French-Canadian translation of the WheelCon-M (WheelCon-M-F) and evaluation of its validity evidence using telephone administration

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.

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.

Effectiveness of the miWe Simulator Training on Powered Wheelchair-driving Skills: A Randomized Controlled Trial

OBJECTIVES

To evaluate the effectiveness of a home-based simulator training, in comparison with a videogame-based training, in terms of powered wheelchair driving skills, skills use in a real-world setting, and driving confidence.

DESIGN

Single-blinded randomized controlled trial.

SETTING

Community.

PARTICIPANTS

New powered wheelchair users (N=47) randomly allocated to simulator group (n=24, 2 drop-out) and control group (n=23, 3 drop-out).

INTERVENTIONS

The miWe wheelchair simulator (simulator group) or a kart driving videogame (control group) was setted-up at participants' homes (computer + joystick). They were instructed to use it at least 20 minutes every 2 days, during a period of 2 weeks.

PRIMARY OUTCOME MEASURE(S)

Assessments were done at baseline (T1) and post-training (T2) using the Wheelchair Skills Test Questionnaire (WST-Q, version 4.1), Wheelchair Confidence Scale (WheelCon), Assistive Technology Outcomes Profile for Mobility, and Life-Space Assessment (LSA). The time necessary to complete 6 WST tasks was measured with a stopwatch.

RESULTS

Participants of the simulator group significantly increased their WST-Q capacity score at T2 by 7.5% (P<.05), whereas the control group remained at the same score (P=.218). Participants of both groups rolled backward and went through a door significantly faster at T2 (P=.007; P=.016), but their speed did not change for the other skills. The WheelCon score significantly increased after training (+4% for the control group and +3.5% for the simulator group, P=.001). There was no T1-T2 difference between groups for the WST-Q performance scores (P=.119), the ATOP-Activity (P=.686), the ATOP-Participation scores (P=.814), and the LSA score (P=.335). No adverse events or side effects were reported during data collection or training.

CONCLUSIONS

Participants of both groups improved some skills and their wheelchair driving confidence. The simulator training group also demonstrated a modest post-training gain in their WST-Q capacity, but more studies would be needed to explore the long-term effects of the McGill immersive wheelchair simulator (miWe) simulator on driving skills.

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.

Geospatial assistive technologies: potential usability criteria identified from manual wheelchair users

Purpose: To advance knowledge of specific usability criteria for Geospatial Assistive Technologies (GATs) and manual wheelchair users, and to develop a profile and expectations for potential future users.Method: A face-to-face cross-sectional study was conducted with 17 community-dwelling manual wheelchair users (aged 18-45 years) who use a mobile device. A semi-structured interview was conducted as follows: (1) four video clips presenting technologies related to GATs (applications on a smartphone or smart watch, augmented reality glasses, virtual reality helmet) were shown; (2) questions were asked about the perceived advantages and disadvantages of route planning prior to travel and navigation while receiving guidance in urban areas; and (3) an activity to rank fifteen defined usability criteria by importance was conducted. Two questionnaires were also self-administered: the Temple University Community Participation Measure and the Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon).Results: This study defines a comprehensive sample profile of manual wheelchair users with GAT and 19 distinctive usability criteria for GATs specifically suited to manual wheelchair users. Fifteen criteria were identified as the most important (actual use, appearance, Bluetooth, comfort, dimensions, ease of use, efficiency, familiarity, features, hands-free operation, information content, quality of information and transportability). Information content and transportability demand higher expectations while the emerging Bluetooth and free-hands criteria are associated with transportability.Conclusion: The results obtained using a user-centric approach yielded useful data to improve GATs and broaden the concept of compatibility among users and specific-use situations to ensure usability.Implications for rehabilitation For manual wheelchair users paired with a geospatial assistance technology:• The smart phone is preferred (compared to the smart watch, augmented reality glasses or virtual reality helmet) for both plan and navigation tasks. Actual use, comfort, ease of use, familiarity, features and informative content are important criteria and the smart phone as mobile device for GATs is perceived favourably to meet the requirements coming up with these criteria.• Especially suitable for guidance and manual wheelchair navigation (double-task), two emergent criteria emerge regarding the usability of GATs: hands-free and Bluetooth. Hands-free is associated with potential usability issues regarding smart phone transportability and to the relevance of augmented reality glasses or smart watches as mobile device for GATs. The Bluetooth connexion appears as being part of the solution for increasing the transportability of any of these mobile devices.• Appearance and dimension of GATs, their efficiency for planning and navigating, and the quality of the delivered information are other important usability criteria.• Since information content and transportability are targeted as the two most important criteria, we should pay special attention in the future to the availability of information about accessibility of destinations and also, to appropriate fixation and Bluetooth systems ensuring, partially or completely, hands-free operation in order to meet user needs.

Measurement properties of the WheelCon for powered wheelchair users

PURPOSE

To evaluate the measurement properties of the Wheelchair Use Confidence Scale for power wheelchair users (WheelCon-P).

DESIGN

One-month test-retest design, using data from a longitudinal study of power wheelchair use.

PARTICIPANTS

Volunteer sample of 73 community dwelling, older adult experienced power wheelchair users who had a mean age of 60.5 ± 7.1 years.

METHODS

Participants completed the WheelCon-P twice to assess retest reliability. Concurrent validity was assessed by evaluating hypothesized relationships between the WheelCon-P and relevant variables.

RESULTS

The baseline mean (standard deviation) WheelCon-P score was 78.8 ± 14.5. Cronbach's α was 0.92. The one-month test-retest intraclass correlation coefficient was 0.85 (CI 0.77-0.90). Correlations ranging from r = 0.26 (social support) to r = 0.49 (wheelchair skills) were found between the WheelCon-P and the validation outcome measures.

CONCLUSION

The WheelCon-P has high internal consistency, strong retest reliability and evidence supporting its validity. Although further work is needed, the WheelCon-P may serve as a useful clinical and research tool for measuring power wheelchair confidence. Implications for rehabilitation The WheelCon-P is a reliable and valid outcome measure for assessing wheelchair confidence. This tool can be used to identify individuals with low power wheelchair confidence who require a confidence-enhancing intervention.

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial

OBJECTIVES

To test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation centers and communities.

PARTICIPANTS

Powered wheelchair users (N=116).

INTERVENTION

Five 30-minute WSTP training sessions.

MAIN OUTCOME MEASURES

Assessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA).

RESULTS

There was no significant t2-t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3.

CONCLUSIONS

Powered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

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.

Rasch analyses of the wheelchair use confidence scale

OBJECTIVES

To compare the functioning of the 101-point response format of the Wheelchair Use Confidence Scale (WheelCon) with shortened 11-point formats, and to evaluate the scale's measurement properties using principal components and Rasch analyses.

DESIGN

Secondary analysis of cross-sectional data.

SETTING

Community.

PARTICIPANTS

Volunteer participants were manual wheelchair users (N=220) ≥19 years of age, with ≥6 months' experience with daily wheelchair use and no cognitive impairment.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

65-item WheelCon.

RESULTS

The 11-point response format outperformed the original 101-point format. Principal component analyses confirmed the presence of 2 dimensions: mobility efficacy and self-management efficacy. Thirteen items in the mobility efficacy subscale and 8 items in the self-management efficacy subscale fit the Rasch Rating Scale model. Five items misfit the model developed using the 21 items from both subscales. In each of the 13- and 8-item subscales, and the 21-item short form, the 2 lowest and highest scores had internal consistency reliability estimates <.70; all other scores had reliability estimates >.70.

CONCLUSIONS

The WheelCon is composed of 2 dimensions. The recoded measurements using a 0-to-10 response scale from the 13-item mobility and 8-item self-management efficacy subscales have good reliability, as do the measurements from the 21-item WheelCon Short Form. The use of the subscales, the short form, or both, depends on the context in which they are being considered. Research to establish the reliability and validity of the measurements using the 0-to-10 response format is warranted.