Effect of an mHealth Wheelchair Skills Training Program for Older Adults: A Feasibility Randomized Controlled Trial

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 = .03) and self-efficacy (P = .06) with large effect sizes (eta(2)(p) = 0.22-0.29). 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. (C) 2019 by the American Congress of Rehabilitation Medicine