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

Abstract

BackgroundProviding 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.MethodsA 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.ResultsEighteen 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.DiscussionOverall, 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.

Telehealth interventions in occupational therapy with older adults: Results from a scoping review targeting better health promotion

“…In the present review, most studies failed to characterise the occupational therapists' work environment, which is crucial for a better understanding of the therapies, including technological availability (Ali et al, 2021;Boehm et al, 2015;Breeden, 2016;Choi & Paik, 2018;Giesbrecht & Miller, 2017;Guidetti et al, 2020;Hansen et al, 2020;Hutchinson et al, 2018;Kringle et al, 2020;F. H. Lai et al, 2020;Laver et al, 2020;Nalder et al, 2018;Serwe et al, 2017;Simonÿ et al, 2019).…”

“…In the present review, most studies failed to characterise the occupational therapists' work environment, which is crucial for a better understanding of the therapies, including technological availability (Ali et al, 2021; Boehm et al, 2015; Breeden, 2016; Choi & Paik, 2018; Giesbrecht & Miller, 2017; Guidetti et al, 2020; Hansen et al, 2020; Hutchinson et al, 2018; Kringle et al, 2020; F. H. Lai et al, 2020; Laver et al, 2020; Nalder et al, 2018; Serwe et al, 2017; Simonÿ et al, 2019). For instance, access to certain platforms or websites may be refused due to the hospital's internet network security procedures required by the laws and policies of the health system organisation (Almathami et al, 2020; Edwards & Patel, 2003; Finkelstein et al, 2006).…”

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

“…Among all people with a disability, wheelchair users are more likely to experience home accessibility issues, require assistance with more activities of daily living on a more frequent basis, and have greater out-of-pocket expenses to obtain assistance [ 4 ]. In Canada, over 95% of MWC users required caregiver assistance with at least one major life activity including 37% for basic mobility [ 4 ]. Restricted mobility is associated with reduced participation and social connectedness [ 5 ], leading to isolation, stress and low self-esteem impacting quality of life [ 6 ].…”

“…Two strategies have demonstrated potential to address these barriers and support equitable care for new MWC users: delivery in the community via eHealth and use of peer trainers. A tablet-based MWC skills home training program, administered and monitored by an occupational therapist, was shown to be feasible and effective, and perceived as highly beneficial among middle and older aged MWC users [ 4 ]. In a randomized controlled trial, statistically significant improvements in participation, wheelchair self-efficacy and skill safety were reported, with large effect sizes [ 24 ].…”

Occupational Therapy, Self-Efficacy, Well-Being in Older Adults Living in Residential Care Facilities: A Randomized Clinical Trial

“…Furthermore, they found a positive relationship between optimism and social, leisure and free-time activities. Social cognitive theory defends self-efficacy as an influence on successful performance, as well as the observation of success in other people, making the stimulus very valuable and whose appropriate interpretation can suppose a positive experience ( Giesbrecht and Miller, 2017 ).…”