Efficacy of the Wheelchair Skills Training Program for Improving Confidence With Using a Manual Wheelchair in Younger and Older Able-bodied Adults: A Pilot RCT

Background and Rationale: Mobility impairment is one of the main correlates of decreased levels of participation in daily and social activities. Mobility disability is often remediable through the use of assistive technology, of which the wheelchair is arguably the most widely used and recognizable form. Statistics suggest over 250,000 Canadians use wheelchairs, the majority of whom are older adults.

Mobility impairment often has psychological consequences that may independently restrict functioning and participation. Confidence is one such consequence, and according to Bandura's Social Cognitive Theory, is the belief individuals have in their ability to perform behaviours to achieve desired outcomes. Furthermore, previous findings have accounted for no more than 40% of the variance of factors influencing wheelchair mobility and participation. It is likely that confidence in wheelchair use may account for some of that variance. Recent findings show that approximately 40% of wheelchair users report having low confidence.

Because confidence is client-specific and modifiable, treatment strategies to address low confidence in using a wheelchair may lead to greater participation among older adults.

Purpose: The overall goal of this research project is to evaluate the efficacy of the Wheelchair Skills Training Program on confidence with using a manual wheelchair in a group of non-wheelchair users.

Objectives:

1. Evaluate the efficacy of the Wheelchair Skills Training Program on improving confidence with using a manual wheelchair.
2. Evaluate the efficacy of the Wheelchair Skills Training Program on improving wheelchair performance.
3. Explore the immediate effect of exposure to wheelchair skills (an outcome measure) on confidence using a manual wheelchair.

Hypotheses:

1. Participants who take part in the Wheelchair Skills Training Program will have significant improvements in confidence with using a manual wheelchair compared with those in the control group, as measured by the Wheelchair Use Confidence Scale (WheelCon)
2. Participants who receive the Wheelchair Skills Training Program will have significant improvements in wheelchair performance compared to the control group, as measured by the Wheelchair Skills Test (WST).
3. All participants will have significant improvements in confidence using a manual wheelchair after exposure to wheelchair skills (during baseline assessment).

Research Method: This study will use 2 concurrent Randomized Controlled Trials to evaluate the efficacy of the Wheelchair Skills Training Program in younger and older adults. Trial 1 and Trial 2 will employ different recruitment approaches for targeting younger versus older adults and different inclusion criteria with regard to age of the participants. Otherwise the research design, protocol and procedures will be the same. Upon completion of data collection, the data will be pooled and stratified by age (younger adult, older adult) for analyses.