Outcomes in occupational therapy students' preparation for wheelchair skills training provision.

While wheelchair skills training has demonstrated highly effective outcomes for wheelchair users, prevalence of receiving comprehensive skills training is low. Studies demonstrate a wheelchair skills "bootcamp" significantly improves occupational therapy students' capacity to demonstrate wheelchair skill performance; however, how bootcamps impact students' self-efficacy to deliver skills training in future clinical practice is unclear. This study explored a large dataset collected from nine successive student cohorts attending a structured wheelchair skills bootcamp at a single site. Bootcamps were 4-4.5 hours in duration and content was based on the Wheelchair Skills Program. Mean improvement in skill capacity was 34.8% (95% CI 33.5; 36.1) and wheelchair self-efficacy improved by 28.7% (95% CI 27.3; 30.1). Post-bootcamp self-efficacy scores for Assessment (80.9%), Training (78.5%), Spotting (87.4%), and Documentation (70.4%) all improved by 30-40%. Mandatory bootcamps had lower baseline scores but similar post-bootcamp and change scores as voluntary ones. Cohorts during the COVID-19 pandemic had significantly lower baseline scores for wheelchair skill capacity and confidence as well as self-efficacy with assessment, but significantly larger improvements post-bootcamp. An experiential bootcamp is effective across a wide range of occupational therapy student cohorts in preparing them to deliver wheelchair skills training in future clinical practice.

Telerehabilitation Delivery in Canada and the Netherlands: Results of a Survey Study.

BACKGROUND: Following the onset of the COVID-19 pandemic, telerehabilitation (TR) has been expanding to address the challenges and risks of in-person delivery. It is likely that a level of TR delivery will continue after the pandemic because of its advantages, such as reducing geographical barriers to service. Many pandemic-related TR initiatives were put in place quickly. Therefore, we have little understanding of current TR delivery, barriers and facilitators, and how therapists anticipate integrating TR into current practice. Knowing this information will allow the incorporation of competencies specifically related to the use and provision of TR into professional profiles and entry-to-practice education, thereby promoting high-quality TR care. OBJECTIVE: This study aimed to obtain a descriptive overview of current TR practice among rehabilitation therapists in Canada and the Netherlands and identify perceived barriers to and facilitators of practice. METHODS: A web-based cross-sectional survey was conducted with occupational, physical, and respiratory therapists and dietitians in Canada (in French and English) and the Netherlands (in Dutch and English) between November 2021 and March 2022. Recruitment was conducted through advertisements on social media platforms and email invitations facilitated by regulatory and professional bodies. The survey included demographic and practice setting information; whether respondents delivered TR, and if so, components of delivery; confidence and satisfaction ratings with delivery; and barriers to and facilitators of use. TR satisfaction and uptake were measured using the Telehealth Usability Questionnaire and modified Technology Acceptance Model. Data were first summarized descriptively, and then, comparisons were conducted between professions. RESULTS: Overall, 723 survey responses were received, mostly from Canada (n=666, 92.1%) and occupational therapists (n=434, 60%). Only 28.1% (203/723) reported receiving specific training in TR, with 1.2% (9/723) indicating that it was part of their professional education. Approximately 19.5% (139/712) reported not using TR at all, whereas most participants (366/712, 51.4%) had been using this approach for 1 to 2 years. Services delivered were primarily teleconsultation and teletreatment with individuals. Respondents offering TR were moderately satisfied with their service delivery and found it to be effective; 90.1% (498/553) indicated that they were likely to continue offering TR after the pandemic. Technology access, confidence, and setup were rated the highest as facilitators, whereas technology issues and the clinical need for physical contact were the most common barriers. CONCLUSIONS: Professional practice and experience with TR were similar in both countries, suggesting the potential for common strategic approaches. The high prevalence of current practice and strong indicators of TR uptake suggest that therapists are likely to continue TR delivery after the pandemic; however, most therapists (461/712, 64.7%) felt ill prepared for practice, and the need to target TR competencies during professional and postprofessional education is critical. Future studies should explore best practice for preparatory and continuing education.

Clinical stakeholders' perspective for the integration of an immersive wheelchair simulator as a clinical tool for powered wheelchair training.

This study aimed to investigate clinical stakeholders' acceptance of an immersive wheelchair simulator as a potential powered wheelchair skills training tool. Focus groups, conducted in four rehabilitation centers, were used to obtain a rich understanding of participants' experiences and beliefs. Then, a cross-sectional survey of the simulator acceptability for clinical practice was created. Twenty-three rehabilitation therapists and clinical program directors participated in the focus groups and thirty-three responded to the survey. Participants generally expressed that use of the simulator would be complementary to training in an actual powered wheelchair, and that it could be useful for challenging situations in rehabilitation centers (e.g. anxious clients; when there is uncertainty around their potential to drive a powered wheelchair; tasks that cannot be assessed in a real-life environment). They also provided suggestions to improve the simulator (e.g. more feedback during tasks; possibility of adjusting control settings such as speed and sensitivity; possibility of adding varied control interfaces). Feedback received from key stakeholders clearly indicated that the wheelchair simulator would be complementary to training provided in a real context of use. However, some important limitations must be addressed to improve the simulator and promote its adoption by clinical programs, therapists and clients.

Improvement and Retention of Wheelchair Skills Training for Students in Entry-Level Occupational Therapy Education.

IMPORTANCE: Although an essential component of best practice, wheelchair skills training is often inadequate; occupational therapy practitioners' professional preparation is a contributing factor. OBJECTIVE: To assess the effectiveness of a boot camp on capacity and self-efficacy in wheelchair skills and self-efficacy in clinical practice, retention of improvements, and effective boot-camp attributes. DESIGN: Concurrent, embedded, mixed-methods cohort design that used blinded, repeated-measures quantitative evaluation with 4-mo follow-up and directed content analysis of a qualitative questionnaire. SETTING: University entry-to-practice program. PARTICIPANTS: Convenience sample (N = 42) of final-year students. INTERVENTION: A 4-hr boot camp with demonstration and supervised practice. Content incorporated skill performance, training and motor-learning strategies, and safe supervision. OUTCOMES AND MEASURES: Skill performance capacity (Wheelchair Skills Test-Questionnaire), self-efficacy with manual wheelchair use (Wheelchair Use Confidence Scale), confidence in provision of manual wheelchair training services (Self-Efficacy in Assessing, Training, and Spotting test), and a boot-camp experience questionnaire. RESULTS: Within-subjects analysis of variance revealed significant improvements on all measures (p < .001) with large effect sizes (ηp² = .68-.88). All measures except skill capacity demonstrated retention; skill capacity decreased 5.3% (95% confidence interval [2.0, 8.5]) but was significantly higher than baseline. Three themes influenced practice confidence: knowledge acquisition, experiential learning, and client empathy. CONCLUSIONS AND RELEVANCE: Results confirm improved wheelchair self-efficacy, capacity, and self-efficacy with clinical intervention skills. Retention of outcomes suggests the potential impact on future practice. Experiential learning supports performance component acquisition and imparts empathy of client experience, which may improve occupational therapy practitioners' perceptions of client potential. WHAT THIS ARTICLE ADDS: A 4-hr experiential boot camp can increase students' capacity and confidence to deliver wheelchair skills training to future clients. Experiential learning increased students' appreciation for clients' experience and expectation of client potential.

Wheelchair Skills Test Outcomes across Multiple Wheelchair Skills Training Bootcamp Cohorts.

User training is a critical component of wheelchair service delivery to ensure individuals with a mobility impairment can negotiate environmental barriers and promote their social participation. A wheelchair "bootcamp", delivered during professional preparation education, is one strategy to better prepare occupational therapists for clinical rehabilitation practice by developing their own wheelchair skills. The purpose of this study was a retrospective review of a large dataset of student cohorts from a single site and delineate bootcamp effects on the Wheelchair Skills Test-Questionnaire (WST-Q) scores. Participant data from eight cohorts was consolidated (n = 307). Comparison of two WST-Q scoring formats revealed significantly lower scores for cohorts using the 4-point version, which was subsequently standardized to the other 3-point version. WST-Q change scores were similar between cohorts, and differences were more reflective of variability in skill level prior to bootcamp than post-bootcamp scores. Students were able to master most basic and intermediate level skills, while advanced skill acquisition was much more variable. This study provides more precise point estimates of wheelchair skill acquisition among occupational therapy students than previous studies. While confirming the benefits of bootcamp education, recommendations for further investigation were identified.

Effect of an mHealth Wheelchair Skills Training Program for Older Adults: A Feasibility Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of an mHealth wheelchair skills training program on clinical outcomes among older adult manual wheelchair users. DESIGN: 2×2 factorial randomized controlled trial. SETTING: Community setting in 2 Canadian cities. PARTICIPANTS: Convenience sample of manual wheelchair users 50 years and older living in the community who were able to self-propel with both hands and communicate in English. Participants (N=18) were randomized into either a mHealth treatment (n=10) or tablet gaming control (n=8) group. INTERVENTIONS: All participants received 2 in-person sessions with their trainer and engaged in a 4-week monitored home training program with a computer tablet. The Enhancing Participation In the Community by improving Wheelchair Skills program provided wheelchair skills training; the control program included 9 dexterity and cognitive training games. MAIN OUTCOME MEASURES: The primary outcome was wheelchair skill capacity. Secondary outcomes included safety, self-efficacy, activity participation, mobility, divided-attention, and health-related quality of life. RESULTS: Data collection was blinded to group allocation. Capacity improved by 2 skills but with no statistically significant between-group difference. The mHealth training program had a significant effect on participation (P=.03) and self-efficacy (P=.06) with large effect sizes (ηp2=0.22-0.29). Mobility, safety with skill performance, and divided attention measures demonstrated medium effect size changes, but only safety with skill performance was statistically significant. The program was more beneficial for participants with <1 year of wheelchair experience. CONCLUSION: Enhancing Participation In the Community by improving Wheelchair Skills participants demonstrated good program adherence and clinical benefits were evident in community participation and wheelchair self-efficacy. Wheelchair safety and mobility were positively affected, while skill capacity showed a small, nonsignificant improvement. Future study should investigate benefit retention over time.

A randomized control trial feasibility evaluation of an mHealth intervention for wheelchair skill training among middle-aged and older adults.

BACKGROUND: Providing mobility skills training to manual wheelchair (MWC) users can have a positive impact on community participation, confidence and quality of life. Often such training is restricted or not provided at all because of the expense of, and limited access to, occupational and physical therapists before and after discharge. This is particularly true among middle-aged and older adults, who often have limited access to rehabilitation services and require more time to learn motor skills. A monitored MWC skills training home program, delivered using a computer tablet (mHealth), was developed as an alternative approach to service delivery. The purpose of this study was to evaluate the feasibility of implementing this mHealth MWC skills training program among middle-aged and older adults. METHODS: A 2 × 2 factorial design randomized controlled trial (RCT) was used to compare the mHealth intervention and control groups, with additional wheeling time as a second factor. Community-dwelling MWC users aged 55 and older, who had used their MWC for less than two years and propelled with two hands, were recruited. Feasibility outcomes related to process, resources, management and treatment criteria were collected. RESULTS: Eighteen participants were recruited, with a retention rate of 94%. Mean (±SD) duration for the first and second in-person training sessions were 90.1 ± 20.5 and 62.1 ± 5.5 min, respectively. In the treatment group, 78% achieved the minimum amount of home training (i.e., 300 min) over four weeks and 56% achieved the preferred training threshold (i.e., 600 min). Trainers reported only seven minor protocol deviations. No tablets were lost or damaged and there was one incident of tablet malfunction. No injuries or adverse incidents were reported during data collection or training activities. Participants indicated 98% agreement on the post-treatment benefit questionnaire. DISCUSSION: Overall, the study protocol enabled implementation of the intervention in a safe, efficient and acceptable manner. Participant recruitment proved to be challenging, particularly gaining access to individuals who might benefit. Resource issue demands were acceptable for administration of the intervention; data collection was more time-consuming than anticipated but could be reduced with minor revisions. Participant retention and home program treatment adherence was high; both participant and trainer burden was acceptable. Treatment group participants reported a positive experience and clinical benefits from training program. The findings suggest a full-scale RCT evaluating the clinical impact of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) intervention is warranted, provided the recruitment issues are addressed through collaborative partnerships and active recruitment strategies.

Needs for mobility devices, home modifications and personal assistance among Canadians with disabilities.

BACKGROUND: People with disabilities often require assistive devices, modifications to their home environment, and physical assistance to facilitate mobility. This study examines self-reported met and unmet needs of people with disabilities who use wheeled mobility devices, compared with non-users. DATA AND METHODS: The 2012 Canadian Survey on Disability followed up with 45,442 individuals who reported a disability on the 2011 National Household Survey, and obtained a 75% response rate. Descriptive statistics with variance estimates and 95% confidence intervals were used to compare wheeled mobility device users and non-users. RESULTS: Nearly 10% of wheeled mobility device users identified an unmet need for an additional mobility device. Compared with non-users, they were twice as likely to modify their home with a ramp and three times as likely to install a lift. The prevalence of unmet need for each type of residence adaptation among wheeled mobility device users was at least double that of non-users. Wheeled mobility device users received assistance with an average of 4.4 activities, compared with 2.0 for non-users, and reported an average of 1.9 activities for which assistance was needed but not received. About one in three relied on paid assistance; for 14% of those who paid for assistance, out-of-pocket expenses amounted to $10,000 or more annually, compared with 2% among non-users. INTERPRETATION: Wheeled mobility device users reported a higher prevalence of met and unmet needs for residence modifications than did non-users. They required help with more activities of life on a more frequent basis, with greater dependence on paid individuals, resulting in higher out-of-pocket expenses. Power and manual wheelchair users reported greater needs than did mobility scooter users.

Prevalence of Wheelchair and Scooter Use Among Community-Dwelling Canadians.

BACKGROUND: Mobility impairments are the third leading cause of disability for community-dwelling Canadians. Wheelchairs and scooters help compensate for these challenges. There are limited data within the last decade estimating the prevalence of wheelchair and scooter use in Canada. OBJECTIVE: The aims of this study were: (1) to estimate the prevalence of wheelchair and scooter use in Canada and (2) to explore relevant demographic characteristics of wheelchair and scooter users. DESIGN: This study was a secondary analysis of a cross-sectional national survey. METHODS: The Canadian Survey on Disability (2012) collected data on wheelchair and scooter use from community-dwelling individuals aged 15 years and over with a self-identified activity limitation on the National Household Survey. Prevalence estimates were calculated as weighted frequencies, with cross-tabulations to determine the number of wheelchair and scooter users in Canada, by province, and demographic characteristics (ie, age, sex) and bootstrapping to estimate the variance of all point estimates. RESULTS: There were approximately 288,800 community-dwelling wheelchair and scooter users aged 15 years and over, representing 1.0% of the Canadian population. The sample included 197,560 manual wheelchair users, 42,360 powered wheelchair users, and 108,550 scooter users. Wheelchair and scooter users were predominantly women, with a mean age of 65 years. Approximately 50,620 individuals used a combination of 2 different types of devices. LIMITATIONS: The results are representative of individuals living in the community in Canada and exclude individuals in residential or group-based settings; estimates do not represent the true population prevalence. CONCLUSION: This analysis is the first in more than 10 years to provide a prevalence estimate and description of wheelchair and scooter users in Canada. Since 2004, there has been an increase in the proportion of the population who use wheelchairs and scooters, likely related to an aging Canadian population. These new prevalence data have potential to inform policy, research, and clinical practice.

Navigating uncharted territory: a qualitative study of the experience of transitioning to wheelchair use among older adults and their care providers.

BACKGROUND: An increasing number of older adults are procuring a wheelchair for mobility; however, the corresponding impact on related injuries, caregiver burden, and participation restriction is concerning. To inform the development of a wheelchair training program, we pursued a clearer understanding of the experience transitioning to wheelchair use for older adult users and their care provider. METHODS: Six focus groups were conducted with older experienced wheelchair users (n = 10) and care providers (n = 4). Transcripts were analyzed using a Conventional Content approach; a coding framework enabled inductive theming and summary of the data. RESULTS: Three themes emerged from the user group: On My Own reflected both limited training and the necessity of venturing out, More Than Meets the Eye addressing barriers to use, and Interdependence between wheelchair users and the ambulatory community. Care provider responses fell into two themes: the All Encompassing impact of assumed responsibilities and Even the Best Laid Plans, where unpredictable and inaccessible environments sabotaged participation. CONCLUSIONS: The transition from ambulatory to wheelchair mobility can feel like uncharted territory. Balanced support and appropriate mentorship are fundamentally important and real-world encounters optimize independence and proficiency with skills. The impact on care providers is extensive, highlighting the importance of skills training.

Rehab on Wheels: A Pilot Study of Tablet-Based Wheelchair Training for Older Adults.

BACKGROUND: Alternative and innovative strategies such as mHealth and eLearning are becoming a necessity for delivery of rehabilitation services. For example, older adults who require a wheelchair receive little, if any, training for proficiency with mobility skills. This substantive service gap is due in part to restricted availability of clinicians and challenges for consumers to attend appointments. A research team of occupational therapists and computer scientists engaged clinicians, consumers, and care providers using a participatory action design approach. A tablet-based application, Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels), was developed to enable in-chair home training, online expert trainer monitoring, and trainee-trainer communication via secure voice messaging. OBJECTIVE: Prior to undertaking a randomized controlled trial (RCT), a pilot study was conducted to determine the acceptability and feasibility of administering an mHealth wheelchair skills training program safely and effectively with two participants of different skill levels. The findings were used to determine whether further enhancements to the program were indicated. METHODS: The program included two in-person sessions with an expert trainer and four weeks of independent home training. The EPIC Wheels application included video instruction and demonstration, self-paced training activities, and interactive training games. Participants were provided with a 10-inch Android tablet, mounting apparatus, and mobile Wi-Fi device. Frequency and duration of tablet interactions were monitored and uploaded daily to an online trainer interface. Participants completed a structured evaluation survey and provided feedback post-study. The trainer provided feedback on the training protocol and trainer interface. RESULTS: Both participants perceived the program to be comprehensive, useful, and easily navigated. The trainer indicated usage data was comprehensive and informative for monitoring participant progress and adherence. The application performed equally well with multiple devices. Some initial issues with log-in requests were resolved via tablet-specific settings. Inconsistent Internet connectivity, resulting in delayed data upload and voice messaging, was specific to individual Wi-Fi devices and resolved by standardizing configuration. Based on the pilot results, the software was updated to make content download more robust. Additional features were also incorporated such as check marks for completed content, a more consumer-friendly aesthetic, and achievement awards. The trainer web interface was updated to improve usability and provides both a numerical and visual summary of participant data. CONCLUSIONS: The EPIC Wheels pilot study provided useful feedback on the feasibility of a tablet-based home program for wheelchair skills training among older adults, justifying advancement to evaluation in an RCT. The program may be expanded for use with other rehabilitation interventions and populations, particularly for those living in rural or remote locations. Future development will consider integration of built-in tablet sensors to provide performance feedback and enable interactive training activities. TRIAL REGISTRATION: ClinicalTrials.gov NCT01644292; https://clinicaltrials.gov/ct2/show/NCT01644292 (Archived by WebCite at http://www.webcitation.org/6XyvYyTUf).

Preliminary evidence to support a "boot camp" approach to wheelchair skills training for clinicians.

OBJECTIVE: To evaluate the impact of providing intensive large-group training on wheelchair-specific self-efficacy and skill capacity among occupational therapy students. DESIGN: Intervention study using before-after trial. SETTING: Universities. PARTICIPANTS: Volunteer sample of master of occupational therapy students (N=65). INTERVENTIONS: Two instructors provided a total of 4.5 hours of wheelchair skills training to groups of 14 to 19 students in a boot camp format, which included a brief lecture, instruction, demonstration, and hands-on practice. MAIN OUTCOME MEASURES: Wheelchair skill capacity (Wheelchair Skills Test Questionnaire [WST-Q]), with scores ranging from 0 to 64, and wheelchair-specific self-efficacy (Wheelchair Use Confidence Scale for Manual Wheelchair Users [WheelCon-M]), with scores ranging from 0 to 10. RESULTS: At postintervention, the mean WST-Q score increased by 24.7 (95% confidence interval, 22.1-27.3; P=.000), reflecting a 38.6% improvement (Cohen d=2.8). The mean WheelCon-M score improved by 3.0 (95% confidence interval, 2.5-3.3; P=.000). CONCLUSIONS: To our knowledge, this is the first study to measure and demonstrate improvement in wheelchair-specific self-efficacy among student clinicians. Participants demonstrated substantively larger improvements and acquired more advanced skills than previous studies using shorter training sessions with smaller groups. This study provides evidence for using a boot camp format as an effective strategy to increase occupational therapy students' confidence and skill with wheelchair mobility, preparing them to place greater emphasis on, and achieve better success in, training future clients.

Development of a wheelchair skills home program for older adults using a participatory action design approach.

Restricted mobility is the most common impairment among older adults and a manual wheelchair is often prescribed to address these limitations. However, limited access to rehabilitation services results in older adults typically receiving little or no mobility training when they receive a wheelchair. As an alternative and novel approach, we developed a therapist-monitored wheelchair skills home training program delivered via a computer tablet. To optimize efficacy and adherence, principles of self-efficacy and adult learning theory were foundational in the program design. A participatory action design approach was used to engage older adult wheelchair users, care providers, and prescribing clinicians in an iterative design and development process. A series of prototypes were fabricated and revised, based on feedback from eight stakeholder focus groups, until a final version was ready for evaluation in a clinical trial. Stakeholder contributions affirmed and enhanced the foundational theoretical principles and provided validation of the final product for the target population.

A mixed methods study of student perceptions of using standardized patients for learning and evaluation.

BACKGROUND: Educators recognize the value of using standardized patients (SPs) when teaching and evaluating clinical skills in rehabilitation entry-to-practice education programs but have published little supporting evidence and have yet to evaluate programmatic SP use from a student perspective. This study explored occupational and physical therapy students' perceptions of SP use in their professional education. METHODS: Recruiting current and graduated students, we conducted a two-phase mixed-methods sequential-explanatory study integrating data from a quantitative survey (phase 1) and qualitative focus groups with representative students (phase 2). Quantitative data were used to direct the second phase and informed selection of a purposive sample to participate in four focus groups (N=12). RESULTS: The 24-item online survey obtained a 32% response rate (N=167). Mean ratings were high, but significant differences were found between the four subsections of Teaching, SP Experience, Feedback, and Evaluation (P=0.000). Secondary analyses revealed significant differences based on sex, program, and age. Qualitative analysis revealed that students found SP use especially helpful earlier in their program to bridge classroom teaching and clinical practice. Students in the occupational and physical therapy programs approached SP interactions differently in terms of the authenticity, personal investment, and value of SP feedback. Educator feedback was perceived as reflective of technical skill, and SP feedback reflective of therapeutic value, which students prioritized differently. Students identified a preferential continuum of options for learning and practicing skills, ranging from peers and instructors through SPs to actual patients. CONCLUSION: SPs were perceived as most useful early on in the professional education program, serving to bolster self-confidence and prepare students for clinical fieldwork. Discipline-specific differences impact the perception of SP use and value. Educators need to be aware of pragmatic and contextual issues when using SPs for examination purposes, including repeated exposure to the same actor.

Feasibility of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) program: study protocol for a randomized controlled trial.

BACKGROUND: Many older adults rely on a manual wheelchair for mobility but typically receive little, if any, training on how to use their wheelchair effectively and independently. Standardized skill training is an effective intervention, but limited access to clinician trainers is a substantive barrier. Enhancing Participation in the Community by Improving Wheelchair Skills (EPIC Wheels) is a 1-month monitored home training program for improving mobility skills in older novice manual wheelchair users, integrating principles from andragogy and social cognitive theory. The purpose of this study is to determine whether feasibility indicators and primary clinical outcome measures of the EPIC Wheels program are sufficiently robust to justify conducting a subsequent multi-site randomized controlled trial. METHODS: A 2 × 2 factorial randomized controlled trial at two sites will compare improvement in wheelchair mobility skills between an EPIC Wheels treatment group and a computer-game control group, with additional wheelchair use introduced as a second factor. A total of 40 community-dwelling manual wheelchair users at least 55 years old and living in two Canadian metropolitan cities (n = 20 × 2) will be recruited. Feasibility indicators related to study process, resources, management, and treatment issues will be collected during data collection and at the end of the study period, and evaluated against proposed criteria. Clinical outcome measures will be collected at baseline (pre-randomization) and post-intervention. The primary clinical outcome measure is wheelchair skill capacity, as determined by the Wheelchair Skills Test, version 4.1. Secondary clinical outcome measures include wheelchair skill safety, satisfaction with performance, wheelchair confidence, life-space mobility, divided-attention, and health-related quality of life. DISCUSSION: The EPIC Wheels training program offers several innovative features. The convenient, portable, economical, and adaptable tablet-based, home program model for wheelchair skills training has great potential for clinical uptake and opportunity for future enhancements. Theory-driven design can foster learning and adherence for older adults. Establishing the feasibility of the study protocol and estimating effect size for the primary clinical outcome measure will be used to develop a multi-site randomized controlled trial to test the guiding hypotheses. TRIAL REGISTRATION: Clinical Trials NCT01740635.

Prevalence and facility level correlates of need for wheelchair seating assessment among long-term care residents.

BACKGROUND: Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care. OBJECTIVE: To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors. METHODS: Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy. RESULTS: The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6-64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (r(p) = -0.684, CI -0.143 to -0.910) was found. CONCLUSION: Prevalence of need for seating assessment in long-term care is high overall but it varies considerably between facilities. Increasing access to occupational therapy services appears to mediate this need.

Participation in community-based activities of daily living: comparison of a pushrim-activated, power-assisted wheelchair and a power wheelchair.

PURPOSE: The purpose of this study was to evaluate pushrim-activated, power-assisted wheelchair (PPW) performance among dual-users in their natural environment to determine whether the PPW would serve as a satisfactory alternative to a power wheelchair for community-based activities. METHODS: A concurrent mixed methods research design using a cross-over trial was used. The outcome measures used were number of hours reported using the different wheelchairs, Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), Functioning Everyday with a Wheelchair (FEW), Psychosocial Impact of Assistive Devices Scale (PIADS) and Canadian Occupational Performance Measure (COPM). RESULTS: The number of hours spent participating in self-identified activities was not significantly different. Only the Self-Esteem subscale of the PIADS identified a statistically significant difference between the PPW and power wheelchair conditions (p = 0.016). A clinically important difference for Performance and Satisfaction was suggested by the COPM, in favour of the power wheelchair. CONCLUSIONS: Additional knowledge was gained about the benefits of PPW technology. Participants were able to continue participating independently in their self-identified community activities using the PPW, and identified comparable ratings of satisfaction and performance with the PPW and the power wheelchair. For some individuals requiring power mobility, the PPW may provide an alternative to the power wheelchair.