Impact of a community-based peer-led eHealth wheelchair skills training program: A randomized control trial.

Abstract

Objective: To measure the effect of a community-based peer-led eHealth manual wheelchair (MWC) skills training program on community participation, wheelchair skills capacity and performance, wheelchair-specific self-efficacy, and health-related quality of life.

Design: Randomized control trial with wait-list control group.

Setting: Community.

Participants: Community-dwelling MWC users 18 year of age or older who propel using both arms (N=50).

Interventions: The 4-week MWC skills training intervention was comprised of three virtual sessions with a peer trainer and a self-directed eHealth home training app delivered via a computer tablet. Peer trainers were experienced MWC users who had received structured training for intervention delivery. Participants were provided with required equipment and encouraged to involve a care provider during home training. Peer trainers tailored the program to life activities participants identified as relevant. The control group were placed on a 4-week no intervention waitlist (reflecting typical clinical practice) and after post-intervention data collection were offered the training program.

Main outcome measure(s): The primary outcome was community participation measured by the Wheelchair Outcome Measure (WhOM). Secondary outcomes included skill capacity and performance on the Wheelchair Skills Test-Questionnaire (WST_Q), self-efficacy on the Wheelchair Use Confidence Scale (WUCS); and health-related quality of life on the Short-Form 36 Health Survey Enabled (SF-36E).

Results: The intention-to-treat (n=50) primary analysis revealed a statistically significant Time*Allocation interaction for community participation (mean p = 0.046 and η_p² = 0.09), increasing by 24%. Per-protocol (n=42) secondary analyses indicated significant improvements of 16.1% in the skill capacity (p=0.004), 11.4% in self-efficacy (p=0.017), and 7% relative improvement in quality of life (p=0.012).

Conclusion(s): The findings indicate that an eHealth MWC training program incorporating peer and tablet app training components was effective in improving community participation, skill capacity, self-efficacy, and quality of life for a wide range of MWC users. An eHealth delivery format offers considerable potential from both an access and resource perspective.