UBC Theses and Dissertations
Development and feasibility evaluation of an mHealth intervention for manual wheelchair skills training with older adults Giesbrecht, Edward Mark
Many older adults rely on a manual wheelchair (MWC) for mobility but are not provided with skills for independent and effective use. Access to wheelchair skills training is constrained by the logistics, expense and limited availability of rehabilitation services. A supervised, home-based program specifically designed for older adults and delivered via a mobile computer tablet (mHealth) could potentially be a useful and efficient strategy to provide skills training. Purpose To explore the experience and needs of older adults transitioning to MWC use (Chapter 2); collaboratively develop, refine and pilot test an mHealth training program (Chapter 3); evaluate the program’s feasibility (Chapter 4); estimate impact on skill capacity and clinical outcomes (Chapter 5); and explore user-perceived benefits (Chapter 6). Methods Qualitative methods were used to understand the MWC transition experience. A mixed-methods Participatory Action Design and pre-post pilot trial were used for program development. A feasibility randomized controlled trial (RCT) assessed feasibility and clinical indicators, and follow-up interviews explored participants’ experiences. Results Older adult MWC users identified a lack of supports during transition to MWC use, particularly with skills training, often resulting in compromised community participation and increased care provider burden. The Participatory Action Design approach proved useful in constructing a viable prototype tablet-based home-training program that incorporated self-efficacy strategies and promoted principles of adult learning. In the feasibility RCT, the program was delivered safely and consistently, achieving most of the feasibility indicators; recruitment proved challenging but participants demonstrated good adherence with only one health-related dropout. There was a statistically significant difference and large effect size for measures of self-efficacy (p = 0.06; ηp² = 0.28) and performance of outdoor wheelchair activities (p = 0.02; ηp² = 0.40), but not for the primary outcome of skill capacity. Participants and care providers identified substantial clinical benefits in terms of confidence with wheelchair use, engagement in activities of life, and reduced care provider demands. Conclusions: The mHealth program shows promise as a potentially effective and appealing wheelchair skills training program for older adult MWC users. Future evaluation should enhance recruitment strategies, facilitating a larger RCT for more robust evaluation of clinical benefits.
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