Reliability and validity of the telephone administration of the wheelchair outcome measure (WhOM) for middle-aged and older users of power mobility devices

Available Assistive Technology Outcome Measures: Systematic Review

BACKGROUND

The World Health Organization claimed that measuring outcomes is necessary to understand the benefits of assistive technology (AT) and create evidence-based policies and systems to ensure universal access to it. In clinical practice, there is an increasing need for standardized methods to track AT interventions using outcome assessments.

OBJECTIVE

This review provides an overview of the available outcome measures that can be used at the follow-up stage of any AT intervention and integrated into daily clinical or service practice.

METHODS

We systematically searched for original manuscripts regarding available and used AT outcome measures by searching for titles and abstracts in the PubMed, Scopus, and Web of Science databases up to March 2023.

RESULTS

We analyzed 955 articles, of which 50 (5.2%) were included in the review. Within these, 53 instruments have been mentioned and used to provide an AT outcome assessment. The most widely used tool is the Quebec User Evaluation of Satisfaction with Assistive Technology, followed by the Psychosocial Impact of Assistive Technology Scale. Moreover, the identified measures addressed 8 AT outcome domains: functional efficacy, satisfaction, psychosocial impact, caregiver burden, quality of life, participation, confidence, and usability. The AT category Assistive products for activities and participation relating to personal mobility and transportation was the most involved in the reviewed articles.

CONCLUSIONS

Among the 53 cited instruments, only 17 (32%) scales were designed to evaluate specifically assistive devices. Moreover, 64% (34/53) of the instruments were only mentioned once to denote poor uniformity and concordance in the instruments to be used, limiting the possibility of comparing the results of studies. This work could represent a good guide for promoting the use of validated AT outcome measures in clinical practice that can be helpful to AT assessment teams in their everyday activities and the improvement of clinical practice.

Influence of Roulez avec confiance, a peer-led community-based wheelchair skills training program, on manual wheelchair users

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.

Benefits of a Wearable Activity Tracker with Safety Features for Older Adults: An Intervention Study

Accidental falls and physical inactivity are important age-related issues for which smart technologies have demonstrated potential utility. This research aimed to explore the benefits of combining wearable activity monitors and telecare for older adults. A four-month interventional study was conducted between June 2021 and February 2022 in Slovenia. A purposive sample of 22 dyads of older adults aged 60 years and over and their relatives or family members used a wearable GoLiveClip device. The Pillar Integration Process was used to analyze the quantitative and qualitative data. Seven pillars emerged: (1) the use of smart technologies as a motivator for physical activity; (2) factors related to smart technology use affecting physical activity levels; (3) increased usefulness of smart technologies for users who completed the study; (4) activity monitoring as the most useful functionality of the solution; (5) the influence of technical problems on usefulness; (6) the influence of age and previous experience with smart technologies on usefulness; and (7) moderate psychological effects of smart technology use. Activity trackers were found to effectively promote physical activity in older adults, and safety features were shown to be an important part of the solution, regardless of health status or physical activity level.

Training Program to Modify Manual Wheelchairs to Simplified Power Wheelchairs for Community Dwelling Elderly People and Caregivers

Mobility aids, particularly power wheelchairs, are necessary for elderly individuals who have health problems and disabilities. However, there is a limitation in providing power wheelchairs for such people in the community. The objectives of this study were to develop a prototype for a simplified power wheelchair and develop and evaluate a training program that has the potential to encourage evaluation and modification of the wheelchair for the elderly and their caregivers in the community. Twenty-four participants consist of elderly people and caregivers who were interested in the training program that comprised two sessions: theory and fieldwork experience. Results showed that the elderly people and caregivers, who had no knowledge or experience of wheelchair modification, were able to learn and provide suggestions for wheelchair users in their community. Two themes emerged from evaluating the training program, which included “benefits from the training program” and “improvement of the training program in the future.” Key concepts were elicited and considered in six categories: sufficient knowledge and practical learning to build confidence, values of fieldwork experiences, team support, organizational support, expansion of various contexts, and system of continued connection and services after training.

Impact of the TEAM Wheels eHealth manual wheelchair training program: Study protocol for a randomized controlled trial

Background

Variable, and typically inadequate, delivery of skills training following manual wheelchair (MWC) provision has a detrimental impact on user mobility and participation. Traditional in-person delivery of training by rehabilitation therapists has diminished due to cost, travel time, and most recently social distancing restrictions due to COVID-19. Effective alternative training approaches include eHealth home training applications and interactive peer-led training using experienced and proficient MWC users. An innovative TEAM Wheels program integrates app-based self-training and teleconference peer-led training using a computer tablet platform.

Objective

This protocol outlines implementation and evaluation of the TEAM Wheels training program in a randomized control trial using a wait-list control group.

Setting

The study will be implemented in a community setting in three Canadian cities.

Participants

Individuals ≥ 18 years of age within one year of transitioning to use of a MWC.

Intervention

Using a computer tablet, participants engage in three peer-led teleconference training sessions and 75–150 minutes of weekly practice using a video-based training application over 4 weeks. Peer trainers individualize the participants’ training plans and monitor their tablet-based training activity online. Control group participants also receive the intervention following a 1-month wait-list period and data collection.

Measurements

Outcomes assessing participation; skill capacity and performance; self-efficacy; mobility; and quality of life will be measured at baseline and post-treatment, and at 6-month follow-up for the treatment group.

Impact statement

We anticipate that TEAM Wheels will be successfully carried out at all sites and participants will demonstrate statistically significant improvement in the outcome measures compared with the control group.

The Wheelchair Outcome Measure for Young People (WhOM-YP): modification and metrics for children and youth with mobility limitations

Purpose: Wheelchairs enhance children's mobility and participation in daily life, yet few participation measures are used to evaluate wheeled mobility interventions. The Wheelchair Outcome Measure for Young People (WhOM-YP) addresses this gap, evaluating importance of and satisfaction with client-identified participation outcomes inside and outside home for children aged 18 years and younger who need wheeled mobility interventions.Methods: Mixed methods study using semi-structured interviews with nine experienced therapists and nine wheelchair users (11-18 years) evaluated the appropriateness of adult Wheelchair Outcome Measure for younger ages. Four key informants reviewed findings and offered additional modifications. Two-week test-retest reliability and construct validity were examined with children and parents; Spearman correlations were estimated among child and parent scores and Mann-Whitney U Test analyzed difference in outside home participation mean weighted satisfaction scores between new and experienced power mobility users.Results: Modifications included age-appropriate changes, adding visuals to rating scales, and separate child and adult ratings dependent on child's age and abilities. Two week test-retest reliability estimates were as hypothesized; WhOM-YP mean satisfaction and mean weighted satisfaction summary scores for inside and outside home participation demonstrated intraclass correlation coefficient (ICC_(2,1)) > 0.70. Discrimination between groups was as predicted; mean weighted satisfaction outside participation difference (p < 0.0001) demonstrated between experienced (median 74.2, n = 22) and inexperienced (median 32.9, n = 10) users. Revised format was conducive for individuals with diverse needs; images helped those with emerging numeracy and literacy skills, and proxy rating could be accommodated.Conclusion: Evidence supports WhOM-YP reliability and validity for measuring participation outcomes in daily life for young people.Implications for rehabilitationThe WhOM-YP offers a client-centred, individualized, participation focused outcome measure for young people who use wheeled mobility. Therapists, children, youth and parents were consulted throughout its development to ensure that the measure is relevant to their needs.The WhOM-YP can be used with children 18 years-of-age and younger. Consistent ratings over a two-week period of time (when no change was expected) were stronger for those 8 years and older. Children as young as 5 years of age can use this measure to share their views but caution is needed in score interpretation for those below 8 years-of-age.The option of parent-report to augment or provide a proxy measure increases WhOM-YP usefulness in rating individualized participation outcomes for a more age and ability diverse population.This is the first study to examine reliability and validity evidence in regards to using the Wheelchair Outcome Measure for Young People (WhOM-YP) with children who have mobility limitations and their parents.

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.

Feasibility of a Systematic, Comprehensive, One-to-One Training (SCOOT) program for new scooter users: study protocol for a randomized control trial

Background

Mobility scooters can facilitate community participation among individuals with mobility limitations. However, accidents are a serious concern with scooter use. Scooter training has been recommended to improve safety, but there are currently few validated programs available. Therefore, we developed a Systematic, Comprehensive, One-to-One Training (SCOOT) program for scooter users. We will conduct a study to evaluate the outcomes produced by the provision SCOOT.

Methods

This feasibility study will use a mixed-methods, rater-blinded, randomized control trial, with a two-step wedge design. The study has two arms: an immediate intervention group, which will receive the intervention directly after baseline assessments, and a delayed intervention group, which will receive the intervention after a 6-week period. Forty participants, who will be stratified based on whether or not participants have previously held a driver’s license, will be randomly assigned to each arm. The intervention for this study consists of 6 weeks of one-to-one scooter training by an experienced occupational therapist, who will provide training once or twice per week over the 6 weeks. The primary outcome measure is subjective scooter skills, measured using the Wheelchair Skills Test for scooters. Secondary outcomes include objective scooter skills, confidence, mobility, and satisfaction with selected participation activities. Descriptive measures include cognitive status, functional status, hearing, vision, physical accessibility of the home and community, and visual attention and task switching. Qualitative interviews will be conducted with the first ten willing participants from each group to learn about their scooter use and experiences with SCOOT.

Discussion

The results of this study will inform a larger randomized control trial. If the intervention is proven to be effective in this larger study, it may have important implications for policy and practice.

Trial registration

ClinicalTrials.gov identifier: NCT02696213. Registered on 23 February 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1963-y) contains supplementary material, which is available to authorized users.

Actual use of and satisfaction associated with rollators and "shopping carts" among frail elderly Japanese people using day-service facilities

Purpose This study aimed at clarifying the actual use of and satisfaction with rollators and "shopping carts" (wheeled walkers with storage) among frail elderly people, who were certified by a long-term care insurance system as users of facilities that provide day-service nursing care and rehabilitation. Methods We identified 1247 frail elderly people who used day-service facilities, and evaluated their actual use of, and satisfaction with, rollators and shopping carts. Results Forty-four (3.5%) individuals used rollators, and 53 (4.3%) used shopping carts. The shopping cart group contained more individuals who were certified as care level 1 (26.4%), than the rollator group (20.5%), and 52.8% of the shopping cart group was certified as care levels 1-3. The scores for "repairs and services" and "follow-up" from the Quebec User Evaluation of Satisfaction with assistive Technology second version (QUEST 2.0) survey were significantly higher in the rollator group than in the shopping cart group. Conclusions The QUEST 2.0 scores revealed that shopping cart users exhibit insufficient "repairs and services" and "follow-up" scores. As frail elderly people with poor care status accounted for >50% of the shopping cart group, these individuals urgently need walking aids that are tailored to their care status. Implications for Rehabilitation We conclude that walking aid fitting must be tailored to each persons care status, and suggest that a system should be established to allow occupational or physical therapists to provide this fitting Moreover, our analysis of the QUEST2.0 service scores revealed that repairs, services, and follow-up are insufficient to meet the needs of shopping cart users.

Translation and validation of the Farsi version of the Wheelchair Outcome Measure (WhOM-Farsi) in individuals with spinal cord injury

BACKGROUND

The Wheelchair Outcome Measure (WhOM) evaluates participation outcomes associated with wheelchair use. While English and French versions of this measure have shown appropriate psychometric properties, it is not clear whether this measure is valid and reliable when used in a culture significantly different from the western culture.

OBJECTIVE

To establish validity and reliability for the WhOM-Farsi.

METHODS

After a forward-backward translation using the International Quality of Life Assessment process, the WhOM-Farsi was administered to 75 Farsi speakers with spinal cord injury. The WhOM-Farsi was administered on two occasions to examine test-retest reliability. Two therapists rated the measure to evaluate inter-rater reliability. Construct validity was assessed by measuring associations between scores of the WhOM-Farsi, the 12-item short-form health survey (SF-12), the Beck Depression Index (BDI-II) and the Spinal Cord Independence Measure (SCIM-III).

RESULTS

The intra class correlation coefficient (ICC) for inter-rater reliability for all scores was 0.99. For test-retest, the ICC was 0.91, 0.94 and 0.83 for Sat, Imp × Sat and body function, respectively. As hypothesized the scores were positively correlated with the SF-12 and SCIM-III scores and negatively correlated with the BDI-II scores.

CONCLUSIONS

The results illustrated there is evidence to support the validity and reliability of the WhOM-Farsi scores.

Development and feasibility of an automated call monitoring intervention for older wheelchair users: the MOvIT project

Background

Recent advances in wheeled mobility technology are multiplying opportunities for community integration and improved quality of life. The mobility needs of older wheelchair users are particularly complex due to a constellation of chronic conditions and comorbidities that may compromise optimal use of the device. The purpose of the Mobility Outcomes via Information Technologies (MOvIT) project is to examine the feasibility of automated calls for the systematic monitoring for adverse outcomes associated with wheelchair use.

Methods

A two-phase mixed methods approach was used. Phase I involved user-centered development and face validation of a monitoring questionnaire with end-users (seven wheelchair users and five healthcare providers). Phase II tested the feasibility of monitoring outcomes using automated calls to administer the MOvIT questionnaire 1 and 3 months after wheelchair delivery with a prospective cohort of older adults (50–84 years of age). When problems were identified, the computer monitoring system notified a clinical coordinator who followed up with respondents requiring interventions. Feasibility data were extracted from the web database and from individual interviews covering perceived ease of use, usefulness and intention to use the MOvIT questionnaire in the future.

Results

The MOvIT monitoring questionnaire developed in phase I tracks nine potential wheelchair-related adverse outcomes considered important for end-users: 1) non-use of wheelchair, 2) pain, 3) skin condition, 4) positioning, 5) wheelchair incidents, 6) psychosocial issues, 7) restricted wheelchair participation, 8) limited wheelchair skills and knowledge, and 9) technical problems. In phase II, 92 individuals who received a wheelchair were eligible, 71 out of 92 accepted (77 %) and 65 out of 71 (92 %) completed the 3-month follow-up. In the sample of 65 participants, a wheelchair-related adverse outcome was confirmed by a rehabilitation professional for 58.5 %, and at least one recommendation was given to 66.2 % during the 3-month monitoring period. A majority of participants found the intervention useful (82.8 %) and said they intended to use the MOvIT monitoring questionnaire in the future (81.5 %). Participants made suggestions to make the calls more adaptive to various ability profiles.

Conclusions

Automated calls tailored for individuals with mobility limitations and associated comorbidities are a promising approach to reach clients who need post-rehabilitation support.

Measuring wheelchair confidence among power wheelchair users: an adaptation of the WheelCon-M using focus groups and a think aloud process

PURPOSE

The aim of this study was to adapt the WheelCon-M, an outcome measure used to assess confidence with manual wheelchair use, into a version that is applicable for power wheelchair users (WheelCon-P).

METHODS

Adaptation of the WheelCon-M into the WheelCon-P occurred in two phases: (1) item modification was conducted using focus groups and (2) item refinement was done using a think aloud process.

RESULTS

The healthcare professionals (n = 12) were mostly female, mostly occupational therapists and practiced an average of 14 years. The power wheelchair users (n = 8) were 50% men with an average of 8 years of power wheelchair experience and a range of diagnoses. In phase 1, of the 63 WheelCon-M items, 6 remained the same, 18 were removed, 38 modified and 15 new items added to develop the WheelCon-P. In phase 2, 15 WheelCon-P items were refined.

CONCLUSIONS

This study resulted in the modification of the WheelCon-M into the WheelCon-P, a 59-item, self-report outcome measure designed to assess confidence with power wheelchair use. The next step in the evolution of this promising new measure is the assessment of its measurement properties. Implications for Rehabilitation The WheelCon-P is a new outcome measure designed to assess confidence with power wheelchair use. This study suggests that the items in this measure will be interpreted as intended.

Validating the wheelchair outcome measure for residents in long-term care

PURPOSE

To determine the retest reliability and construct validity of the self-report and proxy versions of the wheelchair outcome measure (WhOM) among residents in long-term care.

METHOD

The WhOM was administered to 55 wheelchair users living in residential care (38 self-respondents and 17 proxy respondents). Retest data were collected to estimate reliability using intraclass correlation coefficients (ICCs) for each of the tool scores (Importance, Satisfaction and Importance × Satisfaction). For construct validity testing, Spearman's correlation coefficients were used to assess whether WhOM scores were correlated with scores from the Late Life Function and Disability Instrument (LLDI) and Geriatric Depression Scale (GDS).

RESULTS

The ICCs for the WhOM scores were between 0.68 and 0.84. Moderate correlations were found between the self-respondents and proxy respondents groups with Importance × Satisfaction and LLDI (r = 0.46-0.50). No other significant correlations were found.

CONCLUSIONS

This study provides evidence for the reliability and validity of the WhOM for adults in residential care, but further testing is warranted to ensure it can facilitate prescription of the right device at the right time for residents in these settings.

IMPLICATIONS FOR REHABILITATION

Clients who reside in long-term care (LTC) institutions represent a population who have unique needs because of the varied types of activities in which they participate. This study provides support for use of the WhOM on an individual basis among self-responding residents. The study provides some support and use of the WhOM with groups of residents who require proxy respondents. Additional studies with a larger sample size are needed to further explore the psychometrics of the measure.

Test-retest reliability and agreement of the Satisfaction with the Assistive Technology Services (SATS) instrument in two Nordic countries

PURPOSE

The purpose of this study was to investigate test-retest reliability, agreement, internal consistency, and floor- and ceiling effects of the Danish and Finnish versions of the Satisfaction with the Assistive Technology Services (SATS) instrument among adult users of powered wheelchairs (PWCs) or powered scooters (scooters).

METHOD

Test-retest design, two telephone interviews 7-18 days apart of 40 informants, with mean age of 67.5 (SD 13.09) years in the Danish; and 54 informants with mean age of 55.6 (SD 12.09) years in the Finnish sample.

RESULTS

The intra-class correlation coefficient varied between 0.57 and 0.93 for items in the Danish and between 0.41 and 0.93 in the Finnish sample. The percentage agreement varied between 54.2 and 79.5 for items in the Danish and between 69.2 and 81.1 in the Finnish sample, while the Cronbach's alpha values varied between 0.87 and 0.96 in the two samples. A ceiling effect was found in all items of both samples.

CONCLUSIONS

This study indicates that the SATS may be reliably administered for telephone interviews among adult PWC and scooter users, and give information about aspects of the service delivery process for quality development improvement purposes. Further psychometric testing of the SATS is required.

A quality-of-life scale for assistive technology: results of a pilot study of aging and technology

BACKGROUND

In an aging society, it is increasingly important to understand how assistive devices can be used by older people to maintain quality of life despite chronic disabilities. Assistive technology is a mainstay of physical therapist practice, but the potential for device use to affect psychosocial well-being is not yet understood at the population level.

OBJECTIVE

The objective of this study was to develop a parsimonious indicator that can be used in population-based surveys to represent the effect of assistive technologies on quality of life for older people, separate from personal assistance.

DESIGN

This study was a cross-sectional survey.

METHODS

/b> The methods used in this study were psychometric scale development and structural equation modeling.

RESULTS

The results indicated that a parsimonious, valid, and reliable scale reflecting quality of life related to assistive device use can be created from 3 questions designed to measure improvements in safety, control, and participation due to technology. The findings also suggested that assistive technology may more effectively improve quality of life for people with greater levels of functional limitations.

LIMITATIONS

The data were derived from a cross-sectional survey conducted by telephone. The use of personal assistance, on average, was low; thus, the applicability to a population with more profound care needs has yet to be confirmed.

CONCLUSIONS

Determining the broader impact of assistive technology on quality of life with population-level measures may provide insight into how best to leverage technologies to prevent dependence in aging adults.

Measurement properties of the wheelchair outcome measure in individuals with spinal cord injury

STUDY DESIGN

One-week retest methodological study.

OBJECTIVES

To assess the reliability and validity of the wheelchair outcome measure (WhOM) in a sample of individuals with spinal cord injury (SCI).

SETTING

Vancouver, British Columbia, Canada.

METHODS

The WhOM measures the impact of wheelchair interventions on a user's self-selected participation outcomes. The WhOM was administered to 50 participants on two occasions by the same rater, 1 week apart, to assess test-retest reliability. To determine inter-rater reliability, the WhOM was administered a third time approximately 72 h later by a different rater. Validity was evaluated by correlating scores from the WhOM with scores from the Assessment of Life Habits (LIFE-H).

RESULTS

The test-retest intraclass correlation coefficients (ICC(2, 2)) for the WhOM satisfaction (Sat) and WhOM importance (Impt) × Sat scores were 0.83 (95% confidence interval (CI), 0.72-0.90) and 0.88 (95% CI, 0.79-0.93), respectively. The inter-rater ICC for the WhOM Sat and WhOM Impt × Sat scores were 0.91 (95% CI, 0.85-0.95) and 0.90 (95% CI, 0.83-0.94), respectively. As hypothesized, most scores on the WhOM were fair to moderate (r=0.3-0.5) and positively correlated with scores on the LIFE-H.

CONCLUSION

The WhOM is a new outcome measure that demonstrates good reliability and validity among individuals with SCI. It is designed to assist wheelchair users identify and evaluate the impact of wheelchair interventions on participation level outcomes. The WhOM may be applicable for clinical- or research-oriented purposes.