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Purpose: The Wheelchair Skills Training Program (WSTP) is underutilized in pediatrics for training manual wheelchair skills because the voluminous manual lacks pediatric specificity and no materials adapted for pediatric manual wheelchair users (PMWUs) are available. A set of resources (storybook, posters, training workbook) based on the WSTP has previously been developed for training basic indoor wheelchair skills with five to 15-year-old PMWUs. Occupational therapists (OTs) and PMWUs expressed a need for additional resources addressing higher-level skills. Two new sets of resources teaching indoor and community wheelchair skills were developed. Objective: Describe OTs' and PMWUs' satisfaction and perceptions regarding usability, relevance and feasibility in pediatrics with the new resources. Methods: A descriptive qualitative study was conducted. A focus group and interviews were respectively conducted with a convenience sample of OTs and a criterion sample of PMWUs to document perceptions regarding satisfaction, usability, relevance and feasibility. A deductive approach to data analyses was used following the Framework Method. Results: Six OTs expressed satisfaction regarding both sets of resources feeling more confident using the WSTP (relevance) and perceiving potential time efficiencies when planning training interventions (feasibility). They provided suggestions to improve the usability of the second set. Six PMWUs participated in the interviews, two of which provided feedback on both sets. They were satisfied with the resources recommending them to novice and temporary PMWUs aged from three to 11 years. Conclusion: Participants' suggested the resources may contribute to reducing the gap between the evidence supporting the WSTP and its utilization in pediatrics. IMPLICATIONS FOR REHABILITATION: Two sets of knowledge transfer resources based on the Wheelchair Skills Training Program (WSTP) are pediatric-friendly materials that could be used in rehabilitation settings to train wheelchair skills among novice and temporary manual wheelchair users. Both sets of knowledge transfer resources may help bridge the gap between the evidence supporting the WSTP and its utilization in pediatrics by responding to clinicians' needs for playful, easy-to-use and condensed materials to use in their interventions. The perspectives of occupational therapists and pediatric manual wheelchair users are important to improve the wheelchair skills training resources so that they align with both knowledge users' needs and preferences. [ABSTRACT FROM AUTHOR]

To adapt the Wheelchair Use Confidence Scale for Manual Wheelchair Users, French-Canadian Version (WheelCon-M-F) into a paediatric version (WheelCon-M-F-P) and to evaluate its validity. A three-phase process was conducted: (1) item adaptation using secondary analysis of focus group data; (2) item refinement using a think-aloud process; and (3) preliminary validation of the WheelCon-M-F-P (i.e. internal consistency, test-retest reliability, standard error of measurement, smallest real difference, ceiling and floor effects, limits of agreement, and relations with other variables). Phase 1: The sample consisted of occupational therapists (n = 9), paediatric manual wheelchair users (PMWUs) (n = 12), and parents of PMWUs (n = 2). Of the 65 WheelCon-M-F items, 35 were removed, 25 modified and 6 were added for the WheelCon-M-F-P. Phase 2: 4 PMWUs helped refine 14 and remove 3 items. Phase 3: 22 PMWUs participated. Cronbach's alpha, test-retest reliability, standard error of measurement, and smallest real difference were 0.846, 0.818, 3.05, and 8.45 respectively. No ceiling or floor effects were demonstrated. Pearson correlations between the WheelCon-M-F-P and the Wheelchair Skills Test Questionnaire (capacity, confidence, and performance), and the Child Occupational Self-Assessment were 0.688, 0.711, 0.584, and 0.687 respectively. This study provides preliminary evidence of a valid and reliable WheelCon-M-F-P. The Wheelchair Use Confidence Scale for Manual Wheelchair Users, French-Canadian Version (WheelCon-M-F-P) is an outcome measure that can be used clinically with pediatric manual wheelchair users. The WheelCon-M-F-P can help identify modifiable factors associated with wheelchair confidence. Identifying modifiable factors associated with wheelchair confidence can help guide clinicians in establishing a targeted intervention for their pediatric clients. Establishing a targeted intervention can help improve self-efficacy for wheelchair use and social participation of pediatric wheelchair users. [ABSTRACT FROM AUTHOR]

Playful approaches are recommended to enhance wheelchair skills training with young people. Inclusive dance allows participants to discover motor skills and improve social participation. Integrating wheelchair skills training into dance has not been evaluated. This study aimed to explore participants' experiences in dance while integrating wheelchair skills, and the influence of dance on wheelchair skills and wheelchair use confidence in young people. A convergent mixed-methods design was used during a one-week dance camp. Data collection combined observations, two focus groups (with young dancers who used manual wheelchairs and with professional dancers without disabilities), and evaluation of wheelchair skills and confidence. Data analyses included deductive thematic analysis guided by the Quality Parasport Participation Framework, merged with pre–post comparisons in wheelchair skills and confidence. Three young female dancers were 11, 12 and 15 years of age and three professional female dancers were 22, 27 and 27 years of age. Emergent themes included skill mastery, belongingness, and supportive environments. There were improvements in wheelchair skills and confidence (16.7%, 19.4%, 16.7%; 0.8%, 11.4%, 4.5%, respectively). Participants described overall positive experiences with the dance camp and perceived enhanced skills and confidence. This study advances knowledge about innovative approaches to integrate wheelchair skills training for young people. Future larger-scale controlled studies are needed to determine efficacy. [ABSTRACT FROM AUTHOR]

Manual wheelchair (MWC) confidence is a predictor of adult life-space mobility and social participation. To date, scientific literature specific to pediatric MWC confidence is scarce which prevents in-depth understanding. The objective of this study was to explore the perceptions of pediatric MWC users (PMWU), parents, and occupational therapists regarding pediatric MWC confidence. Five focus groups were conducted with PMWUs (n = 12) and occupational therapists (n = 9), and semi-structured interviews were conducted with parents of PMWUs (n = 2). Inductive thematic analysis was performed following verbatim transcription of audio recorded material. Three overarching themes were identified across PMWUs, parents, and occupational therapists: (1) "MWC confidence is not a clinical priority" depicted the construct's varying level of clinical priority and perceived abstractness; (2) "MWC confidence is both a child and parent consideration" revealed nuances between the PMWU's MWC confidence and the parents' perception of the PMWU's MWC confidence; and (3) "Opportunities to develop MWC confidence are context-specific" contrasted afforded and unafforded opportunities to experience independent MWC mobility. Pediatric MWC confidence is an important aspect of wheelchair use that is shaped by a multitude of factors in PMWU's lives. This new area of pediatric study provides support for the need to measure this important construct. This study is the first to explore children's, parents', and occupational therapists' perceptions of pediatric MWC confidence. Pediatric MWC confidence impacts MWC use in a multifaceted fashion. Future studies should consider the development and validation of a self-report measure to assess pediatric MWC confidence. [ABSTRACT FROM AUTHOR]

Appropriate wheelchair provision is necessary for addressing participation barriers experienced by individuals with mobility impairments. Health care professionals involved in the wheelchair service provision process require a specific set of skills and knowledge to enable wheelchair use that meets individual posture, mobility and daily living requirements. However, inconsistencies exist in academic programmes globally about providing comprehensive education and training programmes. The planned scoping review aims to review and synthesize the global literature on wheelchair service provision education for healthcare professional students, healthcare personnel and educators offered by universities, organizations and industries. This scoping review will be guided by the Joanna Briggs Institute (JBI) methodological framework. Comprehensive literature searches will be conducted on various global electronic databases on health to seek out how wheelchair service provision education is organized, integrated, implemented and evaluated. Two independent reviewers will perform eligibility decisions and key data extractions. Data from selected studies will be extracted and analysed using conventional content analysis. Information related to wheelchair service provision education including curriculum development, content, teaching methods, evaluation and models of integration will be synthesized. The planned scoping review will be the first to examine all aspects of wheelchair service provision education across professionals, settings and countries. We anticipate that results will inform the content of a Wheelchair Educators' Package, and if appropriate, a follow-up systematic review. An article reporting the results of the scoping review will be submitted for publication to a scientific journal. A comprehensive examination of wheelchair service provision education could help develop strategies to address the unmet need for wheelchair services globally. Findings for this review will facilitate the planning and development of an evidence-based education package that could bridge the existing knowledge gaps related to safe and effective wheelchair service provision among health professionals involved. This review will also inform the potential barriers and enablers for effective integration and implementation of wheelchair service provision education worldwide. [ABSTRACT FROM AUTHOR]

Introduction: Valid and reliable scores from measurement tools to test competency in basic manual wheelchair-service-provision are needed to promote good practice and support capacity building. The International Society of Wheelchair Professionals' (ISWP) Basic Test Version 1 in English, launched in 2015, is the most frequently used outcome measure tool to test basic manual wheelchair-service-provision knowledge and is part of an international certification process. Despite the wide acceptance and use of the test, its psychometric properties have not yet been established. The objectives of this study were 1) to evaluate the test's psychometric properties, 2) to develop the test's Version 2, and 3) to evaluate the content validity of the new version. Methods: For Objective 1, methods from the Classical Test Theory were used to obtain items' difficulty, item discrimination index and domains' reliability. For Objective 2, a team of experts in wheelchair service delivery and education conducted a systematic qualitative review of the questions' text and answers and updated them using evidence-based guidelines. For Objective 3, an external team reviewed the clarity, relevance and domain allocation of the developed items using a 4-point Likert scale. Descriptive statistics were used to describe and characterize the results for each objective. Item-content (I-CVI) and Scale-content (S-CVI) validity indexes were calculated to compute content validity. Results: For Objective 1, all domains in the test were below the threshold for acceptable internal consistency reliability; 80% of the total test pool (116 items from the total pool of 145) did not meet the thresholds for item difficulty and index of discrimination suggested in the literature. Of the items in the Test, 78% could be responded to intuitively and 66% did not distinguish between test-takers who were knowledgeable in the content area and those who were not. For Objective 2, experts found concerns such as items being grouped in the wrong domain, being repeated, not using person-first language, and using terms inconsistently. Thirty-four (23.4%) items were dropped and 111 (76.5%) were updated. In addition, 61 new items were developed. Members re-categorized the items and proposed a new classification of subdomains. For Objective 3, good agreement between subject-matter experts was found; the S-CVI calculated using the I-CVIs related to item clarity was 84% while using the I-CVIs related to item relevance was 98%. Only 7 items (4.1%) were deemed to be in the wrong domain and 4 items (2.3%) were considered irrelevant and dropped. Conclusion: The psychometric evidence in support of ISWP Basic Test Version 1 in English is suboptimal. A new set of items developed by experts in the field has shown excellent content validity. Ongoing assessments will be needed as ISWP Basic Test Version 2 is implemented and monitored. [ABSTRACT FROM AUTHOR]

The objectives were: (1) to translate and adapt the International Society of Wheelchair Professional (ISWP) basic Wheelchair Service Provision Test (bWSPT) into French-Canadian and (2) to conduct a preliminary evaluation of the French-Canadian version of the ISWP bWSPT internal consistency and relations with other variables among French-Canadian occupational therapy students. For Phase 1, based on the International Test Commission Guidelines for Translating and Adapting Tests, a forward translation and adaptation from English to French-Canadian was conducted by a translation team. For Phase 2, the validity evidence of the French-Canadian bWSPT was evaluated through internal consistency and comparison of bWSPT scores and final grades of a wheelchair-specific course with a sample of occupational therapy students (positive, moderate correlation hypothesized). Internal consistency was measured with Cronbach's α. The correlation was calculated using the Spearman's Rank Correlation Coefficient. For phase 1, 61 of 167 items of the forward adaptation were revised and modified. All revisions were a consensus by the translation team. For phase 2, we found a Cronbach's α of 0.50 and a correlation of ⍴ = 0.27 (p = 0.43) between the bWSPT French-Canadian version and the wheelchair-specific course final grade. The low variability of the data may explain the lower-than-expected correlation. Other possible data-driven reasons have been explored using post-hoc analysis. The ISWP bWSPT, French-Canadian version, is not internally consistent and demonstrates a non-statistically significant, positive, weak correlation with the final grade of a wheelchair service provision-specific course among a cohort of 35 occupational therapy students. The lack of adequately educated wheelchair service providers is a contributing factor to inappropriate wheelchair provision worldwide. The ISWP Wheelchair Service Provision Basic Test (ISWP bWSPT) has been created to evaluate competency among wheelchair service providers and provides a standardized test recognized internationally. A French-Canadian version of the ISWP bWSPT allows competency testing of French-speaking wheelchair service providers across Canada. This study shows that the French-Canadian version of the test is not internally consistent and has a low correlation with a wheelchair provision-specific course among a cohort of 35 occupational therapy students at a French-Canadian university suggesting further refinement is required to improve its measurement properties in this population of test-takers. [ABSTRACT FROM AUTHOR]

This review aimed to collate and summarize available research literature about wheelchair service provision education available to healthcare professional students, healthcare personnel and educators across low- to high-resourced settings. The Joanna Briggs Institute methodological steps for scoping reviews were followed. Included studies were mainly sourced from Medline, Embase, CINAHL, Scopus, Academic Search Complete and ProQuest. Independent title, abstract and full-text screening with defined inclusion and exclusion criteria was performed. All screening and extraction were performed independently by two authors. A thematic approach was used to synthesize results. Data extracted from included studies were charted according to a template that we created. The study quality was also appraised. A total of 25 articles were included (11, 36% from high-income settings) with 12 (48%) observational studies and 13 (52%) experimental studies. The literature addressed three main topics: (1) assessing wheelchair service provision knowledge, (2) implementing training interventions using in-person, online and/or hybrid learning approaches and (3) describing current wheelchair service provision education globally. The most frequently reported training programs used were the Wheelchair Skills Program and the World Health Organization Wheelchair Service Training Package – Basic Level. Limited information has been published about the integration of wheelchair content into the curricula of professional rehabilitation programs. Efforts to build international partnerships, improve the quality and currency of training programs and build resources that can assist educators in the integration of wheelchair-related content into professional rehabilitation programs should be prioritized. This is the first review that examined and synthesized the current state of wheelchair service provision education for rehabilitation students and personnel across low- to high-income countries. Findings from this review indicate that there is limited information about the integration of wheelchair-related content into professional rehabilitation programs. Efforts to build international partnerships, standardize wheelchair service provision content and evaluation and integrate training into professional rehabilitation programs worldwide should be prioritized. [ABSTRACT FROM AUTHOR]

Occupational therapists in Canada play a central role in wheelchair service provision. Inadequate entry-to-practice professional education has been identified as a major concern in the delivery of wheelchair related services. The goal of this study was to describe the current education provided in Canadian occupational therapy programs and to map this content against the recommended WHO 8-step wheelchair service provision process. The study used a descriptive cross-sectional online survey design. Educators were recruited from accredited occupational therapy programs in Canada. Participants completed a short sociodemographic questionnaire and a survey with 97 closed- and open-ended questions regarding the wheelchair service provision education provided in their curriculum. Survey data was then mapped according to the WHO 8-step wheelchair service provision process. Twenty-nine educators from all Canadian occupational therapy programs (n = 14) were enrolled. Most participants (55.2%) were full-time faculty members that had been teaching in occupational therapy programs for an average time of 10.9 years. All programs covered at least 4 of the WHO recommended steps, but only 5 programs covered all steps. Assessment and Prescription steps were covered in every program while the Referral & Appointment, Funding & Ordering, Fitting and User Training steps were covered in most programs. The pedagogic approach, the amount of time dedicated to wheelchair-related content, and the type of evaluation used varied greatly between programs. This study is the first to provide a detailed description of wheelchair service provision education across all Canadian occupational therapy programs according to the WHO 8 steps and provides a foundation for collaborative efforts to promote best practice in entry-to-practice professional education. [ABSTRACT FROM AUTHOR]

Purpose: An estimated 75 million people with disabilities need wheelchairs globally, of whom 5–15% have one. Access to an appropriate wheelchair requires rehabilitation professionals trained to provide wheelchair service. One aim of the International Society of Wheelchair Professionals (ISWP) is to promote and facilitate the integration of wheelchair service provision education into academic rehabilitation programs worldwide. To inform the development of integration strategies, the purpose of this study was to develop an in-depth global portrait of the wheelchair service provision education offered in academic rehabilitation programs, the process of its integration and the associated facilitators and barriers. Method: Semi-structured qualitative interviews were conducted with a purposive sample of 14 representatives from academic rehabilitation programs (i.e., occupational therapy, physical therapy, and prosthetics and orthotics) in 11 countries, including low, middle and upper resourced settings. Findings: Thematic data analyses identified three overarching themes. The first theme, "impact of context", portrays factors related to local population needs, governance and supply chain of equipment and service delivery. The second theme, "current and planned wheelchair education", describes the content, pedagogic approach, student evaluation and feedback process. The third theme, "integration process", details five states of this process. Conclusions: This study describes in-depth the wheelchair service provision education across academic rehabilitation programs and resource settings, illustrating the context-dependent nature of its integration. This understanding may assist the global community of educators in preparing future rehabilitation professionals to better serve wheelchair users. This work has informed the development of ISWP's Seating and Mobility Academic Resource Toolkit (). The Dynamics of Context-Dependent Integration of Wheelchair Service Provision Education in Curricula model, depicting the findings of this study, may help to inform key stakeholders (i.e., academic institutions, health care providers and policy makers) about potential barriers and facilitators to the implementation of adequate wheelchair service provision education in the curricula of academic rehabilitation program. Study findings may lead to creative strategies, such as the expansion of ISWP's Seating and Mobility Academic Resource Toolkit (SMART; ), that may enable academic rehabilitation programs to be a part of the solution to strengthening rehabilitation systems worldwide, through appropriately trained rehabilitation professionals in wheelchair service provision. [ABSTRACT FROM AUTHOR]

About 65 million people use wheelchairs worldwide. Powered wheelchairs offer independent mobility for those who find it difficult to propel a manual wheelchair. Previous studies have described powered wheelchairs as a mixed blessing for the users in terms of usability, accessibility, safety, cost and stigma; however, few studies have explored their impact on mobility and participation over time. Therefore, as part of a larger longitudinal study, we used a combined retrospective and prospective lifecourse perspective to explore the experiences of older adult powered wheelchair users. Based on the interpretive description approach, 19 participants took part in a series of semi-structured interviews over a two-year period about their mobility, social participation and ageing process. The participants were powered wheelchair users, at least 50 years of age, recruited in Vancouver, Montreal and Quebec City (Canada). We identified three themes that highlighted how the powered wheelchair experience was integrated into the life continuum of the users. 'It's my legs' emphasised how powered wheelchairs are a form of mobility that not only enables users to take part in activities, but also impacts their identities, past and present. 'Wheels of change' explored the dynamic nature of powered wheelchair use and changes related to ageing. 'Getting around' illustrated how users' mobility was affected by the interaction with their physical and social environments. Developing public policies to advance social and environmental changes could help countries to ensure equity of access and social inclusion of those ageing with disabilities. [ABSTRACT FROM AUTHOR]

Introducing innovations such as telerehabilitation (TR) into routine care involves complex changes in organizations. This study protocol aims to (1) examine the extent to which a TR platform was implemented as intended in three clinical settings and (2) identify which TR activities were becoming integrated into routine clinical practices, and which factors affect the routine use of the platform. A mixed-method prospective single-case study design with multiple embedded units of analysis will be used. Pre/post-implementation data collection will focus on implementation leaders, clinical champions, upper management, and clinical staff. Qualitative data include semistructured individual interviews with leaders, champions, and upper management as well as focus groups with clinical staff who are users and non-users of the TR platform. Quantitative data include TR use data and TR implementation questionnaires. The consolidated framework for implementation research will be used to analyze the implementation process and normalization process theory will be used to analyze the embedding of TR in routine daily practice. The project is expected to yield evidence regarding which specific TR activities are implemented in day-to-day clinical activities as well as capture threats and opportunities to normalization at a critical moment when it is expected to occur. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that occupational therapy students who receive wheelchair skills training education using a distributed-practice university-course approach versus a condensed-practice boot-camp approach results in greater improvements post-intervention in relevant outcomes. Design: A quasi-experimental, nonequivalent control group design. Setting: A university occupational therapy program. Participants: Occupational therapy students (experimental group) and recent occupational therapy graduates (control group) (N = 58). Interventions: A 15-week, 45-hour wheelchair provision course in which a total of 24 hours were dedicated to wheelchair skills testing and training education (experimental group) versus an 8-hour wheelchair skills training boot-camp (control group). Main outcome measures: Assessments were conducted pre- and post-intervention using the Wheelchair Skills Test Questionnaire (WST-Q), Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon) and Self-Efficacy on Assessing, Training and Spotting wheelchair skills (SEATS). Results: Compared to baseline, the WST-Q, WheelCon and SEATS scores improved significantly for both groups (p <.001). There were no significant differences in change scores (post-intervention – baseline values) between the groups for WST-Q, WheelCon or SEATS scores, however, the experimental group demonstrated a trend (p <.051) of higher scores for all outcome measures. Conclusions: Occupational therapy students who received wheelchair skills training using either a distributed-practice university-course or condensed-practice boot-camp approach demonstrated significant post-training improvements in their WST-Q, WheelCon and SEATS scores, but no significant differences were found between groups. Both a distributed-practice university-course approach and a condensed-practice bootcamp approach for training wheelchair skills to occupational therapy students results in large post-intervention improvements in wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills. The pre-education (optional course) wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills scores found in this cohort of occupational therapy students confirms the need to include this wheelchair content in mandatory occupational therapy curricula. [ABSTRACT FROM AUTHOR]

Aim: In Québec, Canada, the prevalence of children using powered mobility (PM) is not reflective of evidence supporting its use and for achieving developmental milestones. The aim of this study was to explore the perceptions of four key stakeholder groups in a metropolitan area regarding daily use, barriers, facilitators, and clinical practice associated with use of PM. Methods: Using convenience sampling, semi-structured qualitative interviews were conducted with children (n = 6), parents (n = 2), rehabilitation center occupational therapists (OTs; n = 4), and special needs school-based OTs (n = 6). Drawings were used as a supplemental data collection strategy with children. Interviews were audio recorded and transcribed verbatim to conduct thematic analysis. Results: Three overarching themes were identified: (1) "A sense of liberty, except...", highlighting environmental obstacles reducing social participation; (2) "A necessity, for better or for worse," covering benefits and drawbacks of PM; and (3) "First choice versus last resort," raising clinical differences related to provision, assessment, and training. Conclusions: Stakeholders' perceptions illustrated benefits of PM, yet use is contingent on the physical, institutional, and societal environments, leading stakeholders to feel both powerful and powerless as users, parents, or clinicians. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the internal consistency, test–retest reliability and responsiveness of the Self-Efficacy in Assessing, Training and Spotting manual wheelchair skills (SEATS-M) and Self-Efficacy in Assessing, Training and Spotting power wheelchair skills (SEATS-P). Methods: A 2-week test–retest design was used with a convenience sample of occupational and physical therapists who worked at a provincial rehabilitation centre (inpatient and outpatient services). Sixteen participants completed the SEATS-M and 18 participants completed the SEATS-P. Results: For the SEATS-M assessment, training, spotting and documentation sections, Cronbach's alpha coefficients ranged from 0.90 to 0.97, the 2-week intraclass correlation coefficients (ICC1,1) ranged from 0.81 to 0.95, the standard error of measurements (SEM) ranged from 5.06 to 8.70 and the smallest real differences (SRD) ranged from 6.24 to 8.18. For the SEATS-P assessment, training, spotting and documentation sections, Cronbach's alpha coefficients ranged from 0.83 to 0.92, the ICCs ranged from 0.72 to 0.86, the SEMs ranged from 4.54 to 8.91 and the SRDs ranged from 5.90 to 8.27. Conclusions: There is preliminary evidence that both the SEATS-M and the SEATS-P have high internal consistency, good test–retest reliability and support for responsiveness. These tools can be used in evaluating clinician self-efficacy with assessing, training, spotting and documenting wheelchair skills included on the Wheelchair Skills Test. There is preliminary evidence that the SEATS-M and SEATS-P are reliable and responsive outcome measures that can be used to evaluate the self-efficacy of clinicians to administer the Wheelchair Skills Program. Measurement of clinicians' self-efficacy in this area of practice may enable an enhanced understanding of the areas in which clinicians lack self-efficacy, thereby informing the development of improved knowledge translation interventions. [ABSTRACT FROM AUTHOR]

Abstract Objective To examine the change over 1 year in the burden, wheelchair skills, social support, social participation, and mental health of family caregivers providing assistance to older adult powered wheelchair users. Design Longitudinal study. Setting Community. Participants Participants (N=35) included family caregivers (mean age ± SD=63.7±10.2y) who provided at least 2 hours of general care per week for a powered wheelchair user. Intervention Not applicable. Main Outcome Measures The Power Mobility Caregiver Assistive Technology Outcome Measure (frequency of care and subjective burden), the Wheelchair Skills Test Questionnaire for caregivers (wheelchair skills), the Interpersonal Support Evaluation List-6 (social support), the Late-Life Function and Disability Instrument (social participation), the Hospital Anxiety and Depression Scale (mental health). Measures were taken at baseline, 1, 3, 6, and 12 months. Descriptive statistics were calculated, and a linear mixed model was used to assess changes over time in the outcomes. Results The results showed that the caregivers helped on average with 3 powered wheelchair-related activities and 10 other caregiving activities. They also experienced moderate subjective burden and social participation and were within the normal range for depression and anxiety. Moreover, those outcomes remained stable over the 1-year study period. However, the wheelchair skills scores showed significant changes over time, as the scores improved during the first 6 months of the study. Conclusion Given that previous research indicated that subjective burden tends to decline over time among caregivers, the findings of stability in this study may reflect increasing needs among this population of caregivers, who may benefit from additional support and interventions. This would need further consideration. [ABSTRACT FROM AUTHOR]

Abstract Objective To provide a comprehensive description of the current state of knowledge regarding the use of virtual technology (VT) for wheelchair skills training. Data Sources The Cochrane Library, MEDLINE, CINAHL, Embase, ACM, IEEE Xplore, Inspec, and Web of Science databases were searched for relevant articles from 1990 to February 2016. Study Selection We included peer-reviewed studies or long conference proceedings that examined the use of VT as a medium to provide a wheelchair skills training intervention for any population with any diagnosis using any research design. One investigator screened the titles and abstracts, then 2 investigators independently reviewed the full-text articles. Disagreements regarding inclusion were resolved by consensus or a third reviewer. Ten studies were included out of 4994 initially identified. Data Extraction Two investigators extracted data to systematically assess the studies' findings into 5 tables (study design and participant characteristics, equipment and technology used, intervention characteristics, outcome measures, and outcomes). Data Synthesis Most studies demonstrated that VT wheelchair skills training showed improved outcomes (eg, simulation score, completion time, number of collisions) in the virtual environment and/or in the real world. However, subject characteristics, equipment, virtual environment, intervention tasks, and outcome measures varied across the studies. Conclusions There are a variety of studies using VT as an intervention for wheelchair skills training. Given the positive outcomes for most of the studies, it appears as though VT may indeed be a solution that can help to alleviate barriers to wheelchair skills training and subsequently improve wheelchair user skill. [ABSTRACT FROM AUTHOR]

Background/aim: The Assistive Technology Outcome Profile for Mobility (ATOP/M) was designed to isolate the impact of mobility assistive technology on perceived difficulty with activity and participation. The study objectives were to examine its measurement properties (test‐retest reliability and convergent validity) and applicability for middle‐aged and older power wheelchair (PWC) users. Methods: Four ATOP/M subscales were administered using computer adaptive testing (activity with mobility device, activity without mobility device, participation with mobility device, participation without mobility device). Test‐retest reliability (4‐wk interval), convergent validity (a priori hypothesis testing of correlations with participation (Late‐life Disability Instrument) and mobility (Life‐space Assessment)) and applicability (respondent burden, distributions) were examined with 116 PWC users between 50 and 85 years of age presenting with a variety of diagnoses. Results: When using powered mobility, perceived difficulty with activity and participation scores were similar to the general population of mobility devices users (T‐score range 46.3–53.7), while activity and participation were significantly lower without mobility devices (T‐score range 35.3–39.4). Test‐retest reliability intra‐class coefficients of the four subscales ranged between 0.82 and 0.91, and convergent validity was supported by moderate correlations (r = 0.35–0.47). Respondent burden was higher for the without devices subscales and none of the subscales had significant floor/ceiling effects. Conclusion: Our results provide support for reliability and convergent validity of the ATOP/M for PWC users. Specific strategies were recommended to optimise applicability with this population such as administration guidelines for reframing the without device scale and timing of data collection. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the measurement properties of the Wheelchair Use Confidence Scale for power wheelchair users (WheelCon-P). Design: One-month test-retest design, using data from a longitudinal study of power wheelchair use. Participants: Volunteer sample of 73 community dwelling, older adult experienced power wheelchair users who had a mean age of 60.5 ± 7.1 years. Methods: Participants completed the WheelCon-P twice to assess retest reliability. Concurrent validity was assessed by evaluating hypothesized relationships between the WheelCon-P and relevant variables. Results: The baseline mean (standard deviation) WheelCon-P score was 78.8 ± 14.5. Cronbach’s α was 0.92. The one-month test-retest intraclass correlation coefficient was 0.85 (CI 0.77-0.90). Correlations ranging from r = 0.26 (social support) to r = 0.49 (wheelchair skills) were found between the WheelCon-P and the validation outcome measures. Conclusion: The WheelCon-P has high internal consistency, strong retest reliability and evidence supporting its validity. Although further work is needed, the WheelCon-P may serve as a useful clinical and research tool for measuring power wheelchair confidence. Implications for rehabilitation: The WheelCon-P is a reliable and valid outcome measure for assessing wheelchair confidence. This tool can be used to identify individuals with low power wheelchair confidence who require a confidence-enhancing intervention. [ABSTRACT FROM AUTHOR]

Objective: We developed an Italian version of the Wheelchair Use Confidence Scale for Manual Users-Short Form (WheelCon-M-I-short form) and examined its reliability and validity. Methods: The original scale was translated from English to Italian using the “Translation and Cultural Adaptation of Patient Reported Outcomes Measures-Principles of Good Practice” guidelines. The WheelCon-M-I-short form was administered to experienced manual wheelchair users who had a variety of diagnoses. Its internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Wheelchair Outcome Measure (WhOM-I) and the Italian version of the Barthel index (BI). Results: The WheelCon-M-I-short form was administered to 31 subjects. The mean ± SD of the WheelCon-M-I-short form score was 7.5 ± 1.9. All WheelCon-M-I-short form items were either identical or similar in meaning to the WheelCon-M-short form items. Cronbach’s α for the WheelCon-M-I-short form was 0.95 (p < 0.01), and the test-retest reliability (ICC) was 0.978 (p < 0.01). The Pearson correlation coefficient of the WheelCon-M-I-short form scores with the WhOM-I scores was 0.7618 (p < 0.01). The Pearson correlation coefficient of the WheelCon-M-I-short form scores with the Italian BI scores was 0.638 (p < 0.01). Conclusions: The WheelCon-M-I-short form was found to be reliable and a valid outcome measure for assessing manual wheelchair confidence in the Italian population. Implication for Rehabilitation: The WheelCon-M-I-short form is a valid outcome measure available for assessing wheelchair confidence, according to Bandura’s social cognitive theory, self-efficacy is a better predictor of future behavior than skill itself. Translation of the WheelCon-M-short form into the WheelCon-M-I-short form provides a new tool for Italian professionals. Clinicians now have a method to measure this invisible barrier to wheelchair use, and they will be able to make informed decisions when prescribing the use of manual wheelchairs and when training clients in their use. The WheelCon-M-I-short form also provides researchers with a tool in an important and relevant area of study for future research. [ABSTRACT FROM AUTHOR]

Objectives To examine the dimensionality of the Wheelchair Use Confidence Scale for power wheelchair users (WheelCon-P), to identify items that do not fit the Rasch rating scale model as well as redundant items for elimination, and to determine the SEMs and reliability estimates for the entire range of measurements. Design Secondary analysis of cross-sectional data. Setting Community. Participants Volunteer participants (N=189) using wheelchairs (mean age of the sample, 56.7±13.0y; mean years of wheelchair use experience, 20.4±16.4). Interventions Not applicable. Main Outcome Measures 59-Item WheelCon-P. Results Principal component analyses confirmed the presence of 2 self-efficacy dimensions: mobility and social situation. Eleven mobility items and 5 social situation items fit the Rasch rating scale model. Three items misfit the model using all 16 items (ie, WheelCon-P short form). In each of the mobility, social situation, and WheelCon-P short form range of measurements, the 2 lowest and 2 highest measures had internal consistency reliability estimates below .70; all other measures had reliability estimates above .70. Conclusions The WheelCon-P is composed of 2 self-efficacy dimensions related to mobility and social situations. The scores from the WheelCon-P short form and the 11-item mobility and 5-item social situation dimensions using a 0 to 10 response scale have good reliability. [ABSTRACT FROM AUTHOR]

Background:Efficient service delivery models that optimize processes and human resources are required in the current health care climate. A family-centered care approach is recognized as a model that can improve the effectiveness and efficiency of pediatric rehabilitation. The objective of this study was to explore the perceptions of a multidisciplinary health care team regarding the use of thePréparation au plan d’intervention(PAPI), a modified needs assessment tool designed to facilitate a family-centered care approach among children with cerebral motor deficits (CMD) and their families. Methods:One focus group was conducted with the multidisciplinary team (n = 10) of the CMD program at a pediatric rehabilitation center. It was audio recorded and transcribed verbatim for content analysis. Results:Three overarching themes were identified from the analyzes: (1) a facilitator of open communication, (2) a way to gain the unique sense of the child and family and (3) parents as the experts of their child. Conclusions:Health care professionals value the use of the PAPI as a way of facilitating a family-centered care plan process, specifically with children with cerebral motor deficits. [ABSTRACT FROM PUBLISHER]

Purpose:Long-term care (LTC) residents with cognitive impairments frequently experience limited mobility and participation in preferred activities. Although a power wheelchair could mitigate some of these mobility and participation challenges, this technology is often not prescribed for this population due to safety concerns. An intelligent power wheelchair (IPW) system represents a potential intervention that could help to overcome these concerns. The purpose of this study was to explore a) how residents experienced an IPW that used three different modes of control and b) what perceived effect the IPW would have on their daily lives. Materials and methods:We interviewed 10 LTC residents with mild or moderate cognitive impairment twice, once before and once after testing the IPW. Interviews were conducted using a semi-structured interview guide, audio recorded and transcribed verbatim for thematic analyses. Results:Our analyses identified three overarching themes: (1) the difference an IPW would make, (2) the potential impact of the IPW on others and (3) IPW-related concerns. Conclusions:Findings from this study confirm the need for and potential benefits of IPW use in LTC. Future studies will involve testing IPW improvements based on feedback and insights from this study. Implications for rehabilitationIntelligent power wheelchairs may enhance participation and improve safety and feelings of well-being for long-term care residents with cognitive impairments.Intelligent power wheelchairs could potentially have an equally positive impact on facility staff, other residents, and family and friends by decreasing workload and increasing safety. [ABSTRACT FROM PUBLISHER]

Caregiver burnout is a serious concern among informal caregivers, especially for those who provide care to individuals with more severe limitations such as power mobility users. The Power Wheelchair Caregiver Assistive Technology Outcome Measure tool measures device specific and overall burden experienced by informal caregivers of power mobility users. A one-month, test-retest study was conducted to examine the reliability, internal consistency, and construct validity of the Power Wheelchair Caregiver Assistive Technology Outcome Measure. Two construct validity measures were administered: the Hospital Anxiety and Depression Scale and the Late Life Disability Index. The test-retest-reliabilities of part 1 (power wheelchair specific burden) and part 2 (general caregiving burden) were 0.769 and 0.843 respectively. Scores on part 1 were moderately and positively correlated with part 2 and with frequency of participation. Scores on part 2 were moderately and negatively correlated with anxiety, depression, and positively with perceived limitation of participation. The strength and direction of these correlations provide support for the construct validity of the measure and suggest part 1 and part 2 provide complementary information. Further testing is needed to assess the clinical utility and responsiveness of the measure. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to adapt the WheelCon-M, an outcome measure used to assess confidence with manual wheelchair use, into a version that is applicable for power wheelchair users (WheelCon-P). Methods: Adaptation of the WheelCon-M into the WheelCon-P occurred in two phases: (1) item modification was conducted using focus groups and (2) item refinement was done using a think aloud process.Results: The healthcare professionals (n = 12) were mostly female, mostly occupational therapists and practiced an average of 14 years. The power wheelchair users (n = 8) were 50% men with an average of 8 years of power wheelchair experience and a range of diagnoses. In phase 1, of the 63 WheelCon-M items, 6 remained the same, 18 were removed, 38 modified and 15 new items added to develop the WheelCon-P. In phase 2, 15 WheelCon-P items were refined.Conclusions: This study resulted in the modification of the WheelCon-M into the WheelCon-P, a 59-item, self-report outcome measure designed to assess confidence with power wheelchair use. The next step in the evolution of this promising new measure is the assessment of its measurement properties.Implications for RehabilitationThe WheelCon-P is a new outcome measure designed to assess confidence with power wheelchair use.This study suggests that the items in this measure will be interpreted as intended. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate the test–retest reliability, concurrent validity and responsiveness of the Wheelchair Skills Test – Questionnaire (WST-Q) Version 4.1 for powered wheelchair users.Methods: A volunteer sample of 72 community-dwelling, experienced powered wheelchair users, ranging in age from 50 to 77 years, participated in this study. Participants completed measures at baseline and 1 month later.Results: Mean ± standard deviation total percentage WST-Q scores at baseline and 1 month were 83.7% ± 10.9 and 86.3% ± 10.0 respectively. Cronbach’s alpha was 0.90 and the 1 month test–retest intraclass correlation coefficient (ICC1,1) was 0.78 (confidence interval: 0.68–0.86). There were no floor or ceiling effects. Percentages of agreement between baseline and 1 month for individual skills ranged from 72.2% to 100%. The correlations between the WST-Q and the objective Wheelchair Skills Test (WST), WheelCon and Life Space Assessment werer = 0.65,r = 0.47 andr = 0.47 respectively. The standard error of measurement (SEM) and smallest real difference (SRD) were 5.0 and 6.2 respectively.Conclusion: The WST-Q 4.1 has high internal consistency, strong test–retest reliability and strong support for concurrent validity and responsiveness.Implications for Rehabilitation:There is evidence of reliability, validity and responsiveness of the Wheelchair Skills Test – Questionnaire (WST-Q) among experienced older adult powered wheelchair users.The WST-Q can be used to measure powered wheelchair skills, guide intervention and measure change over time. [ABSTRACT FROM PUBLISHER]

Background: The L Test is a reliable/valid clinical evaluation of mobility that measures walking speed in seconds. It can be used with individuals with lower limb amputation. Responsiveness of the L Test is not yet determined.Objectives: The purpose of this pilot study was to determine how well the L Test identified individuals with a lower limb amputation who have/have not undergone a minimal clinically important difference.Study Design: Prospective follow-up study.Methods: In total, 33 individuals with lower limb amputation, deemed to require a major intervention, were recruited consecutively from a follow-up clinic. Participants completed the L Test at baseline and follow-up. A Global Rating Change scale was also completed at follow-up.Results: The participants had a mean age ± standard deviation of 60 ± 13.0 years, and 81.8% had a transtibial amputation. The mean ± standard deviation for the L Test change scores was 6.0 ± 13.9. The area under the curve was 0.67, and the minimal clinically important difference was 4.5 s.Conclusions: The L Test identified individuals as having an important clinical change. Results must be interpreted with caution, as the accuracy, based on the Global Rating Change scale, is low. Further inquiry into the L Test is encouraged.Clinical Relevance: The L Test can guide the clinical management of individuals with lower limb amputation. Results from this pilot study indicate that individuals with a lower limb amputation who improve by at least 4.5 s on the L Test after an intervention have likely undergone an important change. This result must be interpreted with caution given that the ability of the L Test to correctly identify individuals, who have and have not undergone an important change, using the Global Rating Change scale as the gold standard, is limited because this is a pilot study. It is plausible that the precision of the cut-point threshold could increase or decrease given a larger sample or when using a different method of identifying important clinical change. [ABSTRACT FROM AUTHOR]

Purpose: To explore power wheelchair users', caregivers' and clinicians' perspectives regarding the potential impact of intelligent power wheelchair use on social participation. Methods: Semi-structured interviews were conducted with power wheelchair users ( n = 12), caregivers ( n = 4) and clinicians ( n = 12). An illustrative video was used to facilitate discussion. The transcribed interviews were analyzed using thematic analysis. Results: Three main themes were identified based on the experiences of the power wheelchair users, caregivers and clinicians: (1) increased social participation opportunities, (2) changing how social participation is experienced and (3) decreased risk of accidents during social participation. Conclusion: Findings from this study suggest that an intelligent power wheelchair would enhance social participation in a variety of important ways, thereby providing support for continued design and development of this assistive technology. [ABSTRACT FROM AUTHOR]

Purpose: There is limited information on the difficulties individuals experience in manoeuvring their power wheelchairs during daily activities. The aim of this study was to describe the nature and context of power wheelchair driving challenges from the perspective of the user. Methods: A qualitative design using semi-structured interviews with power wheelchair users. Qualitative content analysis was used to identify themes. Results: Twelve experienced power wheelchair users were interviewed. Findings revealed that power wheelchair driving difficulties were related to the accomplishment of activities of daily living, and the influence of environmental context. Four key themes emerged: (1) difficulties accessing and using public buildings-facilities, (2) outdoor mobility, (3) problems in performing specific wheelchair mobility tasks/manoeuvres and (4) barriers and circumstances that are temporary, unforeseen or specific to a particular context. Conclusion: This qualitative study furthers our understanding of the driving difficulties powered wheelchair (PW) users experience during daily activities. This knowledge will assist clinicians and researchers in two areas: in choosing assessment measures that are ecologically valid for power wheelchair users; and, in identifying and refining the content of training programs specific to the use of power wheelchairs. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to: (1) translate the Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon-M) into a French-Canadian version (WheelCon-M-F); and (2) evaluate the WheelCon-M-F validity evidence based on response processes, internal structure, and relations with other variables. Methods: The WheelCon-M was translated from English to French using the Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice guidelines. We used a test-retest design to examine the validity of the WheelCon-M-F with 24 community dwelling, experienced manual wheelchair users who had a variety of musculoskeletal and neurological diagnoses. Results: The mean ± SD WheelCon-M-F score was 63.8 ± 19.9. All WheelCon-M-F items were either identical or similar in meaning to the WheelCon-M items. Clarification issues were identified with 27/63 items. Cronbach's alpha was 0.98 and the retest intraclass correlation coefficient was 0.87. The standard error of measurement and smallest real difference were 7.2 and 19.9, respectively. There were no floor or ceiling effects. WheelCon-M-F correlations with social support and participation were r = 0.54 and 0.78, respectively. Conclusions: The WheelCon-M-F is a valid outcome measure for assessing manual wheelchair confidence in the French-Canadian population. [ABSTRACT FROM AUTHOR]

Background. Confidence in one's ability to perform a given task can be a stronger predictor of performance than skill itself. There are currently no measures to assess confidence with manual wheelchair use. The objective of this study was to develop and assess the content validity of the Wheelchair Use Confidence Scale (WheelCon-M). Method. A two-phase mixed-methods design was used. Semi-structured interviews were conducted to generate items, followed by a Delphi survey for item selection. Persons who use a wheelchair, health care professionals, and researchers participated in both phases of the study. Results. An 84-item WheelCon-M was developed based on the qualitative data. After the Delphi survey, a final 62-item WheelCon-M was composed of the following six areas (number of items per area): Negotiating the Physical Environment (33 items), Activities Performed using a Manual Wheelchair (11 items), Knowledge and Problem Solving (6 items), Advocacy (4 items), Managing Social Situations (5 items) and Managing Emotions (3 items). Conclusion. This article reports the development and content validation of the WheelCon-M. As a scale to measure confidence with wheelchair use was not available prior to this work, clinicians now have a method of identifying individuals who have low confidence with wheelchair use. [ABSTRACT FROM AUTHOR]

Objective To test the hypothesis that caregivers enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance, and to describe the nature of that assistance. Design Multicenter cross-sectional study. Setting Rehabilitation centers and communities. Participants Participants (N=152) included caregivers (n=76) and wheelchair users (n=76). Interventions None. Main Outcome Measures Version 4.3 of the Wheelchair Skills Test (WST) and the Wheelchair Skills Test-Questionnaire (WST-Q). For each of the 30 individual skills, we recorded data about the wheelchair user alone and in combination (blended) with the caregiver. Results The mean total WST capacity scores ± SD for the wheelchair users alone and blended were 78.1%±9.3% and 92.4%±6.1%, respectively, with a mean difference of 14.3%±8.7% ( P <.0001). The mean WST-Q capacity scores ± SD were 77.0%±10.6% and 93.2%±6.4%, respectively, with a mean difference of 16.3%±9.8% ( P <.0001). The mean WST-Q confidence scores ± SD were 75.5%±12.7% and 92.8%±6.8%, respectively, with a mean difference of 17.5%±11.7% ( P <.0001). The mean differences corresponded to relative improvements of 18.3%, 21.0%, and 22.9%, respectively. The nature and benefits of the caregivers' assistance could be summarized in 7 themes (eg, caregiver provides verbal support [cueing, coaching, reporting about the environment]). Conclusions Caregivers significantly enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance, and they do so in a variety of ways. These findings have significance for wheelchair skills assessment and training. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThis study aimed to better understand how the powered wheelchair (PWC) impacts the experiences of family caregivers of PWC users, and explore the strategies and resources used by caregivers to cope with their role.This mixed-methods study was part of a larger cross-sectional research study conducted in four Canadian cities. Twenty-three family caregivers of PWC users, who provided at least 2 h of support per week, completed the Power Mobility Caregiver Assistive Technology Outcome (PM-CATOM), an 18-item measure assessing PWC-related and overall burden experienced by family caregivers. We also conducted semi-structured interviews and analysed them using inductive content analysis.From the quantitative PM-CATOM results, the caregivers perceived low level of burden for the wheelchair-related items, (Median:4.5; Range 3 to 5). Most perceived burden when physically helping the wheelchair user and when providing verbal hints. In terms of overall help, the caregivers experienced some level of burden (Median 3.5: Range 3 to 5). Most caregivers identified burden associated with the limitation to their recreational and/or leisure activities (52.2%) and feeling that they have more to do than they can handle. We identified 3 themes in the interviews: the burden experiences of caring for PWC users, the positive experiences of caregiving, and the coping strategies and resources used by caregivers of PWC users.Our study showed that understanding the experiences of caregivers of AT users is central as they are directly and indirectly impacted by the PWC in their lives and caregiving roles. The caregivers experienced some burden related to wheelchair-related help, especially around the driving of the powered wheelchair (PWC).However, the PWC provide independence not only to the user but also to the family caregivers, allowing them to share quality time and helping each otherThe PWC impact the interaction with the social and physical environment of the caregivers.Caregiver-oriented interventions should build on the strengths of the caregivers and contribute to their well-being.The caregivers experienced some burden related to wheelchair-related help, especially around the driving of the powered wheelchair (PWC).However, the PWC provide independence not only to the user but also to the family caregivers, allowing them to share quality time and helping each otherThe PWC impact the interaction with the social and physical environment of the caregivers.Caregiver-oriented interventions should build on the strengths of the caregivers and contribute to their well-being. [ABSTRACT FROM AUTHOR]