1
|
Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
Collapse
Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
| |
Collapse
|
2
|
Fasipe G, Goršič M, Rahman MH, Rammer J. Community mobility and participation assessment of manual wheelchair users: a review of current techniques and challenges. Front Hum Neurosci 2024; 17:1331395. [PMID: 38249574 PMCID: PMC10796510 DOI: 10.3389/fnhum.2023.1331395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
According to the World Health Organization, hundreds of individuals commence wheelchair use daily, often due to an injury such as spinal cord injury or through a condition such as a stroke. However, manual wheelchair users typically experience reductions in individual community mobility and participation. In this review, articles from 2017 to 2023 were reviewed to identify means of measuring community mobility and participation of manual wheelchair users, factors that can impact these aspects, and current rehabilitation techniques for improving them. The selected articles document current best practices utilizing self-surveys, in-clinic assessments, and remote tracking through GPS and accelerometer data, which rehabilitation specialists can apply to track their patients' community mobility and participation accurately. Furthermore, rehabilitation methods such as wheelchair training programs, brain-computer interface triggered functional electric stimulation therapy, and community-based rehabilitation programs show potential to improve the community mobility and participation of manual wheelchair users. Recommendations were made to highlight potential avenues for future research.
Collapse
Affiliation(s)
- Grace Fasipe
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Maja Goršič
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Mohammad Habibur Rahman
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
- Department of Mechanical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Jacob Rammer
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| |
Collapse
|
3
|
Manocha RHK, Best KL, Charette C, Curlock H, Sigfusson M, Faure C, Miller WC, Routhier F. Walking aid training as a clinical competence in Canadian entry-to-practice professional academic programs. Disabil Rehabil Assist Technol 2024; 19:112-119. [PMID: 35510304 DOI: 10.1080/17483107.2022.2070675] [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: 10/18/2021] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Multiple healthcare professionals fit walking aids (WA) and train individuals on their use. The purpose of this investigation was to describe curricula on WA fitting and training in Canadian entry-to-practice professional programs. MATERIALS AND METHODS An online survey was administered to leads from all accredited programs (n = 199). Seventeen questions asked about the importance of WA education, instructional methods and time dedicated to WA fitting and skills training, and how the pandemic had affected WA curriculum delivery. RESULTS Responses were received from 97 programs. While most occupational therapy (OT, 8/15), physiatry (PM&R, 5/9), and physical therapy (PT, 12/19) trainees received more than 3 h of instruction on WA fitting, most nursing (29/40) and pharmacy (7/8) programs spent less than 3 h on this topic. Most OT (9/15) and PT (15/19) programs spent more than 3 h on WA skills training whereas most nursing (25/40), pharmacy (4/8), and PM&R (5/9) programs spent less than 3 h on this subject. Across all programs, 52% educated students on adapting activities of daily living for WA while 18% provided education on WA maintenance and repair. Only 19/89 programs consulted a formal WA skills training resource for curriculum development. Seventeen of 55 programs modified their WA curricula due to the pandemic. CONCLUSIONS There is a wide range in curricular approaches to WA education in Canadian professional programs. This highlights the need for a standardised WA education program to guide curricular development to ultimately improve safe WA use for clients with short- and long-term mobility impairments.IMPLICATIONS FOR REHABILITATIONCurricula on walking aids is extremely variable within and between programs.Navigating terrains, adapting activities of daily living, and maintenance are poorly taught.There is a need for a national standardized curriculum on walking aids.This curriculum should be modular and designed for practitioners, students, and patients.
Collapse
Affiliation(s)
- Ranita H K Manocha
- Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Krista L Best
- Département de réadaptation, Faculté de médecine, Université Laval, Laval, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Caroline Charette
- Département de réadaptation, Faculté de médecine, Université Laval, Laval, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Hannah Curlock
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Merissa Sigfusson
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Céline Faure
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - François Routhier
- Département de réadaptation, Faculté de médecine, Université Laval, Laval, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| |
Collapse
|
4
|
Beaudoin M, Best KL, Raymond É, Routhier F. Influence of Roulez avec confiance, a peer-led community-based wheelchair skills training program, on manual wheelchair users. Disabil Rehabil Assist Technol 2023; 18:1093-1100. [PMID: 34591734 DOI: 10.1080/17483107.2021.1983655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/16/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Few studies have demonstrated that peer-led manual wheelchair (MWC) skills training can increase MWC skills, MWC use self-efficacy and satisfaction with participation of MWC users. Limited information is available on MWC skills training in the community. The primary objective was to measure the influence of Roulez avec confiance (RAC, which translated to "Wheeling with confidence"), a peer-led community-based wheelchair skills training program, on satisfaction with participation. The secondary objectives were to explore the: (1) influence of RAC on MWC use self-efficacy, MWC skills, and quality of life; (2) experiences of the participants who completed RAC and (3) three-month retention of outcomes. METHODS A parallel mixed design was used with validated questionnaires on satisfaction with participation (WhOM), MWC use self-efficacy (WheelCon-M), MWC skills (WST-Q), quality of life (SWLS) and a semi-structured interview on participants' experiences. Non-parametric longitudinal analyses of the questionnaires and thematic content analysis of the interviews were completed. RESULTS Nineteen community-dwelling MWC users participated. There was a statistically significant increase (p < 0.0001) in all outcomes except quality of life (p = 0.16). Improvements were retained after three months. Participants mentioned their background influenced their experiences in RAC. Positive elements about RAC and areas for improvement were discussed. Participants reported overall positive social experiences and stated that the physical environment influenced RAC. Finally, participants spoke about what they learned and emotions they felt during RAC. CONCLUSIONS Peer-led community-based MWC training influenced satisfaction with participation, MWC skills, and MWC use self-efficacy. This study was a first step in demonstrating the efficiency of RAC.IMPLICATIONS FOR REHABILITATIONLimited information is available on manual wheelchair skills training in the community.Peer-led community-based manual wheelchair training influenced satisfaction with participation, manual wheelchair skills and use self-efficacy.This study was a first step in demonstrating the efficiency of Roulez Avec Confiance.
Collapse
Affiliation(s)
- Maude Beaudoin
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Krista L Best
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Émilie Raymond
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
- School of Social Work and Criminology, Université Laval, Quebec City, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| |
Collapse
|
5
|
Best KL, Bourassa S, Sweet SN, Routhier F. Expert consensus for a digital peer-led approach to improving physical activity among individuals with spinal cord injury who use manual wheelchairs. J Spinal Cord Med 2023; 46:53-61. [PMID: 34726571 PMCID: PMC9897743 DOI: 10.1080/10790268.2021.1986308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
CONTEXT Active Living Lifestyles for manual wheelchair users (ALLWheel) uses a digital peer-led approach to incorporate two behavior change theories to address a critical need for leisure-time physical activity (LTPA) programs for individuals with spinal cord injury (iSCI). OBJECTIVE The objective of this study was to obtain expert opinion and consensus for the ALLWheel program. DESIGN Mixed-methods (qualitative and quantitative) were used to gather expert opinion and consensus for the ALLWheel program using an action research approach. SETTING Rehabilitation center. PARTICIPANTS Experts in SCI and LTPA included iSCI who used manual wheelchairs, healthcare professionals, and community collaborators. PROCEDURES Two, 90-minute focus groups were conducted and transcribed verbatim, analyzed thematically, and the results were used to create a Delphi survey. Delphi surveys were completed online using consecutive rounds until ≥70% consensus per item was attained. Cumulative percent concordances were calculated to determine consensus. RESULTS Twelve experts in SCI and LTPA participated in focus groups. Four themes were generated: Need for LTPA programs; Important considerations; Perceptions about peer-coaches; and Feelings about smartphones, which were used to generate the Delphi survey. Consensus on the ALLWheel program was attained in two rounds. CONCLUSIONS Experts established a need for fun and personalized community-based LTPA programs. Ensuring that healthcare professionals would be involved in the ALLWheel program alleviated safety concerns, and experts agreed there were benefits of peers delivering the program. Experts agreed that the ALLWheel program targeted important psychological factors (i.e. autonomy, relatedness, self-efficacy, and motivation) and affirmed the potential for a potentially large geographic reach.
Collapse
Affiliation(s)
- Krista L. Best
- Department of Rehabilitation, Université Laval, Quebec City, Canada,Centre for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada,Correspondence to: Krista L. Best, Centre for interdisciplinary research in rehabilitation and social integration (Cirris); Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 525, boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada; Ph: +1 4185299141 ext. 6041.
| | - Sophie Bourassa
- Department of Rehabilitation, Université Laval, Quebec City, Canada,Centre for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Shane N. Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Canada,Centre for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| |
Collapse
|
6
|
Ouellet B, Best KL, Wilson D, Miller WC. Exploring the Influence of a Community-Based Peer-Led Wheelchair Skills Training on Satisfaction with Participation in Children and Adolescents with Cerebral Palsy and Spina Bifida: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11908. [PMID: 36231211 PMCID: PMC9564843 DOI: 10.3390/ijerph191911908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Peer-led approaches improve satisfaction with participation, wheelchair skills and wheelchair use self-efficacy in adults, but the evidence is limited in children. This pilot study aimed to explore the influence of community-based, peer-led, group wheelchair training program (i.e., Seating To Go) on satisfaction with participation (primary outcome), wheelchair skills, and wheelchair use self-efficacy in children and adolescents with cerebral palsy and spina bifida. METHODS A single group pre-post design was used. Invitations were shared online and diffused by clinicians and advocacy and provider groups to recruit a convenience sample of eight pediatric wheelchair users. Participants completed the Seating To Go program in groups that were facilitated by adult wheelchair users. Satisfaction with participation (Wheelchair Outcome Measure-Young People), wheelchair skills (Wheelchair Skills Test), wheelchair use self-efficacy (Wheelchair Use Confidence Scale), and perceived wheelchair skills capacity (Wheelchair Skills Test Questionnaire; proxy rating: parents) were evaluated before and after the Seating To Go program. Descriptive statistics and nonparametric longitudinal data analysis were conducted to explore changes in all outcomes from baseline to post-intervention. RESULTS Pediatric wheelchair users (ranging in age from 5 to 15 years) and their parents reported statistically significant improvements in satisfaction with participation. The improvements in wheelchair skills and wheelchair confidence were also statistically significant, but not the parents' perception of their children's wheelchair skills. CONCLUSIONS A community-based peer-led approach to wheelchair skills training seems promising for improving wheelchair outcomes in pediatric wheelchair users. Further controlled studies with larger samples are warranted.
Collapse
Affiliation(s)
- Béatrice Ouellet
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et en Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M 2S8, Canada
| | - Krista L. Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et en Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M 2S8, Canada
| | - Deb Wilson
- Seating To Go—Geneva Healthcare, Hamilton 3204, New Zealand
| | - William C. Miller
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- G.F. Strong Rehabilitation Centre—Rehabilitation Research Lab, Vancouver, BC V5Z 2G9, Canada
| |
Collapse
|
7
|
Price A, de Bell S, Shaw N, Bethel A, Anderson R, Coon JT. What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1264. [PMID: 36909883 PMCID: PMC9316011 DOI: 10.1002/cl2.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Peer support interventions involve people drawing on shared personal experience to help one another improve their physical or mental health, or reduce social isolation. If effective, they may also lessen the demand on health and social care services, reducing costs. However, the design and delivery of peer support varies greatly, from the targeted problem or need, the setting and mode of delivery, to the number and content of sessions. Robust evidence is essential for policymakers commissioning peer support and practitioners delivering services in health care and community settings. This map draws together evidence on different types of peer support to support the design and delivery of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent, high quality evidence on the effectiveness and cost-effectiveness of the use of peer support in health and social care. Search Methods We searched MEDLINE, seven further bibliographic databases, and Epistemonikos for systematic reviews (in October 2020), randomised controlled trials (in March 2021) and economic evaluations (in May 2021) on the effectiveness of peer support interventions in health and social care. We also conducted searches of Google Scholar, two trial registers, PROSPERO, and completed citation chasing on included studies. Selection Criteria Systematic reviews, randomised controlled trials and economic evaluations were included in the map. Included studies focused on adult populations with a defined health or social care need, were conducted in high-income countries, and published since 2015. Any measure of effectiveness was included, as was any form of peer support providing the peer had shared experience with the participant and a formalised role. Data Collection and Analysis Data were extracted on the type of peer support intervention and outcomes assessed in included studies. Standardised tools were used to assess study quality for all studies: assessing the methodological quality of systematic reviews 2 for systematic reviews; Cochrane risk of bias tool for randomised controlled trials; and consensus health economic criteria list for economic evaluations. Main Results We included 91 studies: 32 systematic reviews; 52 randomised controlled trials; and 7 economic evaluations. Whilst most included systematic reviews and economic evaluations were assessed to be of low or medium quality, the majority of randomised controlled trials were of higher quality. There were concentrations of evidence relating to different types of peer support, including education, psychological support, self-care/self-management and social support. Populations with long-term health conditions were most commonly studied. The majority of studies measured health-related indicators as outcomes; few studies assessed cost-effectiveness. Studies were unevenly distributed geographically, with most being conducted in the USA. Several gaps were evident regarding the delivery of peer support, particularly the integration of peers and professionals in delivering support and interventions of longer duration. Authors' Conclusions Although there is evidence available to inform the commissioning and delivery of peer support in health and social care, there are also clear gaps that need to be addressed to further support provision, particularly regarding cost-effectiveness. The effectiveness of peer support in different countries, with varying health and social care systems, is a priority for future research, as is the integration of peers with professionals in delivering peer support.
Collapse
Affiliation(s)
- Anna Price
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Siân de Bell
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| |
Collapse
|
8
|
Kenyon LK, Hesse EN, Pakkala KJ, Vanderest S. Outcomes of a child-based manual wheelchair skills peer training program: an exploratory case report. Disabil Rehabil Assist Technol 2021; 18:1-5. [PMID: 34048664 DOI: 10.1080/17483107.2021.1931966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this exploratory case series was to describe the outcomes for both a child-learner and a child-peer after a single manual wheelchair (MWC) skills training session involving child-based peer training techniques, followed by related home-based skills practice. MATERIALS AND METHODS Participants were a 9-year-old with L4-L5 spina bifida (pseudonym: Amari) and a 3-year-old with T10 spina bifida (pseudonym: Mary). Pre-intervention examination included administration of the Wheelchair Skills Test Questionnaire (WST-Q), the MWC short scale within the Mobility domain of the Paediatric Evaluation of Disability - Computer Adapted Test (MWC PEDI-CAT), and the Canadian Occupational Performance Measure (COPM). The peer training session, facilitated by a physical therapy team, involved games and activities involving MWC use. When appropriate, Amari was asked to talk aloud and verbally describe the components of the skills she was performing. Each child and her mother were instructed in specific MWC skills to practice at home over a 3-week period. RESULTS Both participants' post-intervention WST-Q capacity, confidence, and performance scores increased. Increases in parent-proxy COPM scores indicated clinically meaningful change in all identified occupational performance problems. Mary's total MWC PEDI-CAT post-intervention score increased by 11 points. Both mothers reported that the participation in the activities helped also to improve their child's self-esteem and self-image. CONCLUSIONS Both the participants in this exploratory case appeared to demonstrate improvements in MWC skills, self-esteem, and self-image following a single child-based MWC skills peer training session and related home-based skills practice. Future research involving such peer training methods is warranted.
Collapse
Affiliation(s)
- Lisa K Kenyon
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Elizabeth N Hesse
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Katelynn J Pakkala
- 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
| |
Collapse
|
9
|
Bourassa J, Routhier F, Gagnon C, Rahn C, Hébert LJ, St-Gelais R, Rodrigue X, Brais B, Best KL. Wheelchair mobility, motor performance and participation of adult wheelchair users with ARSACS: a cross-sectional study. Disabil Rehabil Assist Technol 2020; 18:378-386. [PMID: 33307884 DOI: 10.1080/17483107.2020.1858195] [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: 10/22/2022]
Abstract
PURPOSE Although approximately 45% of adults with Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) are permanent wheelchair users, this sub population has been less studied. The purpose of this study was to document wheelchair mobility, motor performance, and participation in a cohort of adult wheelchair users with ARSACS. METHODS We recruited 36 manual and powered wheelchair users with ARSACS, aged between 34 and 64 years, for this cross-sectional study. Participants completed measures regarding wheelchair mobility (Wheelchair Skills Test Questionnaire [WST-Q-F], Wheelchair Use Confidence Scale [WheelCon-F] and Wheelchair Outcome Measure [WhOM-F]), motor performance (Scale for the Assessment and Rating of Ataxia [SARA], Disease Severity Index for adults with ARSACS [DSI-ARSACS], Upper Extremity Performance Test for the Elderly [TEMPA], Standardised Finger to Nose Test [SFNT], grip strength, pinch strength, Lower Extremity Motor Coordination Test [LEMOCOT], Berg Balance Scale [BBS], Timed Up and Go [TUG] and 10-meter Walk Test [10mWT]), and participation (Barthel Index, LSA-F and LIFE-H). Results were compared between age groups (≤49 years and ≥50 years), types of wheelchair used, and available reference values. Correlations were computed between wheelchair mobility, upper limb function, and participation. RESULTS Participants presented limitations regarding wheelchair skills, motor performance, and participation in daily activities. Despite preserved upper limb strength, wheelchair skills, upper and lower limb coordination, standing balance, and functional independence were generally more impaired after 50 years of age and among powered wheelchair users. Significant moderate correlations were found between wheelchair skills and self-efficacy, upper limb strength and coordination, and participation in daily and social activities. CONCLUSIONS This study provided the first data sets describing specific characteristics of manual and powered wheelchair users with ARSACS. It supports a need to offer wheelchair skills training interventions to adults with ARSACS, which could increase their daily and social participation.IMPLICATIONS FOR REHABILITATIONAdult wheelchair users with ARSACS present with limited wheelchair skills, significantly impaired motor performance, and reduced participation that generally decreases with age. This profile may serve as comparative data for clinicians to anticipate disease progression.This study provides the first data on distinguishing characteristics between PWC users and MWC users with ARSACS. The main characteristics of PWC users include more severe functional limitations and motor impairments, as well as limited grip strength that contrasts with the general preservation of this function among other adults with ARSACS.There is a need to offer and evaluate wheelchair skills training interventions in the future for adults with ARSACS. The general preservation of grip and pinch strength observed in this population suggests a potential for improvement. Considering the associations found between wheelchair mobility and participation, such interventions may increase users' daily and social participation.
Collapse
Affiliation(s)
- Julie Bourassa
- Department of Rehabilitation, Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Interdisciplinary Research Group on Neuromuscular Disorders, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
| | - Caroline Rahn
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Luc J Hébert
- Department of Rehabilitation, Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada.,Department of Radiology-Nuclear Medicine, Université Laval, Quebec City, Canada
| | - Raphaël St-Gelais
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Interdisciplinary Research Group on Neuromuscular Disorders, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
| | - Xavier Rodrigue
- Institut de réadaptation en déficience physique de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Krista L Best
- Department of Rehabilitation, Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| |
Collapse
|
10
|
Bourassa J, Best KL, Gagnon C, Hébert LJ, Brais B, Routhier F. Measurement properties of wheelchair use assessment tools in adults with autosomal recessive spastic ataxia of Charlevoix-Saguenay. Disabil Rehabil Assist Technol 2020; 17:907-915. [DOI: 10.1080/17483107.2020.1821104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julie Bourassa
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Krista L. Best
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
- Interdisciplinary Research Group on Neuromuscular Disorders, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada
| | - Luc J. Hébert
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
- Department of Radiology-Nuclear Medicine, Université Laval, Quebec City, Canada
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| |
Collapse
|
11
|
Pellichero A, Best KL, Routhier F, Miller WC. Exploring Older Adults’ Experiences and Perceptions with a Peer-Led Wheelchair Training Program. The Canadian Journal of Occupational Therapy 2020; 87:192-199. [DOI: 10.1177/0008417420922635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Manual wheelchair (MWC) training is important, but less than 50% of new wheelchair users receive any training. The Wheelchair training Self-efficacy Enhanced for Use (WheelSeeU), a community-based peer-led MWC training program, is feasible and effective for improving wheelchair skills. However, implementing effective programs requires an understanding of stakeholders’ experiences. Purpose. Explore older adults’ perceptions about their participation in the WheelSeeU program. Method. Qualitative interviews were conducted with participants who completed the WheelSeeU program. Thematic analysis was conducted. Findings. Three themes emerged. 1. Getting my life back described participants’ perceived impact of the WheelSeeU program on their lives. 2. I can do it too, implied critical facilitators for success. 3. Social gains, revealed participants’ feelings of social inclusion through participation in the program. Implications. Older adults expressed satisfaction and quality of participation with the WheelSeeU program that increased autonomy, improved MWC mobility and self-efficacy, and enhanced social connectedness.
Collapse
|
12
|
Kirby RL, Smith C, Parker K, Han L, Theriault CJ, Doucette SP. Practices and views of occupational therapists in Nova Scotia regarding wheelchair-skills training for clients and their caregivers: an online survey. Disabil Rehabil Assist Technol 2020; 15:773-780. [PMID: 32255698 DOI: 10.1080/17483107.2020.1749890] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To determine the extent to which Occupational Therapists (OTs) in Nova Scotia (NS) conduct wheelchair skills training, the nature of training and the OTs' perceptions on training.Materials and methods: Anonymous online survey.Results: We received 110 responses from OTs living in NS and involved in direct patient care, 96 (93%) of whom reported helping clients obtain manual wheelchairs. Of the OTs who responded to the question "…do you typically provide wheelchair-skills training…?", 40 (43.5%) answered "Yes, usually" for clients and 40 (46.0%) for caregivers. The median duration of training sessions for clients and caregivers was 30 and 20 min; the median number of sessions was 2 and 1. Regarding the importance of training, 65 (73.9%) OTs answered "Very important" and 22 (25%) "Somewhat important" for clients and 55 (64.0%) answered "Very important" and 29 (33.7%) "Somewhat important" for caregivers. About one-third of OTs considered themselves adequately prepared for the trainer role. A variety of barriers and facilitators to training were identified. Trainers were significantly more likely than non-trainers to consider wheelchair skills training as important (p = .0003 for clients and p = .0039 for caregivers) and to consider themselves adequately prepared for the trainer role (p = .002 for clients and .003 for caregivers).Conclusions: Only a minority of NS OTs usually provide wheelchair-skills training for clients or their caregivers and the training provided is minimal, despite a majority who consider such training to be important. Only about one-third of OTs feel prepared for the training role.Implications for rehabilitationOnly a minority of Occupational Therapists (OTs) in Nova Scotia, Canada usually provide wheelchair-skills training for clients or their caregivers.The training that is provided is minimal.A majority of OTs consider such training to be important.Only about one-third of OTs feel prepared for the training role.
Collapse
Affiliation(s)
- Ronald Lee Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada
| | - Cher Smith
- Department of Occupational Therapy, Nova Scotia Health Authority, Halifax, Canada
| | - Kim Parker
- Department of Assistive Technology Program, Nova Scotia Health Authority, Halifax, Canada
| | - Lu Han
- Department of Occupational Therapy, Nova Scotia Health Authority, Halifax, Canada
| | | | | |
Collapse
|
13
|
Lamontagne ME, Best KL, Clarke T, Dumont FS, Noreau L. Implementation Evaluation of an Online Peer-Mentor Training Program for Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 25:303-315. [PMID: 31844382 DOI: 10.1310/sci19-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Community-based spinal cord injury (SCI) associations play a critical role in successful community integration of individuals having experienced an SCI, with knowledge translation being increasingly important for the process. The implementation of a new online peer-mentor training program was perceived as being useful in improving and standardizing training practices for peer mentors across Canada. It was also seen as an opportunity to explore the context, process, and influence of a formal implementation process in SCI community-based associations that are corporate members of SCI Canada with a view to informing future implementation efforts. Objectives: The objectives of this study were to (a) explore the context in which the implementation process will be conducted, (b) identify barriers and facilitators that influence the implementation process, and (c) measure the influence of the implementation process on service delivery. Methods: A sequential cross-sectional design was used with SCI Canada provincial member associations. SCI Canada's purpose is to support collaboration among provincial corporate members. SCI Canada enlisted the participation of several employees from the provincial associations to assess the implementation context using the Evidence-Based Practice Attitude Scale and the Organizational Readiness to Change Assessment and to identify barriers to and facilitators of the implementation of an evidence-based practice through an open-ended questionnaire based on the Consolidated Framework for Implementation Research. A pre-post design was used to evaluate the influence of the implementation process on peer-mentors using the Determinants of Implementation Behavior Questionnaire. Results: Participants reported an overall positive attitude toward evidence-based practice and a positive perception of the organizational readiness to change. The relevance of the practice chosen was a facilitator because peer support is central to the mission of SCI Canada and this type of practice is in line with the organization' culture and values. Equally important, but as an obstacle, is the scarcity of existing resources within the association in general and specifically resources devoted to the implementation of the program. Finally, the implementation process seems to influence half of the implementation determinant types on potential peer mentors. Conclusion: Community-based organizations, such as the provincial association members of SCI Canada, show positive context for the implementation of evidence-based practices. However, successful implementation of online peer-mentor training will require specific consideration of financial and human resources.
Collapse
Affiliation(s)
| | - Krista L Best
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | | | - Frederic S Dumont
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Luc Noreau
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| |
Collapse
|
14
|
Bayley MT, Kirby RL, Farahani F, Titus L, Smith C, Routhier F, Gagnon DH, Stapleford P, Alavinia SM, Craven BC. Development of Wheeled Mobility indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2019; 42:130-140. [PMID: 31573457 PMCID: PMC6783799 DOI: 10.1080/10790268.2019.1647934] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Wheeled mobility is critical for individuals with Spinal Cord Injury or Disease (SCI/D) related paralysis. The World Health Organization (WHO) developed guidelines highlighting eight steps in wheelchair service delivery: (1) referral and appointment; (2) assessment; (3) prescription; (4) funding and ordering; (5) product preparation; (6) fitting; (7) user training; and, (8) follow-up maintenance/repairs. This article describes the processes used to develop structure, process and outcome indicators that reflect the WHO guidelines within the Domain of Wheeled Mobility rehabilitation for Canadians. Methods: Wheeled mobility experts within the SCI-High Project Team used the WHO guideline to inform the Construct refinement and development of a Driver diagram. Following seven meetings, the Driver diagram and review of outcome measures and literature synthesis regarding wheelchair service delivery informed indicator selection and group consensus. Results: The structure indicator examines the proportion of SCI/D service providers within a rehabilitation program who have specialized wheelchair training to ensure prescription, preparation, fitting, and maintenance quality. The process indicator evaluates the average number of hours of wheelchair service delivery provided per patient during rehabilitation. The intermediary outcome indicator (rehabilitation discharge), is a target capacity score on the Wheelchair Skills Test Questionnaire (WST-Q). The final outcome indicators (at 18 months post rehabilitation admission) are the Life Space Assessment (LSA) and the Wheelchair Use Confidence Scale (WheelCon) short form mean scores. Conclusion: Routine implementation of the selected Wheeled Mobility structure, process and outcome indicators should measurably advance care within the Wheeled Mobility Domain for Canadians living with SCI/D by 2020.
Collapse
Affiliation(s)
- Mark T. Bayley
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R. Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Farnoosh Farahani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Laura Titus
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Cher Smith
- Department of Occupational Therapy, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - François Routhier
- Department of Rehabilitation, Laval University, Québec City, Québec, Canada
| | - Dany H. Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Québec, Canada
| | - Patricia Stapleford
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, Neural Engineering & Therapeutic Team, KITE, Toronto Rehabilitation Institute- University Health Network, 520 Sutherland Drive, Toronto, ON, Canada, M4G 3V9; Ph: (416) 597-3422.
| |
Collapse
|