Rasch Analyses of the Wheelchair Use Confidence Scale for Power Wheelchair Users

Development, reliability, and validity assessment of a fall concerns scale for people who use wheelchairs and scooters (FCS-WC/S)

PURPOSE

To evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S).

MATERIALS AND METHODS

Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022.

RESULTS

The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test-retest reliability (α ≥ 0.90, ICC = 0.86-0.9), as well as concurrent validity (Spearman's rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis.

CONCLUSIONS

Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.

Cultural adaptation and validation in Italian of the Seated Postural Control Measure for Adults 2.0

OBJECTIVE

The aim of this study was to assess the cultural adaptation and validation in Italian of the Seated Postural Control Measure for Adults 2.0 (SPCMA 2.0).

METHODS

The original scale was translated and culturally adapted from French to Italian using the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures-Principles of Good Practice" guidelines. Its internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Wheelchair use Confidence Scale and Wheelchair Skills Test 4.2.

RESULTS

Fifty-nine people were evaluated and re-evaluated after 48 h. Most of the items and subscale totals were stable in the 2 evaluations as they reported an intraclass correlation coefficient value of >0.77. The test-retest analysis of the dynamic evaluation was performed on the same patients 48 h apart. The analysis for construct validity showed statistically significant correlations with Wheelchair use Confidence Scale and Wheelchair Skills Test 4.2.

CONCLUSIONS

Seated Postural Control Measure for Adults 2.0 is one of the few tools that allow researchers to perform a quantitative and standardized posture assessment in a cost-effective and time-saving way. Furthermore, it has been demonstrated that it is an easy-to-administer scale and requires readily available tools. The limitations of this study highlighted above and the need to use quantitative and qualitative tools in clinical practice imply the need to conduct future studies.

Exploration of pediatric manual wheelchair confidence among children, parents, and occupational therapists: a qualitative study

PURPOSE

Manual wheelchair (MWC) confidence is a predictor of adult life-space mobility and social participation. To date, scientific literature specific to pediatric MWC confidence is scarce which prevents in-depth understanding. The objective of this study was to explore the perceptions of pediatric MWC users (PMWU), parents, and occupational therapists regarding pediatric MWC confidence.

METHODS

Five focus groups were conducted with PMWUs (n = 12) and occupational therapists (n = 9), and semi-structured interviews were conducted with parents of PMWUs (n = 2). Inductive thematic analysis was performed following verbatim transcription of audio recorded material.

RESULTS

Three overarching themes were identified across PMWUs, parents, and occupational therapists: (1) "MWC confidence is not a clinical priority" depicted the construct's varying level of clinical priority and perceived abstractness; (2) "MWC confidence is both a child and parent consideration" revealed nuances between the PMWU's MWC confidence and the parents' perception of the PMWU's MWC confidence; and (3) "Opportunities to develop MWC confidence are context-specific" contrasted afforded and unafforded opportunities to experience independent MWC mobility.

CONCLUSIONS

Pediatric MWC confidence is an important aspect of wheelchair use that is shaped by a multitude of factors in PMWU's lives. This new area of pediatric study provides support for the need to measure this important construct.IMPLICATIONS FOR REHABILITATIONThis study is the first to explore children's, parents', and occupational therapists' perceptions of pediatric MWC confidence.Pediatric MWC confidence impacts MWC use in a multifaceted fashion.Future studies should consider the development and validation of a self-report measure to assess pediatric MWC confidence.

French-Canadian translation, cultural adaptation, and preliminary evaluation of the wheelchair service provision - basic test validity among occupational therapy students

PURPOSE

The objectives were: (1) to translate and adapt the International Society of Wheelchair Professional (ISWP) basic Wheelchair Service Provision Test (bWSPT) into French-Canadian and (2) to conduct a preliminary evaluation of the French-Canadian version of the ISWP bWSPT internal consistency and relations with other variables among French-Canadian occupational therapy students.

METHODS

For Phase 1, based on the International Test Commission Guidelines for Translating and Adapting Tests, a forward translation and adaptation from English to French-Canadian was conducted by a translation team. For Phase 2, the validity evidence of the French-Canadian bWSPT was evaluated through internal consistency and comparison of bWSPT scores and final grades of a wheelchair-specific course with a sample of occupational therapy students (positive, moderate correlation hypothesized). Internal consistency was measured with Cronbach's α. The correlation was calculated using the Spearman's Rank Correlation Coefficient.

RESULTS

For phase 1, 61 of 167 items of the forward adaptation were revised and modified. All revisions were a consensus by the translation team. For phase 2, we found a Cronbach's α of 0.50 and a correlation of ⍴ = 0.27 (p = 0.43) between the bWSPT French-Canadian version and the wheelchair-specific course final grade. The low variability of the data may explain the lower-than-expected correlation. Other possible data-driven reasons have been explored using post-hoc analysis.

CONCLUSION

The ISWP bWSPT, French-Canadian version, is not internally consistent and demonstrates a non-statistically significant, positive, weak correlation with the final grade of a wheelchair service provision-specific course among a cohort of 35 occupational therapy students.IMPLICATIONS FOR REHABILITATIONThe lack of adequately educated wheelchair service providers is a contributing factor to inappropriate wheelchair provision worldwide.The ISWP Wheelchair Service Provision Basic Test (ISWP bWSPT) has been created to evaluate competency among wheelchair service providers and provides a standardized test recognized internationally.A French-Canadian version of the ISWP bWSPT allows competency testing of French-speaking wheelchair service providers across Canada.This study shows that the French-Canadian version of the test is not internally consistent and has a low correlation with a wheelchair provision-specific course among a cohort of 35 occupational therapy students at a French-Canadian university suggesting further refinement is required to improve its measurement properties in this population of test-takers.

Evaluation of the Nino® Two-Wheeled Power Mobility Device: A Pilot Study

Novel technologies such as the Nino® two-wheeled powered mobility device are promoted as offering an intuitive improved experience compared to conventional wheelchair mobility use. The Nino® has a smaller footprint than a power wheelchair, a zero-degree turning radius, tiller-based steering, and relies on the user leaning forwards and back to move and brake. This study aimed to evaluate manual wheelchair users' ability to use the Nino® to complete a variety of wheelchair skills, and also investigated task demand, user confidence, and user perceptions. Twelve participants with a mean of 22 years of experience using a wheelchair completed the study; most had spinal cord injuries and one had multiple sclerosis. Our findings indicate that Wheelchair Skills Test scores were significantly higher for individuals in their manual wheelchair than in the Nino®. Results from the Wheelchair Use Confidence Scale showed that confidence scores increased significantly after completing Nino® training, and that participants were significantly more confident using their manual chair than the Nino®. Cognitive workload, as measured by the NASA-Task Load Index, was significantly higher in the Nino® than in participants' manual wheelchairs. Findings from qualitative interviews suggest that the Nino® is unlikely to be suitable as a functional replacement of an individual's manual wheelchair. Most participants felt unsafe during braking. Other perceptions included that the Nino may be a good alternative for use as a recreational outdoor mobility device, a powered mobility option to help prevent upper extremity overuse injuries, have a positive impact on social interactions, but that a high degree of focus was required during use. In addition to needing to address safety, usability, and functional concerns, the data suggests a clinical focus on training individuals to use these new devices may be necessary for effective community use.

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.