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Feasibility of a Systematic, Comprehensive, One-to-One Training (SCOOT) program for new scooter users:… Mortenson, W. B; Jang, Sharon; Goldsmith, Charlie H; Hurd Clarke, Laura; Hobson, Sandra; Emery, Richelle May 25, 2017

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STUDY PROTOCOL Open AccessFeasibility of a Systematic, Comprehensive,One-to-One Training (SCOOT) program fornew scooter users: study protocol for arandomized control trialW. Ben Mortenson1*, Sharon Jang2, Charlie H. Goldsmith3, Laura Hurd Clarke4,5, Sandra Hobson6and Richelle Emery7AbstractBackground: Mobility scooters can facilitate community participation among individuals with mobility limitations.However, accidents are a serious concern with scooter use. Scooter training has been recommended to improvesafety, but there are currently few validated programs available. Therefore, we developed a Systematic, Comprehensive,One-to-One Training (SCOOT) program for scooter users. We will conduct a study to evaluate the outcomes producedby the provision SCOOT.Methods: This feasibility study will use a mixed-methods, rater-blinded, randomized control trial, with a two-stepwedge design. The study has two arms: an immediate intervention group, which will receive the interventiondirectly after baseline assessments, and a delayed intervention group, which will receive the intervention after a6-week period. Forty participants, who will be stratified based on whether or not participants have previouslyheld a driver’s license, will be randomly assigned to each arm. The intervention for this study consists of 6 weeksof one-to-one scooter training by an experienced occupational therapist, who will provide training once or twiceper week over the 6 weeks. The primary outcome measure is subjective scooter skills, measured using the WheelchairSkills Test for scooters. Secondary outcomes include objective scooter skills, confidence, mobility, and satisfaction withselected participation activities. Descriptive measures include cognitive status, functional status, hearing, vision, physicalaccessibility of the home and community, and visual attention and task switching. Qualitative interviews willbe conducted with the first ten willing participants from each group to learn about their scooter use andexperiences with SCOOT.Discussion: The results of this study will inform a larger randomized control trial. If the intervention is provento be effective in this larger study, it may have important implications for policy and practice.Trial registration: ClinicalTrials.gov identifier: NCT02696213. Registered on 23 February 2016.Keywords: Scooter, Training, Randomized control trial, Learning* Correspondence: ben.mortenson@ubc.ca1The Department of Occupational Science and Occupational Therapy,University of British Columbia, T-325-2211 Wesbrook Mall, Vancouver, BC V6T2B5, CanadaFull list of author information is available at the end of the article© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Mortenson et al. Trials  (2017) 18:235 DOI 10.1186/s13063-017-1963-yBackgroundMany people have disabilities that necessitate the use ofpowered mobility devices. Mobility scooters (i.e., threeor four wheeled devices controlled by a tiller) may bepreferred over power wheelchairs, as they are generallymore affordable and perceived as less stigmatizing [1, 2].Although the prevalence of scooter use has been in-creasing in North America [3, 4], scooter use appears tovary considerably in different countries. For example, itwas estimated that 0.3% of Canadians used a scooter [4],whereas in Australia this figure was 1% [5].Scooters, like many mobility devices, may be a mixedblessing [1]. Several studies have found that theprovision of a mobility scooter is positively associatedwith feelings of independence, higher frequency of dailyactivities, and increased social participation [6–9]. How-ever, scooter-related accidents (e.g., falls, collisions withstationary and moving objects) are a concern, as theycan cause serious, sometimes fatal injuries to users andothers [10, 11]. A wide spectrum of injury rates havebeen reported for scooter users (e.g., from 1.54 [12] to15 [5] injuries per person per year). Similarly, a varietyof accident rates have been reported for power wheel-chair users (e.g., 5–18% of community dwelling usersexperience accidents each year [13]). To improve safety,scooter training has been recommended [14], whichcould include advanced skills such as navigating curbsand uneven surfaces, accessing public transit and eleva-tors, and avoiding obstacles [15].There are a variety of potential benefits of wheeledmobility skills training but few users report receivingformal training. Manual wheelchair training has beenfound to improve skills [13] and increase confidence[16]. However, most scooter users receive very littletraining, which may be attributed to limited accessibility.Two surveys found that a quarter of scooter users re-ceived training [5, 15]. Although there appears to begreat variability in terms of the training provided [15],training appears to focus on rudimentary skills (e.g.,basic operating skills, driving indoors and outdoors,transferring on and off the scooter), rather than moreadvanced skills such as crossing streets or using trans-portation [15].Research on the efficacy of scooter training is limited.In a scoping review conducted by Mortenson and Kim[17], two small scale, randomized control trials (RCTs)were identified. One trial found that 3D virtual realitytraining in combination with conventional training pro-duced similar improvements in scooter skills as conven-tional training alone. The second study found thatscooter skills improved significantly with meta-cognitivetraining combined with on-road driving practice, com-pared to computerized cognitive training alone [18].However, the validity of these findings are threatened bytheir small sample sizes, lack of non-intervention controlarms, and use of non-validated outcome measures [17],such as the study-specific functional evaluation ratingscale used in the study by Jannink et al. [19].To improve the mobility and social participation ofscooter users and to decrease safety concerns, we createda community-based training program built on the Wheel-chair Skills Training Program [20] and feedback fromVancouver Coastal Health scooter prescribers, called Sys-tematic, Comprehensive, One-to-One, Training (SCOOT)for scooters. We are conducting a study to explore thefeasibility of a mixed-methods RCT, which will evaluatethe efficacy of this intervention. Based on the typology offeasibility research [21], this study will focus on processassessment (i.e., recruitment rate, retention rate, treatmentfidelity, adherence rate, suitability of the eligibility criteriaand measures, and respondent burden) and on scientificassessment (i.e., safety of the intervention, reliability andvalidity of the measures with this population, estimates ofthe effect of the intervention and variances of the effects).HypothesisWe anticipate that the feasibility outcomes will supporta subsequent multi-site trial. We expect that our recruit-ment targets will be met, that > 90% treatment, > 80%adherence, and > 80% retentions will be obtained, thatSCOOT will be as safe as non-intervention, and thatparticipants will provide complete responses to > 90% ofitems from all measures.ObjectivesQuantitative objectiveTo evaluate the outcomes produced by the provision ofa comprehensive program of scooter training amongolder adults.Qualitative objectivesTo explore how this intervention is experienced by re-cipients and trainers and to understand how the inter-vention was implemented in context.MethodsStudy designTo conduct this exploratory, mixed-method, rater-blinded RCT, a two-step wedge design will be used, asillustrated in Fig. 1. With a step-wedge design, partici-pants are randomly assigned to receive the same inter-vention at different times [22]. For this study, a total of40 participants, stratified based on whether or not theyhave previously held an automobile driver’s license, willbe randomly assigned to either the immediate interven-tion group or the delayed intervention group. As illus-trated in Fig. 1, the immediate intervention group willreceive the intervention after consent and baseline dataMortenson et al. Trials  (2017) 18:235 Page 2 of 9have been collected, while the delayed group will receivethe intervention after a 6-week delay. The primary end-point of this study is at 6 weeks, so we can compare theeffects of the intervention with the group who has yet toreceive it.RandomizationThe allocation of each participant will be communicatedto the study research coordinator after baseline data andconsent have been obtained. The allocations will bemanaged by the study statistician using an auditablecomputer program and a 1:1 allocation ratio within eachstratum. Blocking sizes will not be revealed until neededfor analysis.EthicsEthical approval for this study has been provided by theUniversity of British Columbia (H15-09121) and by theVancouver Coastal Health Authority (V15-09121). Thisstudy was funded through a grant from the CanadianInstitute of Health Research (340545). This protocolpaper has been written in accordance with the SPIRIT(Standard Protocol Items: Recommendations for Inter-ventional Trials) guidelines (Additional file 1) [23]. Anymodification of important protocol will be made throughan ethics amendment with the institutional review boardprior to implementing the given change.ParticipantsFor this feasibility study we plan to recruit 40 partici-pants. As the majority of wheeled mobility users areolder adults [4], the eligible community dwelling partici-pants for this study are (1) English-speaking adults, (2)aged ≥ 60 years, (3) have one month or less combinedexperience of using a scooter within the past year, and(4) are able to independently transfer in and out of ascooter. We have not defined the population of interestbased on their diagnoses (e.g., stroke, spinal cord injury,Parkinson’s disease), because the use of a scooter is notdiagnosis specific. Individuals who have cognitiveFig. 1 SPIRIT figure. II Immediate Intervention, DI Delayed Intervention, WST Wheelchair Skills Test for Scooters, WST-Q Wheelchair SkillsTest – Questionnaire for Scooters, WheelCon Wheelchair Use Confidence Scale, WhOM Wheelchair Outcome Measure, LSA Life SpaceAssessment, SUID Scooter Use Incidents Diary, SPAQ Scooter Physical Accessibility Questionnaire, MoCA Montreal Cognitive Assessment,HHIE Hearing Handicap Inventory for the Elderly, LLDI Late Life Disability IndexMortenson et al. Trials  (2017) 18:235 Page 3 of 9impairments that will prevent them from providingconsent and from reliably completing the study ques-tionnaires, reside in a nursing home, or plan to moveoutside the study intervention delivery area within thenext year will be excluded.Participants will be recruited through a variety ofsources, including community healthcare units, vendors,and various seniors’ groups and seniors’ centres. Partici-pants will be recruited through these organizations viaposters, presentations, social media, and referrals. Occu-pational therapy staff and vendors will invite eligibleclients to consider the trial.ProcedureThe research coordinator and principal investigator willtrain raters to administer all study measures. This trai-ning will include review of manuals, observations of pre-recorded mock interviews and assessments with practicescoring, practice administration with other research staffwith feedback provided, and video recording of practiceadministration for self-reflection.Upon enrolment, participants will be provided with aunique ID number, and the researcher will obtain writ-ten consent prior to baseline testing with all participants.The immediate intervention group will receive SCOOTafter their baseline testing once or twice per week over a6-week period (varying from 9 to 18 hours total), whilethe delayed intervention group will receive SCOOT6 weeks after baseline testing. Upon completion of theintervention, all participants will be re-assessed at 6, 12,26, and 52 weeks after randomization. Participants willalso be asked not to participate in any additional traininguntil 12 weeks have elapsed. The intervention will bediscontinued upon the participant’s request, or if theyare unable to continue with the research due to unfore-seen events (e.g., illness).Measures will be administered in a random order toreduce order effects. All measures, except the Wheel-chair Outcome Measure (WhOM), will be collected by ablinded research assistant. The WhOM will be admi-nistered by the study therapist as this will inform theintervention. During training sessions, the therapist de-livering the intervention will record any adverse effectsof the intervention such as falls. As suggested by Littleet al. [24], to reduce missing data, we will stress, duringthe consent process and whenever there is contact be-tween participants and study personnel, the importanceof collecting measurement data for the duration ofthe study, especially for those who discontinue theintervention.Experimental interventionSCOOT is a community-based, client-centered interven-tion that embeds skills training into social activities thatusers want to accomplish. It also uses trainer-facilitatedproblem solving to identify strategies to manage envi-ronmental barriers and to enable better user social par-ticipation. This intervention represents a departure fromcustomary scooter training that is often very limited andwhich focuses on learning discrete skills outside of theuser’s normal environment. With SCOOT, skill training(i.e., on driving, basic and advanced scooter skills) willtake place during self-selected, home- or community-based activities that participants want to perform usingtheir scooters. We will identify these activities using theWhOM [21], which identifies the most importanthome- and community-based activities participantswish to perform using their scooters (described below).The skills training component of the intervention isbased on the scooter version of the Wheelchair SkillsTraining program [20].The intervention will be held in the neighborhood ofthe participants, located in the Greater Vancouver RegionsDistrict of British Columbia, Canada. The intention ofconducting the study within the neighborhood of the par-ticipant is to facilitate the transferability of training and toimprove the ecological validity. In addition, training in thecommunity aims to reduce participant burden of travellingto our research site, and to improve adherence. Theseneighborhoods are all located within an urban setting, andlocations include, but are not limited to, community cen-ters, grocery stores, and parks.SCOOT for scooter mobility skills will be provided byoccupational therapist trainers who will be trained bythe principal investigator to use the same standardizedapproach. The therapist will keep a record of the skillsthat they have taught and hours of training provided.During training sessions, the therapist delivering theintervention will record any adverse effects of the inter-vention such as falls. We will collect data on the numberof therapist visits, length of visits, therapist years ofpractice, years of experience working in this area, andtherapist qualifications.Outcome measuresPrimary outcome measure (subjective skill capacity)The subjective version of Kirby et al.’s Wheelchair SkillsTest [20] for scooters incorporates three domains ofskills training, namely skill capacity, confidence, and per-formance. For this study, the primary outcome measurewill be perceived capacity. It consists of 29 items thatare scored by the participant from 0 to 2, where 0 = un-safe or unable, 1 = safe with difficulty, and 2 = safe with-out difficulty; a percent score is calculated by dividingthe total score by the number of applicable items andmultiplying that number by 100. The measure assessesbasic indoor mobility skills (driving forward and back-wards), transfers on and off the scooter, and outdoorMortenson et al. Trials  (2017) 18:235 Page 4 of 9driving skills, including maneuvering, curbs, and ramps.The intraclass correlation coefficient (ICC) for 2-weektest-retest reliability of the Wheelchair Skills Test amongpower wheelchair users is 0.78 (95% confidence interval,0.68–0.86) [25]. As scooters and power wheelchairs areboth motorized mobility devices, a similar reliabilityamong scooter users is expected.Secondary outcomes (body structure and function andactivity and participation levels)Objective scooter skills Objective scooter skills will bemeasured using Kirby et al.’s Wheelchair Skills Test [20].The test consists of 29 rater administered items thatinclude operating the scooter and indoor and outdoorscooter skills, similar to the subjective version. The ICCfor the test-retest reliability of the objective version ofthe measure among 20 experienced scooter users is 0.90(95% confidence interval, 0.74–0.95) [26].Satisfaction with participation in selected activitiesThe WhOM is a participant-specific tool that evaluatessatisfaction with participant-identified home and com-munity activities associated with wheeled-mobilityprovision using an 11-point scale (0 = completely unsatis-fied to 10 = completely satisfied) [21]. A mean satisfactionscore is calculated by dividing the sum of all satisfactionscores by the number of goals. The WhOM demonstratespromising psychometric properties among community-dwelling, power-mobility users with good 2-week test-retest reliability (ICC = 0.91 for the mean satisfactionscore) [27] and moderate correlations with other measuresof social participation and device satisfaction [28].Mobility The Life Space Assessment [29] is a self-reportmeasure of participants’ frequency and independence ofmobility in increasingly larger life spaces (e.g., withintheir (1) home, (2) yard, (3) neighborhood, (4) city ortown, and (5) beyond) over the past month. Frequency ismeasured on a four-point scale: 1 = less than once perweek; 2 = 1–3 times per week; 3 = 4–6 times per week;and 4 = daily. Independence is measured on a three-pointscale (1 = personal assistance required; 1.5 = assistivedevice used; 2 = independent). A total composite life-space score, which varies from 0 to 120, can be calculatedby multiplying the frequency by the independence by theweighting for each life space (1–5) and adding thesetogether. Among power-mobility users (scooter andpower-wheelchair users), the 2-week test-retest reliabilityis high for the composite score (ICC = 0.87) [30]. Life-space mobility has been found to be significantly higherfor those who have had their power-mobility devices forsix months or longer [31].Scooter skills confidence in the social environmentWe will use the shortened version of the social environ-ment scale of the Wheelchair Use Confidence Scale formanual wheelchair users [32] that was developed bySakakibara [33] to assess scooter users’ confidence ne-gotiating their social milieu. For this study the wordwheelchair was replaced with scooter. The scale usesan 11-point scale (0 = not confident to 10 = completelyconfident) and a total mean score between 0 and 100can be calculated by finding the sum of the scores ofeach item.Scooter use and incidents Participants will be asked tokeep a diary of any scooter-related adverse events,including the following: tips or falls from the scooter,injuries to self, accidental contact with others, injuries toothers, and damage to property. Participants will beasked to record the number of hours per day that theyuse their scooters over the course of the study.Descriptive measures and covariates (body function, health,environmental, and personal factors)Descriptive data will be collected that includes participants’socio-demographic characteristics (age, sex, income levelof education, ethnic origin, language, marital status, type ofdwelling, diagnoses, duration of functional problems,previous experience driving vehicle(s), and amount of for-mal care-giving received, if any). Although randomizationshould control for differences between the treatmentgroups, we will collect data on the following constructsthat could affect scooter-user outcomes and which willprovide additional descriptive information. The data thenmay be used as covariates, if there are important diffe-rences between the groups at baseline.Cognitive status The Montreal Cognitive Assessment[34], a widely used, cognitive test with high test-retestreliability (r = 0.92), has a better ability to detect mildcognitive impairment than the Mini-mental Status Exam[35]. Scores on the test vary from 0–30, where scores of26 or above are considered normal.Functional status The activity-limitation domain of theLate Life Functioning and Disability Measure-ComputerAssisted Testing (Version 1.04) (LLFDI-CAT) [36] willbe used to measure the participant’s self-perceived, phy-sical function. Drawing from a bank of 141 items, CATcontinues until a standard error of 3 or less is obtainedfor the domain score, or a maximum of 10 items hasbeen administered. The activity-limitation domain de-monstrated high test-retest reliability (r = 0.85) among asample of 102 community-dwelling older adults; it wasmoderately correlated (r = 0.72) with the physical com-ponent summary score of the Veteran’s Rand-36 [37].Mortenson et al. Trials  (2017) 18:235 Page 5 of 9The activity-limitation domain has two sub-scales: (1)basic mobility and handling and (2) daily activities. Stan-dardized scores vary from 0 to 100, where the meanscore is 50 and lower scores are indicative of greaterlimitation.Hearing We will use the Hearing Handicap Inventoryfor the Elderly Screening Version to measure hearingdisability [38]. It is a 10-item self-report questionnaire.Scores vary from 0 to 40, and scores above 26 suggestan important hearing handicap. Its psychometric proper-ties have been demonstrated across multiple studies [39].Scooter characteristics We will collect detailed infor-mation about the participant’s scooters including thenumber of wheels, smallest turning radius, size of wheels,length, width, and clearance.Scooter physical accessibility of participant homeand community This will be measured by using 14 di-chotomous (yes/no) questions, where no is scored as a0 and yes is scored as a 1. Questions were derived inpart from those asked in a study about environmentalaccessibility factors related to wheelchair use [40] andthe Usability Scale for Assistive Technology-WheeledMobility version [41]. Higher scores indicate greateraccessibility, which may facilitate increased mobilityand social participation.Visual attention and task switching Trail Making B[42] will be used to measure visual attention and taskswitching. For this measure, the time required to drawlines between a sequential pattern of numbers andletters is recorded. The measure demonstrates high test-retest reliability (r = 0.95) [43]. Scores on the measureare predictive of on-road automobile driving perfor-mance [43].Visual acuity The Snellen eye chart [44] will be used tomeasure visual acuity. We will convert Snellen scores tothe Logarithm of the Minimum Angle of Resolution(LogMAR) by taking the negative log of the Snellenscore in decimal form [45], as LogMAR is recommendedfor statistical analyses [46]. LogMAR is based on a loga-rithmic scale (from 0 to 1), where 1 is indicative of per-fect vision.Qualitative methodsInterviews will be conducted (1) at baseline prior toscooter training, (2) at 6 weeks, (3) at 6 months, and (4)at the end of the study. The initial interviews will focuson how participants currently use their scooters and theconcerns they have, the second interviews will focus onhow the intervention was experienced, and the finalinterviews will focus on longer-term outcomes of scooteruse. We will interview the first ten interested partici-pants in each group. Additional participants will be se-lected purposefully, depending on the analysis of thedata from these first participants. These participants willbe selected to elucidate themes emerging from the datafrom the first participants, and to understand negativecases better. For example, if one participant reacts nega-tively to the intervention, we will interview additionalparticipants with similar demographic profiles.AnalysisQuantitative dataData will be input into a password protected documentand will be double checked for accuracy. Descriptive sta-tistics (e.g., means, frequencies, proportions, standarddeviations) and distributions and box plots will be usedto display all study data. The percentage of skills taughtwill be calculated to determine the treatment fidelity,and the percentage of sessions attended will be calculatedto determine adherence. These quantitative data will besupplemented with data from the qualitative portion ofthe study. We will explore the use of multiple imputationfor missing outcome measure data [47]. A detailed sta-tistical analysis plan to handle various statistical analysisissues will be created [48]. To identify covariates that willbe controlled for in the larger study, we will identify fac-tors that are strongly related to the primary and secondaryoutcome measures. To determine the effect size for theprimary and non-count secondary outcome measures, wewill perform various models, controlling for baselinescores, using an intention-to-treat analysis. That is, all par-ticipants will be included in the group to which they wereallocated for purposes of analysis, whether or not theycompleted the intervention for that group. As this is afeasibility study, we will also calculate effect sizes based onthe intervention received (e.g., on an as-treated basis).Using G*Power 3.1.0, this sample size should give us theability to detect a large effect size of 0.46 (with α = 0.05and power = 80%). For count data (e.g., use, accidents, andfalls), we will determine the effect size by using Poissonregression [49].Qualitative dataAudio files will be transcribed verbatim and will beanonymized by replacing any proper nouns with pseudo-nyms to protect the identity of the participants. Basedon the process outlined by Thorne et al. [50, 51], we willread and re-read the data to identify key concepts basedon recurring, converging, and contradictory patterns. Inaddition, themes and illustrative examples will be identi-fied during this process. We will develop broad catego-ries to organize and inductively code the raw data.Codes within and across participants will be developedMortenson et al. Trials  (2017) 18:235 Page 6 of 9through this iterative. Example codes will be comparedbetween interview transcripts. Any “negative cases” thatdo not fit with conceptual understandings of the datawill be explored to develop explanations for the ob-served variability. Ultimately, codes will be grouped intorelevant themes and organized in a manner that isintended to promote understanding of how the SCOOTintervention was experienced, to contextualize under-standings about how the intervention is implemented,and to determine how SCOOT affected participants.DiscussionAlthough mobility training is generally thought to en-hance users’ skills, daily activities, and social participa-tion, there is little research evidence to support theseassumptions [20]. We expect that the feasibility out-comes will be strong enough to support the conductingof a subsequent multi-site trial with a sufficient samplesize to enable us to quantify definitive outcomes such asadverse events (e.g., injuries and abandonment). Further-more, this feasibility study will inform research that canproduce credible new knowledge describing multipleoutcomes that users experience following SCOOT. Itwill also lay the groundwork for additional studies thatexamine the cost-effectiveness of this intervention andattempt to identify more economical ways of deliveringthis training, such as by peer mentoring, telehealth, ordigital media.If SCOOT is shown to be effective, it may have import-ant practice and policy implications. It will enable serviceproviders to offer evidenced-based scooter training for thefirst time. Policymakers can be approached to lobby forchanges in the ways that scooter training is provided andfunded. We will relay these findings to policymakersthrough our institutional collaborators. Additionally, wewill submit manuscripts describing this work to high-impact, peer-reviewed journals and give presentations atinternational and national conferences. Furthermore, re-sults will be shared with collaborating health organizationsvia in-services and workshops with staff, and by publishinga lay summary of the findings in organizational newslet-ters. Most importantly, by improving safety, decreasinginjuries, preventing fatalities, and enabling social partici-pation, it is anticipated that the SCOOT will have apowerful effect on the physical and mental health andquality of life of Canadians who rely on these devices andthat of their families.As a feasibility study for a RCT, the research has se-veral limitations. First, given the single-site nature of thisresearch, new feasibility issues may arise in attemptingto apply the results to additional sites; however, findingsfrom our feasibility study should be able to help usanticipate many of these problems so that they can beaddressed proactively. Secondly, the size of the currentsample only allows for the detection of large effect sizes.Larger samples may be required to detect smaller effectsizes, which may occur with important secondary out-comes such as accidents and injuries.In summary, given the limited research on scootertraining, this feasibility study is needed to lay thegroundwork for a larger RCT to evaluate whether ournovel, community-based intervention improves mobility,social participation, and safety. If the results of this lar-ger experimental study are positive, we will performadditional research evaluating the best way to deliverthis intervention, e.g., mentorship or online training.Economic studies can be performed to conduct a cost-benefit analysis of the intervention in the future.Trial statusThis trial is currently actively recruiting for participants.Additional fileAdditional file 1: SPIRIT 2013 Checklist: Recommended items to addressin a clinical trial protocol and related documents*. (DOC 120 kb)AbbreviationsICC: intraclass correlation coefficient; LogMAR: logarithm of the minimumangle of resolution; RCT: randomized control trial; SCOOT: Systematic,Comprehensive, One-to-One Training for scooters; WhOM: WheelchairOutcome MeasureAcknowledgementsNot applicable.FundingThis study is funded by the Canadian Institute of Health Research (340545).Availability of data and materialsNot applicable.Authors’ contributionsWBM, LHC, CHG, SJ, SH, and RE all contributed to the design of the study.CHG was responsible for the quantitative statistical analysis methodology,while LHC and WBM were responsible for the qualitative analysis methodology.SJ and WBM drafted the manuscript, and all authors were involved with thefinal approval of the version to be published. All study investigators will haveaccess to the final data set. There are no contractual agreements that limitaccess for investigators.Competing interestsThe authors declare that they have no competing interests.Consent for publicationNot applicable.Ethics approval and consent to participateEthics approval has been obtained through the Vancouver Coastal HealthAuthority (V15-09121) and the University of British Columbia (H15-09121).This study has been registered at clinicaltrials.gov (NCT02696213). Writtenconsent will be obtained from the participants during the baseline measurement,prior to any testing.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in publishedmaps and institutional affiliations.Mortenson et al. Trials  (2017) 18:235 Page 7 of 9Author details1The Department of Occupational Science and Occupational Therapy,University of British Columbia, T-325-2211 Wesbrook Mall, Vancouver, BC V6T2B5, Canada. 2GF Strong Rehabilitation Center, 4255 Laurel Street, Vancouver,BC V5Z 2G9, Canada. 3Mary Pack Arthritis Center, 895 West 10th Ave.,Vancouver, BC V5Z 1L7, Canada. 4University of British Columbia, 1924 WestMall, Vancouver, BC V6T 1Z2, Canada. 5School of Kinesiology, University ofBritish Columbia, 1156-1924 West Mall, Vancouver, BC V6T 1Z2, Canada.6University of Western Ontario, 1201 Western Road, London, ONT N6G 1H1,Canada. 7Vancouver Coastal Health – Community Care, 520 West 6thAvenue, Vancouver, BC V5Z 1A1, Canada.Received: 12 January 2017 Accepted: 2 May 2017References1. Mortenson WB, Miller WC, Boily J, Steele B, Odell L, Crawford EM, DesharnaisG. Perceptions of power mobility use and safety within residential facilities.Can J Occup Ther. 2005;72:142–52.2. Mortenson WB, Miller WC. 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Int J Qual Methods. 2004;3(1):1–11.•  We accept pre-submission inquiries •  Our selector tool helps you to find the most relevant journal•  We provide round the clock customer support •  Convenient online submission•  Thorough peer review•  Inclusion in PubMed and all major indexing services •  Maximum visibility for your researchSubmit your manuscript atwww.biomedcentral.com/submitSubmit your next manuscript to BioMed Central and we will help you at every step:Mortenson et al. Trials  (2017) 18:235 Page 9 of 9

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