Impact of a community-based peer-led eHealth wheelchair skills training program: A randomized control trial

Ed Giesbrecht; Krista L Best; William C Miller; François Routhier; Kara-Lyn Harrison; Julie Faieta; Maude Leberge

doi:10.1016/j.apmr.2024.12.011

Impact of a community-based peer-led eHealth wheelchair skills training program: A randomized control trial

Arch Phys Med Rehabil. 2024 Dec 19:S0003-9993(24)01408-4. doi: 10.1016/j.apmr.2024.12.011. Online ahead of print.

Authors

Ed Giesbrecht¹, Krista L Best², William C Miller³, François Routhier², Kara-Lyn Harrison⁴, Julie Faieta⁵, Maude Leberge⁶

Affiliations

¹ University of Manitoba, Rady Faculty of Health Sciences, College of Rehabilitation Sciences, Department of Occupational Therapy, Canada. Electronic address: ed.giesbrecht@umantioba.ca.
² Department of Rehabilitation, Université Laval, Quebec City, QC, Canada; Centre interdisciplinaire de recherche en readaptation et en integration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada.
³ Departent of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, BC Canada.
⁴ Applied Health Sciences, University of Manitoba in Winnipeg, MB.
⁵ Department of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
⁶ Département d'opérations et systèmes de decision, Université Laval, Quebec City, QC, Canada.

PMID: 39709023
DOI: 10.1016/j.apmr.2024.12.011

Abstract

Objective: To measure the effect of a community-based peer-led eHealth manual wheelchair (MWC) skills training program on community participation, wheelchair skills capacity and performance, wheelchair-specific self-efficacy, and health-related quality of life.

Design: Randomized control trial with wait-list control group.

Setting: Community.

Participants: Community-dwelling MWC users 18 year of age or older who propel using both arms (N=50).

Interventions: The 4-week MWC skills training intervention was comprised of three virtual sessions with a peer trainer and a self-directed eHealth home training app delivered via a computer tablet. Peer trainers were experienced MWC users who had received structured training for intervention delivery. Participants were provided with required equipment and encouraged to involve a care provider during home training. Peer trainers tailored the program to life activities participants identified as relevant. The control group were placed on a 4-week no intervention waitlist (reflecting typical clinical practice) and after post-intervention data collection were offered the training program.

Main outcome measure(s): The primary outcome was community participation measured by the Wheelchair Outcome Measure (WhOM). Secondary outcomes included skill capacity and performance on the Wheelchair Skills Test-Questionnaire (WST_Q), self-efficacy on the Wheelchair Use Confidence Scale (WUCS); and health-related quality of life on the Short-Form 36 Health Survey Enabled (SF-36E).

Results: The intention-to-treat (n=50) primary analysis revealed a statistically significant Time*Allocation interaction for community participation (mean p = 0.046 and η_p² = 0.09), increasing by 24%. Per-protocol (n=42) secondary analyses indicated significant improvements of 16.1% in the skill capacity (p=0.004), 11.4% in self-efficacy (p=0.017), and 7% relative improvement in quality of life (p=0.012).

Conclusion(s): The findings indicate that an eHealth MWC training program incorporating peer and tablet app training components was effective in improving community participation, skill capacity, self-efficacy, and quality of life for a wide range of MWC users. An eHealth delivery format offers considerable potential from both an access and resource perspective.

Keywords: Wheelchair; community; eHealth; peer-led; training.