing participation and support-seeking to facilitate lifestyle change (i.e., encouraging leisure activities to facilitate community integration). Key stakeholder perspectives contributed to the development of a self-management mobile app that will be evaluated in future research.