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Effect of an mHealth wheelchair skills training program for older adults: a feasibility randomized controlled trial
Giesbrecht EM, Miller WC
Archives of Physical Medicine and Rehabilitation 2019 Nov;100(11):2159-2166
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the effect of an mHealth wheelchair skills training program on clinical outcomes among older adult manual wheelchair users. DESIGN: 2x2 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 = 0.03) and self-efficacy (p = 0.06) with large effect sizes (etap2 = 0.22 to 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.

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