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Kenyon LK, McNally D, Ray J, Vanderest S, Best KL. Factors clinicians consider when providing pediatric wheelchair skills training: a modified think aloud study. Disabil Rehabil Assist Technol 2024; 19:1956-1963. [PMID: 37480332 DOI: 10.1080/17483107.2023.2238004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Children who use a manual wheelchair (WC) or a power WC may not receive adequate WC skills training. Clinicians report knowledge as a barrier to the provision of paediatric WC skills training. The purpose of this study was to explore the breadth and depth of specific factors clinicians consider when providing WC skills training for children. METHODS Data in this modified Think Aloud study were gathered via one-on-one, Zoom-based, audio-recorded Think Aloud Sessions. Sessions consisted of participants viewing four videos, each of different children performing a different WC skill while thinking aloud (verbally expressing) about the factors they recognized, observed, and considered while watching the video. After each video, participants also responded to questions regarding the specific WC skill and the provision of WC skills training for the child in the video. Factors participants reported were independently identified by three researchers through a deductive process of directed content analysis and categorized using the International Classification of Functioning, Disability and Health (ICF) coding system. RESULTS Twenty-eight English-speaking clinicians participated in the study. A total of 1246 distinct factors were mapped to 352 unique ICF codes spanning all four ICF Domains. The largest number of identified factors mapped to codes within the Activities and participation Domain (42.25%). CONCLUSION Participants reported considering multiple factors across the ICF in the provision of WC skills training for children. Providing paediatric WC skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities.
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Affiliation(s)
- Lisa K Kenyon
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Daniel McNally
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Jacob Ray
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Sebastian Vanderest
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Krista L Best
- Faculty of Medicine, Université Laval, Quebec City, Quebec, CA, USA
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Krayn-Deckel N, Presaizen K, Kalron A. Cognitive status is associated with performance of manual wheelchair skills in hospitalized older adults. Disabil Rehabil Assist Technol 2024; 19:24-29. [PMID: 35400273 DOI: 10.1080/17483107.2022.2060353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine the relationship between manual wheelchair skills and cognitive function in hospitalized older adults. METHODS The observational study included older adults who used a manual wheelchair following hip/knee surgery. Participants underwent a series of tests to evaluate manual wheelchair skills and cognitive performance. Four items appearing on the Wheelchair Skills Test: brake handling (locking/unlocking), a 10-metre forward roll, a 2-metre backward roll and rotating in place, were used to evaluate manual wheelchair skills. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), the Clock Drawing Test, and the Loewenstein Occupational Therapy Cognitive Assessment. The relationship between wheelchair skills and cognitive scores was assessed by a series of univariate linear regression analyses. RESULTS Fifty older adults, aged 65-85, participated in the study. The MoCA-7 (orientation) explained 19.3% of the variance related to the turn in place wheelchair skill, 18.8% of the variance related to the two-metre backwards roll and 31.9% of the variance related to the 10-metre forward roll. The addition of gender (to the MoCA-7) increased the explained variance related to the 10-metre forward roll and turn in place skills to 38.5% and 28.5%, respectively. As for the brakes handling skill test, gender explained 18.3% of the variance. The addition of the CDT (to gender) increased the explained variance for the brakes handling skill to 31.4%. CONCLUSIONS Because cognitive impairments negatively affect the performance of wheelchair skills, rehabilitation therapists may need to adjust wheelchair mobility training methods for cognitively impaired older adults.Implication for rehabilitationGiven the prevalence of older adults with cognitive impairments who use manual wheelchairs, it is critical to better understand the relationship between cognition and wheelchair skills.Poor results reported on the cognitive tests, specifically, visual attention and orientation, were found to be associated with poor performance of four manual wheelchair skills.Rehabilitation therapists should consider the cognitive status of older adults when teaching manual wheelchair skills, specifically in new users. Future studies should examine whether a customized preparation program, enhancing visuospatial orientation, can benefit manual wheelchair control in older adults.
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Affiliation(s)
- Nurit Krayn-Deckel
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Bayit Balev Rehabilitation Center, Maccabi Health Care Services Group, Ra'anana, Israel
| | - Katya Presaizen
- Bayit Balev Rehabilitation Center, Maccabi Health Care Services Group, Ra'anana, Israel
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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3
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Worobey LA, Kirby RL, Cowan RE, Dyson-Hudson TA, Shea M, Heinemann AW, Pedersen JP, Hibbs R, Boninger ML. Using remote learning to teach clinicians manual wheelchair skills: a cohort study with pre- vs post-training comparisons. Disabil Rehabil Assist Technol 2022; 17:752-759. [PMID: 32809896 PMCID: PMC8204376 DOI: 10.1080/17483107.2020.1804633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To test the hypothesis that remote learning to teach clinicians manual wheelchair skills is efficacious. MATERIALS AND METHODS A convenience sample of therapists (physical and occupational) and students were enrolled in pairs in a cohort study with pre- versus post-training comparisons. The intervention was a hybrid of self-study and hands-on practice paired with remote feedback for ten intermediate and advanced manual wheelchair skills. Participants practiced with self-selected frequency and duration, uploading a session log and video(s) to an online platform. A remote trainer provided asynchronous feedback prior to the next practice session. Capacity and confidence in completing the ten skills were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q). Knowledge of wheelchair skills training and motor learning was assessed using a 62-item Knowledge Test. Secondary outcome measures included skill achievement, as confirmed by submitted video recordings, and participant feedback about the training. RESULTS Across 41participants, scores were higher at follow-up compared to baseline for WST-Q capacity (73.9 ± 19.1 vs 16.8 ± 15.6, p < 0.001), WST-Q confidence (80.1 ± 12.2 vs 47.6 ± 18.2, p = 0.003) and knowledge (70.8 ± 7.5 vs 67.0 ± 5.4, p = 0.004). CONCLUSIONS Remote learning can increase wheelchair skills capacity and confidence as well as knowledge about such training and assessment. This model should be further investigated as a delivery method for training rehabilitation professionals. CLINICAL TRIAL REGISTRATION NUMBER NCT01807728.Implications for rehabilitationWheelchair skills training is one of the 8 steps of wheelchair provision as outlined by the World Health Organization.Wheelchair skills are not a core part of most clinical curriculums and many clinicians cite a lack of resources and uncertainty on how to implement wheelchair skills training into practice as major barriers to providing such training.Remote learning offers the benefits of structured wheelchair skills training with expert feedback on an individual's own schedule that is not afforded by one-day "bootcamp"-type courses or on-the-job training, which are how many clinicians currently learn wheelchair skills.In a sample of physical and occupational therapists and students, remote learning was effective at increasing capacity and confidence to perform manual wheelchair skills as well as knowledge of wheelchair training.
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Affiliation(s)
- Lynn A Worobey
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA, USA
| | - R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada
| | - Rachel E Cowan
- Department of Physical Medicine & Rehabilitation, University of Alabama, Birmingham, AB, USA
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mary Shea
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Allen W Heinemann
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Shirley Ryan Ability Lab, Chicago, IL, USA
| | | | - Rachel Hibbs
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA, USA
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Assessment of Wheelchair Propulsion Performance in an Immersive Virtual Reality Simulator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158016. [PMID: 34360309 PMCID: PMC8345396 DOI: 10.3390/ijerph18158016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
Maneuvering a wheelchair is an important necessity for the everyday life and social activities of people with a range of physical disabilities. However, in real life, wheelchair users face several common challenges: articulate steering, spatial relationships, and negotiating obstacles. Therefore, our research group has developed a head-mounted display (HMD)-based intuitive virtual reality (VR) stimulator for wheelchair propulsion. The aim of this study was to investigate the feasibility and efficacy of this VR stimulator for wheelchair propulsion performance. Twenty manual wheelchair users (16 men and 4 women) with spinal cord injuries ranging from T8 to L2 participated in this study. The differences in wheelchair propulsion kinematics between immersive and non-immersive VR environments were assessed using a 3D motion analysis system. Subjective data of the HMD-based intuitive VR stimulator were collected with a Presence Questionnaire and individual semi-structured interview at the end of the trial. Results indicated that propulsion performance was very similar in terms of start angle (p = 0.34), end angle (p = 0.46), stroke angle (p = 0.76), and shoulder movement (p = 0.66) between immersive and non-immersive VR environments. In the VR episode featuring an uphill journey, an increase in propulsion speed (p < 0.01) and cadence (p < 0.01) were found, as well as a greater trunk forward inclination (p = 0.01). Qualitative interviews showed that this VR simulator made an attractive, novel impression and therefore demonstrated the potential as a tool for stimulating training motivation. This HMD-based intuitive VR stimulator can be an effective resource to enhance wheelchair maneuverability experiences.
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Smith EM, Miller WC, Mitchell I, Mortenson WB, Mihailidis A. Evaluation of the feasibility of an error-minimized approach to powered wheelchair skills training using shared control. Disabil Rehabil Assist Technol 2020; 18:333-342. [PMID: 33216664 DOI: 10.1080/17483107.2020.1849434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Emma M Smith
- Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland.,GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - William C Miller
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | - Ian Mitchell
- Department of Computer Science, University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | - Alex Mihailidis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Ossada VAY, Souza JG, Cruz DMC, Campos LCB, Medola FO, Costa VDSP. Cross-cultural adaptation of wheelchair skills test (version 4.3) for wheelchair users and caregivers to the Portuguese language (Brazil). Disabil Rehabil Assist Technol 2019; 15:491-498. [PMID: 31145013 DOI: 10.1080/17483107.2019.1604826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To perform cross-cultural adaptation of the Wheelchair Skills Test of manual wheelchair users and their caregivers into the Brazilian Portuguese language.Methods: The study was composed of translation, synthesis of translations, back-translation, review by an expert committee and pre-test, when the test was applied in the target population. Included were translators, subject specialists and coordinators to carry out the cross-cultural adaptation process, and manual wheelchair users and their caregivers with at least six months of wheelchair experience for the pre-test.Results: Forty-three people participated in the study, 30 for the pre-test and 13 for the stages that preceded the pre-test. The mean age of manual wheelchair users was 40.2 (±10.7) years and of caregivers was 44.2 (±15.7) years. Of the 47 phrases translated in the first stage, 36 discrepancies were found and resolved. During the analysis by the committee of experts the instrument underwent 13 modifications in order to achieve the best possible equivalence between the original version and the final version and was understandable by the people evaluated. The total pre-test scores of wheelchair users and their caregivers were 66.2 (±24.6) and 88.7 (±14.2), respectively.Conclusions: This instrument was able to evaluate the abilities of wheelchair users and their caregivers in Brazil, as well as being useful for training in rehabilitation programs.Implications for rehabilitationThe need to use wheelchair (WC) properly has made clinicians and rehabilitation professionals more concerned with assessing and training users' abilities with their WC.Cross-cultural adaptation allows for the linguistic modification of the original language of the evaluation tool into a new language and enables the comparison of research results in different countries.Immediate use of the instrument for WC users and caregivers in Brazil, both for evaluation and for training, is necessary and may be a means for rehabilitation professionals to improve their evaluations, their treatments and optimize the skills that aim at independence.
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Affiliation(s)
- Vinícius Aparecido Yoshio Ossada
- Department of Physiotherapy, Universidade Pitágoras Unopar (UNOPAR), Londrina, Brazil.,Department of Physiotherapy, Centro Universitário Filadélfia (UniFil), Londrina, Brazil
| | - Jônatas Garcia Souza
- Department of Physiotherapy, Universidade Pitágoras Unopar (UNOPAR), Londrina, Brazil
| | | | | | - Fausto Orsi Medola
- Department of Design, Universidade Estadual Paulista (UNESP), Bauru, Brazil
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Lam JF, Gosselin L, Rushton PW. Use of Virtual Technology as an Intervention for Wheelchair Skills Training: A Systematic Review. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Best KL, Miller WC, Routhier F, Eng JJ. Feasibility of the trial procedures for a randomized controlled trial of a community-based peer-led wheelchair training program for older adults. Pilot Feasibility Stud 2017; 4:18. [PMID: 28725451 PMCID: PMC5512940 DOI: 10.1186/s40814-017-0158-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/14/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A novel peer-led manual wheelchair (MWC) training program may support the training needs of older adults, but establishing program feasibility is a pragmatic first step. The purpose of this study was to evaluate the feasibility of a peer-led Wheelchair training Self-Efficacy Enhanced for Use (WheelSeeU) program. METHODS Forty MWC users (mean age 65 years) were randomly assigned to the experimental (WheelSeeU) or control group. Feasibility indicators of process, resources, management, and safety were collected throughout the study. RESULTS The consent rate was 49%. Participant retention rate was 90% post-intervention and 87.5% at follow-up (6 months). All participants reported perceived benefits from WheelSeeU. Participants and trainers adhered to the study protocol (>90%), and fidelity of the WheelSeeU intervention was attained (>90%). There were no adverse events. CONCLUSIONS WheelSeeU is an innovative and feasible approach for providing MWC training to older adults that is accessible beyond initial rehabilitation without increased clinician burden. With minor modifications, it is feasible that WheelSeeU can be administered to older adults living in the community. TRIAL REGISTRATION NCT01838135.
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Affiliation(s)
- Krista L. Best
- Department of Rehabilitation, Université Laval, Quebec City, QC Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre integré de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Quebec City, QC Canada
| | - William C. Miller
- The Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- The Rehabilitation Research Program, Vancouver Coastal Research Institute, GF Strong Rehabilitation Centre, Vancouver, BC Canada
- Rehabilitation Research Lab, UBC Department of Occupational Science & Occupational Therapy, Vancouver, BC Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, QC Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre integré de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Quebec City, QC Canada
| | - Janice J. Eng
- The Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- The Rehabilitation Research Program, Vancouver Coastal Research Institute, GF Strong Rehabilitation Centre, Vancouver, BC Canada
- Rehabilitation Research Lab, UBC Department of Occupational Science & Occupational Therapy, Vancouver, BC Canada
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Sol ME, Verschuren O, de Groot L, de Groot JF. Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise. BMC Pediatr 2017; 17:51. [PMID: 28193204 PMCID: PMC5307781 DOI: 10.1186/s12887-017-0809-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 02/07/2017] [Indexed: 12/01/2022] Open
Abstract
Background Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents. Methods Mixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the ‘COnsensus-based Standards for the selection of health Measurement Instruments’ (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing. Results Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons. Conclusions The newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0809-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marleen Elisabeth Sol
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, Utrecht, 3501 AA, The Netherlands. .,Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. .,De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | | | - Janke Frederike de Groot
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, Utrecht, 3501 AA, The Netherlands.,Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Rushton PW, Mortenson BW, Viswanathan P, Wang RH, Miller WC, Hurd Clarke L. Intelligent power wheelchair use in long-term care: potential users' experiences and perceptions. Disabil Rehabil Assist Technol 2016; 12:740-746. [PMID: 27982717 DOI: 10.1080/17483107.2016.1260653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Long-term care (LTC) residents with cognitive impairments frequently experience limited mobility and participation in preferred activities. Although a power wheelchair could mitigate some of these mobility and participation challenges, this technology is often not prescribed for this population due to safety concerns. An intelligent power wheelchair (IPW) system represents a potential intervention that could help to overcome these concerns. The purpose of this study was to explore a) how residents experienced an IPW that used three different modes of control and b) what perceived effect the IPW would have on their daily lives. MATERIALS AND METHODS We interviewed 10 LTC residents with mild or moderate cognitive impairment twice, once before and once after testing the IPW. Interviews were conducted using a semi-structured interview guide, audio recorded and transcribed verbatim for thematic analyses. RESULTS Our analyses identified three overarching themes: (1) the difference an IPW would make, (2) the potential impact of the IPW on others and (3) IPW-related concerns. CONCLUSIONS Findings from this study confirm the need for and potential benefits of IPW use in LTC. Future studies will involve testing IPW improvements based on feedback and insights from this study. Implications for rehabilitation Intelligent power wheelchairs may enhance participation and improve safety and feelings of well-being for long-term care residents with cognitive impairments. Intelligent power wheelchairs could potentially have an equally positive impact on facility staff, other residents, and family and friends by decreasing workload and increasing safety.
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Affiliation(s)
- Paula W Rushton
- a School of Rehabilitation , Université de Montréal , Montréal , Québec , Canada.,b CHU Sainte-Justine Research Center , Montréal , Québec , Canada
| | - Ben W Mortenson
- c Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , British Columbia , Canada.,d International Collaboration on Repair Discoveries , Vancouver , British Columbia , Canada.,e Rehabilitation Research Program, GF Strong Rehabilitation Research Lab , Vancouver , British Columbia , Canada
| | - Pooja Viswanathan
- f Department of Occupational Science and Occupational Therapy , Intelligent Assistive Technology and Systems Lab, University of Toronto , Toronto , Ontario , Canada.,g Toronto Rehabilitation Institute , Toronto , Ontario , Canada
| | - Rosalie H Wang
- f Department of Occupational Science and Occupational Therapy , Intelligent Assistive Technology and Systems Lab, University of Toronto , Toronto , Ontario , Canada.,g Toronto Rehabilitation Institute , Toronto , Ontario , Canada
| | - William C Miller
- c Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , British Columbia , Canada.,d International Collaboration on Repair Discoveries , Vancouver , British Columbia , Canada.,e Rehabilitation Research Program, GF Strong Rehabilitation Research Lab , Vancouver , British Columbia , Canada.,h Vancouver Coastal Health Research Institute , Vancouver , British Columbia , Canada
| | - Laura Hurd Clarke
- h Vancouver Coastal Health Research Institute , Vancouver , British Columbia , Canada.,i School of Kinesiology , University of British Columbia , Vancouver , British Columbia , Canada
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Giesbrecht EM, Miller WC, Jin BT, Mitchell IM, Eng JJ. Rehab on Wheels: A Pilot Study of Tablet-Based Wheelchair Training for Older Adults. JMIR Rehabil Assist Technol 2015; 2:e3. [PMID: 28582240 PMCID: PMC5454553 DOI: 10.2196/rehab.4274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/04/2015] [Accepted: 03/22/2015] [Indexed: 11/27/2022] Open
Abstract
Background Alternative and innovative strategies such as mHealth and eLearning are becoming a necessity for delivery of rehabilitation services. For example, older adults who require a wheelchair receive little, if any, training for proficiency with mobility skills. This substantive service gap is due in part to restricted availability of clinicians and challenges for consumers to attend appointments. A research team of occupational therapists and computer scientists engaged clinicians, consumers, and care providers using a participatory action design approach. A tablet-based application, Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels), was developed to enable in-chair home training, online expert trainer monitoring, and trainee-trainer communication via secure voice messaging. Objective Prior to undertaking a randomized controlled trial (RCT), a pilot study was conducted to determine the acceptability and feasibility of administering an mHealth wheelchair skills training program safely and effectively with two participants of different skill levels. The findings were used to determine whether further enhancements to the program were indicated. Methods The program included two in-person sessions with an expert trainer and four weeks of independent home training. The EPIC Wheels application included video instruction and demonstration, self-paced training activities, and interactive training games. Participants were provided with a 10-inch Android tablet, mounting apparatus, and mobile Wi-Fi device. Frequency and duration of tablet interactions were monitored and uploaded daily to an online trainer interface. Participants completed a structured evaluation survey and provided feedback post-study. The trainer provided feedback on the training protocol and trainer interface. Results Both participants perceived the program to be comprehensive, useful, and easily navigated. The trainer indicated usage data was comprehensive and informative for monitoring participant progress and adherence. The application performed equally well with multiple devices. Some initial issues with log-in requests were resolved via tablet-specific settings. Inconsistent Internet connectivity, resulting in delayed data upload and voice messaging, was specific to individual Wi-Fi devices and resolved by standardizing configuration. Based on the pilot results, the software was updated to make content download more robust. Additional features were also incorporated such as check marks for completed content, a more consumer-friendly aesthetic, and achievement awards. The trainer web interface was updated to improve usability and provides both a numerical and visual summary of participant data. Conclusions The EPIC Wheels pilot study provided useful feedback on the feasibility of a tablet-based home program for wheelchair skills training among older adults, justifying advancement to evaluation in an RCT. The program may be expanded for use with other rehabilitation interventions and populations, particularly for those living in rural or remote locations. Future development will consider integration of built-in tablet sensors to provide performance feedback and enable interactive training activities. Trial Registration ClinicalTrials.gov NCT01644292; https://clinicaltrials.gov/ct2/show/NCT01644292 (Archived by WebCite at http://www.webcitation.org/6XyvYyTUf).
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Affiliation(s)
- Edward Mark Giesbrecht
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Department of Occupational Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - William C Miller
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Department of Occupational Therapy and Occupational Science, University of British Columbia, Vancouver, BC, Canada
| | - Boyang Tom Jin
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Ian M Mitchell
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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The Need for Updated Clinical Practice Guidelines for Preservation of Upper Extremities in Manual Wheelchair Users. Am J Phys Med Rehabil 2015; 94:313-24. [DOI: 10.1097/phm.0000000000000203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The Need for and Feasibility of Wheelchair Skills Training in Long-term Care. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Giesbrecht EM, Miller WC, Mitchell IM, Woodgate RL. Development of a wheelchair skills home program for older adults using a participatory action design approach. BIOMED RESEARCH INTERNATIONAL 2014; 2014:172434. [PMID: 25276768 PMCID: PMC4167954 DOI: 10.1155/2014/172434] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/20/2014] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
Restricted mobility is the most common impairment among older adults and a manual wheelchair is often prescribed to address these limitations. However, limited access to rehabilitation services results in older adults typically receiving little or no mobility training when they receive a wheelchair. As an alternative and novel approach, we developed a therapist-monitored wheelchair skills home training program delivered via a computer tablet. To optimize efficacy and adherence, principles of self-efficacy and adult learning theory were foundational in the program design. A participatory action design approach was used to engage older adult wheelchair users, care providers, and prescribing clinicians in an iterative design and development process. A series of prototypes were fabricated and revised, based on feedback from eight stakeholder focus groups, until a final version was ready for evaluation in a clinical trial. Stakeholder contributions affirmed and enhanced the foundational theoretical principles and provided validation of the final product for the target population.
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Affiliation(s)
- Edward M. Giesbrecht
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - William C. Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Ian M. Mitchell
- Department of Computer Science, University of British Columbia, 2366 Main Mall, Vancouver, BC, Canada V6T 1Z4
| | - Roberta L. Woodgate
- Faculty of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, Canada R3T 2N2
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Best KL, Routhier F, Miller WC. A description of manual wheelchair skills training: current practices in Canadian rehabilitation centers. Disabil Rehabil Assist Technol 2014; 10:393-400. [DOI: 10.3109/17483107.2014.907367] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Feasibility of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) program: study protocol for a randomized controlled trial. Trials 2013; 14:350. [PMID: 24156396 PMCID: PMC3874600 DOI: 10.1186/1745-6215-14-350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background Many older adults rely on a manual wheelchair for mobility but typically receive little, if any, training on how to use their wheelchair effectively and independently. Standardized skill training is an effective intervention, but limited access to clinician trainers is a substantive barrier. Enhancing Participation in the Community by Improving Wheelchair Skills (EPIC Wheels) is a 1-month monitored home training program for improving mobility skills in older novice manual wheelchair users, integrating principles from andragogy and social cognitive theory. The purpose of this study is to determine whether feasibility indicators and primary clinical outcome measures of the EPIC Wheels program are sufficiently robust to justify conducting a subsequent multi-site randomized controlled trial. Methods A 2 × 2 factorial randomized controlled trial at two sites will compare improvement in wheelchair mobility skills between an EPIC Wheels treatment group and a computer-game control group, with additional wheelchair use introduced as a second factor. A total of 40 community-dwelling manual wheelchair users at least 55 years old and living in two Canadian metropolitan cities (n = 20 × 2) will be recruited. Feasibility indicators related to study process, resources, management, and treatment issues will be collected during data collection and at the end of the study period, and evaluated against proposed criteria. Clinical outcome measures will be collected at baseline (pre-randomization) and post-intervention. The primary clinical outcome measure is wheelchair skill capacity, as determined by the Wheelchair Skills Test, version 4.1. Secondary clinical outcome measures include wheelchair skill safety, satisfaction with performance, wheelchair confidence, life-space mobility, divided-attention, and health-related quality of life. Discussion The EPIC Wheels training program offers several innovative features. The convenient, portable, economical, and adaptable tablet-based, home program model for wheelchair skills training has great potential for clinical uptake and opportunity for future enhancements. Theory-driven design can foster learning and adherence for older adults. Establishing the feasibility of the study protocol and estimating effect size for the primary clinical outcome measure will be used to develop a multi-site randomized controlled trial to test the guiding hypotheses. Trial registration Clinical Trials NCT01740635.
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Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual Wheelchair Skills Capacity Predicts Quality of Life and Community Integration in Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2012; 93:2237-43. [DOI: 10.1016/j.apmr.2012.05.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/11/2012] [Accepted: 05/31/2012] [Indexed: 11/29/2022]
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Gil-Agudo A, Solís-Mozos M, del-Ama AJ, Crespo-Ruiz B, de la Peña-González AI, Pérez-Nombela S. Comparative ergonomic assessment of manual wheelchairs by paraplegic users. Disabil Rehabil Assist Technol 2012; 8:305-13. [PMID: 23078201 DOI: 10.3109/17483107.2012.719060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of the present study was to describe and test the reliability of a comprehensive product-centered approach to assessing functional performance and wheelchair user perceptions on device ergonomics and satisfaction of performance. A pilot study was implemented using this approach to evaluate differences among four manual wheelchairs. METHOD Six wheelchair users with complete spinal cord injury (SCI) at the thoracic level and with no previous upper limbs impairment were recruited for this study. After finishing circuit tasks, subjects were asked to complete a questionnaire about ergonomic wheelchair characteristics (manoeuvrability, stability, comfort and ease of propulsion) and satisfaction about task performance. On the other hand, objective data were recorded during user performance as the time required to complete each test, kinetic wheelchair propulsion data obtained with two SMARTWheels® and physiological parameters (heart rate and physiological index). RESULTS Kuschall Champion® and Otto Bock Voyage® wheelchairs were ranked best for most ergonomic aspects specially in manoeuvrability (p < 0.05). Less time was required to execute most of the circuit tasks in both wheelchair models (p < 0.05). CONCLUSIONS This approach proposed highlight the importance of looking both kinds of information, user perception and user functional performance when evaluating a wheelchair or comparing across devices.
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Affiliation(s)
- Angel Gil-Agudo
- Biomechanics and Technical Aids Unit, Physical Medicine and Rehabilitation Department, National Hospital for Spinal Cord Injury. SESCAM, Toledo, Spain.
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