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UBC Theses and Dissertations

Manual wheelchair users : understanding participation and skill development. Best, Krista Lynn


Wheelchair skills, required for manual wheelchair (MWC) use, are strongly associated with independent mobility, physical activity, and participation. Training can improve mobility and participation in meaningful activities for MWC users, but strategies are required to enhance skill development. Peer-led self-efficacy interventions have been effective at enhancing skills in other clinical areas, and present a novel approach to MWC training that may enhance use. Purpose: develop an understanding of MWC use and current MWC training education and practices, and to explore and evaluate a novel approach to improving MWC use. Methods: secondary analysis of a national survey to determine physical activity levels in older wheelchair users; surveys of rehabilitation centres and universities to describe MWC training practices and curriculum; systematic review and meta-analyses to evaluate the effect of peer-led interventions on physical activity and self-efficacy; and a pilot randomized controlled trial to evaluate a peer-led MWC training program for improving wheelchair self-efficacy and wheelchair use. Results: Only 8% and 41% of older wheelchair users participated in physical and leisure activity, and wheelchair use was found to be a primary risk factor for low levels of participation. A description of current MWC training in practice showed that 78% of clinicians provided basic MWC mobility training, but only 12% taught the advanced skills needed to achieve optimal community participation. Nearly 80% of entry-to-practice programs included MWC skills training in curriculum; however, only 38% used a validated training program. In a broad review, self-efficacy interventions had a small effect on physical activity (Cohen’s d = 0.2) and self-management self-efficacy (Cohen’s d =0.2). Peer-led MWC training had a large effect on wheelchair use self-efficacy (Cohen’s d =0.8), wheelchair skills capacity (Cohen’s d =0.7) and satisfaction with participation (Cohen’s d = 0.7), and no effect on wheelchair skills performance or life-space mobility. Conclusion: wheelchair use increases risk of physical inactivity. This may be related to wheelchair skills training, which currently relies on clinicians. Self-efficacy enhanced interventions can promote behaviour change. Peer-led MWC training may augment existing training, enhance self-efficacy and promote increased MWC use, which may elicit health benefits that are associated with physical activity.

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