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BACKGROUND: Level and non-level transfers are essential tasks of daily living for wheelchair users. Minimal research has examined the role of shoulder pain and fear of falling on transfer quality. The purpose of this study is to (1) examine the association between shoulder pain, fear of falling (FoF) and transfer quality and (2) explore the feasibility of assessing non-level transfers to-and-from the floor. METHODS: Cross-sectional design was used to explore shoulder pain, FoF, and transfer quality in 30 manual wheelchair users (aged 18-42; 15 males). Participant demographic information (age, sex, race, disability, and years using wheelchair), Spinal Cord Injury-Fall Concern Scale (SCI-FCS), and Wheelchair User Shoulder Pain Index (WUSPI) was collected. Three types of transfers: (1) level, (2) uphill, and (3) floor-to-table were graded by a trained researcher using the Transfer Assessment Instrument (TAI) 3.0. Kruskal–Wallis test was used to determine differences in transfer quality based on condition. Spearman correlation was used to determine associations between demographic data, WUSPI, SCI-FCS, and transfer quality scores. RESULTS: All participants safely completed the uphill non-level transfer; 27 safely completed the floor-to-table non-level transfer. Statistical analysis revealed no difference in TAI score across transfer conditions. Spearman correlation revealed a significant correlation between WUSPI and SCI-FCS scores (r = .68, P = .01) and WUSPI and uphill TAI scores (r = -.45, P = .01). CONCLUSION: Increases in shoulder pain are related to decreased uphill transfer quality and increased FoF. Non-level transfers to-and-from the floor are feasible within clinical or laboratory settings.

Research Objectives To examine the differences in community participation and quality of life among individuals who use wheelchairs full time with and without fear of falling. Design Cross-sectional study design. Setting University research laboratory. Participants Individuals (NZ85) who use a manual or power wheelchair full time who are living with various health conditions and have a history of at least 1 fall in the past 12 months (age, 45.4 15.8y; disability duration, 21.5 13.6y) were included. Forty-six (54%) were manual wheelchair users. Interventions Not applicable. Main Outcome Measures To quantify FOF, participants responded (yes/no) to the question: “Are you worried or concerned that you might fall?” Community participation and QOL were indexed by the Community Participation Indicator (CPI) and the World Health Organization Quality of Life-Brief version (WHOQOL-BREF), respectively. A multivariate analysis of variance (MANOVA) was performed to examine the differences in CPI and WHOQOL-BREF scores among wheelchair users who reported FOF and no FOF. Results A total of 54 participants (63.5%) reported that they were worried or concerned about falling. The MANOVA revealed significant differences in overall CPI (F2,82Z4.714; PZ.012; Wilks’ lZ0.897) and WHOQOL-BREF (F4,63Z3.32; PZ.016; Wilks’ lZ.826) scores. Participants who reported FOF demonstrated significantly lower CPI and WHOQOL-BREF scores compared with those who did not report FOF. Conclusions FOF and associated activity curtailment are prevalent and may be a factor influencing full time wheelchair users’ community participation and QOL. Prospective research is needed to better understand how FOF influences community participation and QOL among individuals who use wheelchairs full time. Findings would support the development of interventions, specifically for individuals who use wheelchairs full time, to reduce FOF and improve community participation and QOL. Author(s) Disclosures Dr Sosnoff disclosed financial relationships with Abbvie and Permobil, outside the submitted work. The other authors have nothing to disclose.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This poster describes how the Medical Research Council’s process evaluation guidelines were applied in a clinical trial undertaken to evaluate a complex intervention designed to reduce falls among full-time wheelchair or scooter users with multiple sclerosis. Preliminary process evaluation findings relevant to implementation and mechanisms of impact based on postintervention survey and interview data from both participants and interventionists will be presented. Primary Author and Speaker: Toni Van Denend Additional Authors and Speakers: Elizabeth Walker Peterson, Laura Rice Contributing Authors: Jonghun Sung

Date Presented 03/26/20 This poster describes how the Medical Research Council’s process-evaluation guidelines were applied in a clinical trial undertaken to evaluate a complex intervention designed to reduce falls among full-time wheelchair or scooter users with MS. Preliminary process-evaluation findings relevant to implementation and mechanisms of impact based on post-intervention surveys and interview data from both participants and interventionists will be presented. Primary Author and Speaker: Toni Van Denend Additional Authors and Speakers: Elizabeth Peterson, Laura Rice Contributing Authors: JongHun Sung

Supplemental Material, CRE768385_Supplementry_tables_CLN for Perceptions of fall circumstances, injuries and recovery techniques among power wheelchair users: a qualitative study by Laura A Rice, JongHun Sung, Joseph Peters, Wendy D Bartlo and Jacob J Sosnoff in Clinical Rehabilitation

Objective: To determine the feasibility of dual task training in persons with Multiple Sclerosis. Design: Randomized, single-blinded controlled trial. Setting: University research laboratory. Participants: A total of 234 individuals inquired about the investigation. After screening, 20 individuals with multiple sclerosis who self-reported problems with multitasking and were ambulatory volunteered for the investigation. 14 participants completed the post-assessment following the 12-week intervention. Intervention: Participants were randomly assigned to either single task training program which focused on balance and walking function ( n=6) or dual task training program that incorporated cognitive tasks in balance and walking training ( n=8). Measures: Before and after the 12-week interventions participants underwent assessments of walking; dual task walking; balance (Berg Balance Scale and balance confidence) and cognition as indexed by the Brief International Cognitive Assessment for MS. Results: There was an 8.5% recruitment rate, a 70% retention rate, and a 100% adherence rate. There was a trend for dual task gait speed to improve in the dual task training group following the intervention (Pre: task 1: 109.8±39, task 2: 104.2±34.1; Post: task 1:127.6±40.1, task 2: 122.8±37.4; P=0.14; η2 = 0.24). There was also a trend for the dual task training group (28.1) to have greater performance than the control group (24.7) on visuospatial memory ( P=0.10; η2= 0.23). There were no changes in cognitive performance during walking trials. Conclusions: The study procedures were found to be feasible and improvements should be made in recruitment efforts going forward. Further examination of dual task training programs in individuals with multiple sclerosis is warranted.

Supplemental Digital Content is available in the text, Introduction: Falls are a serious concern for wheelchair and scooter users with multiple sclerosis (MS). Approximately, 75% of the population reports at least one fall in a 6-month period and nearly half report frequent falls. Falls can result in physical injuries and contribute to activity curtailment. Despite the negative consequences, limited evidenced-based fall prevention programs designed specifically for wheelchair and scooter users with MS exist. Purpose: Recognizing the threat falls pose to health and well-being and the dearth of fall prevention programs, the purpose of this study is to perform a structured process evaluation and examine the feasibility and efficacy of a community-based intervention specifically designed to reduce fall incidence among wheelchair and scooter users with MS. Secondary aims of the intervention are to improve functional mobility skills associated with fall risk (e.g., transfer and wheelchair skills, balance), increase knowledge of fall risk factors, decrease fear of falling, and enhance quality of life and community participation. Methods: To evaluate our specific aims, a clinical trial will be performed with 160 wheelchair and scooter users with MS. (ClinicalTrials.gov Identifier: NCT03705364). Participants will be recruited to participate in a small group-style community-based program. The content of the program will be based on factors found to be associated with falls among wheelchair and scooter users with MS. These factors include but are not limited to, wheelchair/scooter related characteristics, transfer activities, impaired seated balance, and environmental factors. A physical or occupational therapist, will implement the intervention, which is comprised of 6 sessions that occur once weekly. The incidence of falls, along with an examination of wheelchair/scooter and transfer skills, seated postural control and knowledge of fall related risk factors will be compared between intervention and control participants, with assessment periods occurring prior to the intervention, 1 to 2 weeks after completion of the 6-week intervention session, and 12 weeks after the intervention period is complete. Conclusion: Results from this study will guide the refinement of the intervention program and inform future research among a large and diverse group of wheelchair and scooter users living with MS.

Falls are common in persons with multiple sclerosis (MS), and are related to physical injury and reduce the quality of life. Mobility impairments are a significant risk factor for falls in persons with MS. Although there is evidence that mobility in persons with MS can be improved with rehabilitation, much less is known about fall prevention. This review focuses on fall prevention in persons with MS. Ten fall prevention interventions consisting of 524 participants with a wide range of disability were systematically identified. Nine of the 10 investigations report a reduction in falls and/or proportion of fallers following treatment. The vast majority observed an improvement in balance that co-occurred with the reduction in falls. Methodological limitations preclude any firm conclusions. Numerous gaps in the understanding of fall prevention in persons with MS are discussed. Well-designed randomized control trials targeting mobility and falls are warranted.