Effect of a Community-Based Peer-Led eHealth Wheelchair Skills Training Program: A Randomized Control Trial.

Abstract

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. Randomized control trial with wait-list control group. Community. Community-dwelling MWC users aged 18 years or older who propel using both arms (N=50). The 4-week MWC skills training intervention was comprised of 3 virtual sessions with a peer trainer and a self-directed eHealth home training application 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 wait-list (reflecting typical clinical practice) and after postintervention data collection were offered the training program. The primary outcome was community participation measured by the Wheelchair Outcome Measure. Secondary outcomes included skill capacity and performance on the Wheelchair Skills Test-Questionnaire, self-efficacy on the Wheelchair Use Confidence Scale, and health-related quality of life on the Short-Form 36 Health Survey Enabled. The intention-to-treat (n=50) primary analysis revealed a statistically significant Time*Allocation interaction for community participation (mean P=.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=.004), 11.4% in self-efficacy (P=.017), and 7% relative improvement in quality of life (P=.012). The findings indicate that an eHealth MWC training program incorporating peer and tablet application 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.