Evaluation of pediatric-specific resources to support utilization of the Wheelchair Skills Training Program by the users of the resources: a descriptive qualitative study.

BACKGROUND: Children's ability to engage in meaningful activities is positively influenced by their ability to move independently. Preliminary evidence in children suggests that wheelchair skills training improves wheelchair skills, which are important for independent mobility. The Wheelchair Skills Training Program is a standardized program to teach wheelchair skills. However, it is underutilized in pediatric rehabilitation settings. To increase its utilization, 3 pediatric-specific Wheelchair Skills Training Program resources related to indoor skills were developed (i.e., a storybook, four instructional posters, and a training workbook). This study aimed to describe occupational therapists' (OTs) and pediatric manual wheelchair users' (PMWUs) perceived satisfaction with the storybook, instructional posters and training workbook, and to explore their perceptions regarding the usability, relevance, and feasibility of these resources in pediatric rehabilitation settings. METHODS: A descriptive qualitative design was used. Convenience samples of OTs and PMWUs were recruited in a rehabilitation center and affiliated schools. A focus group with OTs and semi-structured interviews with PMWUs were conducted by videoconference to obtain participants' feedback on the resource prototypes and suggestions for improvement. Data were deductively analyzed using the Framework method. RESULTS: Eight OTs and 5 PMWUs expressed general satisfaction with the resources, describing them as usable, relevant, and feasible to integrate into wheelchair skills training with novice wheelchair users and younger children. All OTs and 3 PMWUs expressed the desire to use the resources for wheelchair skills training. Two PMWUs perceived the resources were not relevant to them because they already mastered the skills. The participants suggested minor modifications for improving the resources (e.g., more action in the story, increased precision of illustrations related to the characters' position in the wheelchair). CONCLUSION: OTs and PMWUs were satisfied with the resources, perceiving them to be applicable for training wheelchair skills among young children and novice wheelchair users. The resources represent a concrete solution to facilitate the use of the Wheelchair Skills Training Program in pediatric rehabilitation settings. Additional resources are needed to better reach older and more experienced PMWUs (i.e., of intermediate and advanced skill levels).

Adapting the Wheelchair Skills Program for pediatric rehabilitation: recommendations from key stakeholders.

BACKGROUND: Backed by over 20 years of research development, the Wheelchair Skills Program (WSP) has proven to be a safe and effective program to improving wheelchair skills for adult wheelchair users. However, evidence is lacking for the pediatric population, which may help to explain the limited use of the WSP in pediatric settings. While additional evidence specific to the pediatric population is needed, concurrent implementation of the WSP into pediatric clinical practice is equally prudent to allow those users to benefit from the years of accumulated WSP evidence. To facilitate implementation of evidence-based programs into practice, adaptation is also often required to improve the fit between the program and the local context. Therefore, the objective of this study was to understand what adaptations, if any, are required for the WSP to be implementable in a pediatric setting. METHODS: A deductive qualitative descriptive study design was used, guided by the Knowledge to Action Framework and Consolidated Framework for Implementation Research (CFIR). Occupational Therapists (OTs) from a pediatric rehabilitation center and two specialized schools in Montreal, Canada were invited to participate in a 90-min focus group. The Framework Method was followed for the data analysis. RESULTS: One focus group in each site (n = 3) was conducted with a total of 19 participants. From the OTs' perspectives, our analysis revealed benefits of WSP use and various issues (e.g. some skills seem unrealistic) affecting its uptake in relation to the constructs of the CFIR Intervention Characteristics domain. The results provided guidance for the recommendations of adaptations (e.g. addition of a caregiver assistance score) to enhance implementation of the WSP in pediatric rehabilitation settings and helped to identify the need for the production of new knowledge and knowledge translation (KT) tools. CONCLUSIONS: Implementation of the WSP with the adaptations and KT tools proposed could allow pediatric manual wheelchair users to improve their wheelchair skills.

Development of a toolkit for educators of the wheelchair service provision process: the Seating and Mobility Academic Resource Toolkit (SMART).

BACKGROUND: Insufficient wheelchair training among rehabilitation professionals has been identified as an important factor that hinders access to appropriate wheelchair services. The aim of this study was to develop a toolkit to promote the integration of wheelchair education into academic curricula of rehabilitation programs. METHODS: A participatory action research design was carried out in three phases: (1) development of the Initial and Alpha Versions involving secondary analyses of surveys (n = 72), interviews (n = 14), and academic training partners meeting presentations (n = 16); (2) development of the Beta Version based on feedback from collaborators (n = 21); and (3) development of the Launch Version based on feedback from participants attending presentations of the Beta Version at conferences, symposiums, and webinars (n = 94). RESULTS: Over 100 individuals participated in reviews of the Seating and Mobility Academic Resource Toolkit (SMART). Initial development addressed modifiable factors that perpetuate insufficient wheelchair education in academic curricula (e.g., limited awareness, limited expertise). Internal feedback on the web-based Alpha Version resulted in modifications of appearance and multimedia, structure and design, and navigation. External feedback then led primarily to fine-tuning the navigation of SMART. Positive reviews were received from global wheelchair professionals (i.e., educators, researchers, clinicians). The Launch Version of the SMART (smart.wheelchairnetwork.org) provides a forum for sharing and accessing resources to inform the integration and enhancement of wheelchair content into university rehabilitation programs. CONCLUSIONS: As an open-source open-access online "living document," SMART has the potential to promote the integration of wheelchair service provision education into academic curricula of rehabilitation programs. Future studies will explore the ease of use and the effectiveness of the SMART.

Longitudinal Outcomes Among Family Caregivers of Power Mobility Users.

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.

Powerful or Powerless? Children's, Parents', and Occupational Therapists' Perceptions of Powered Mobility.

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.

Use of Virtual Technology as an Intervention for Wheelchair Skills Training: A Systematic Review.

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.

Rasch Analyses of the Wheelchair Use Confidence Scale for Power Wheelchair Users.

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.

Extent to Which Caregivers Enhance the Wheelchair Skills Capacity and Confidence of Power Wheelchair Users: A Cross-Sectional Study.

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.

Reliability, convergent validity and applicability of the Assistive Technology Outcome Profile for Mobility for middle-aged and older power wheelchair users.

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.

Wheelchair Skills Capacity and Performance of Manual Wheelchair Users With Spinal Cord Injury.

OBJECTIVES: To describe the wheelchair skills capacity and performance of experienced manual wheelchair users with spinal cord injury (SCI) and to assess measurement properties of the Wheelchair Skills Test (WST) and Wheelchair Skills Test Questionnaire (WST-Q). DESIGN: Cross-sectional descriptive study involving within-subject comparisons. SETTING: Four Spinal Cord Injury Model Systems centers. PARTICIPANTS: Manual wheelchair users with SCI (N=117). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: WST and WST-Q version 4.2 as well as measures for Confidence, Basic Mobility, Independence, Ability to Participate, Satisfaction, and Pain Interference. RESULTS: The median (interquartile range) values for WST capacity, WST-Q capacity, and WST-Q performance were 81.0% (69.0%-90.0%), 88.0% (77.0%-97.0%), and 76.0% (66.3%-84.0%). The total WST capacity scores correlated significantly with the total WST-Q capacity scores (r=.76; P<.01) and WST-Q performance scores (r=.55; P<.01). The total WST-Q capacity and WST-Q performance scores were correlated significantly (r=.63; P<.001). Success rates were <75% for 10 of the 32 (31%) individual skills on the WST and 6 of the 32 (19%) individual skills on the WST-Q. Regression models for the total WST and WST-Q measures identified statistically significant predictors including age, sex, body mass index, and/or level of injury. The WST and WST-Q measures correlated significantly with the Confidence, Basic Mobility, Independence, or Pain Interference measures. CONCLUSIONS: Many people with SCI are unable to or do not perform some of the wheelchair skills that would allow them to participate more fully. More wheelchair skills training may enhance participation and quality of life of adults with SCI. The WST and WST-Q exhibit good content, construct, and concurrent validity.

Rasch analyses of the wheelchair use confidence scale.

OBJECTIVES: To compare the functioning of the 101-point response format of the Wheelchair Use Confidence Scale (WheelCon) with shortened 11-point formats, and to evaluate the scale's measurement properties using principal components and Rasch analyses. DESIGN: Secondary analysis of cross-sectional data. SETTING: Community. PARTICIPANTS: Volunteer participants were manual wheelchair users (N=220) ≥19 years of age, with ≥6 months' experience with daily wheelchair use and no cognitive impairment. INTERVENTIONS: None. MAIN OUTCOME MEASURE: 65-item WheelCon. RESULTS: The 11-point response format outperformed the original 101-point format. Principal component analyses confirmed the presence of 2 dimensions: mobility efficacy and self-management efficacy. Thirteen items in the mobility efficacy subscale and 8 items in the self-management efficacy subscale fit the Rasch Rating Scale model. Five items misfit the model developed using the 21 items from both subscales. In each of the 13- and 8-item subscales, and the 21-item short form, the 2 lowest and highest scores had internal consistency reliability estimates <.70; all other scores had reliability estimates >.70. CONCLUSIONS: The WheelCon is composed of 2 dimensions. The recoded measurements using a 0-to-10 response scale from the 13-item mobility and 8-item self-management efficacy subscales have good reliability, as do the measurements from the 21-item WheelCon Short Form. The use of the subscales, the short form, or both, depends on the context in which they are being considered. Research to establish the reliability and validity of the measurements using the 0-to-10 response format is warranted.

Exploratory Validation of a Multidimensional Power Wheelchair Outcomes Toolkit.

OBJECTIVE: To evaluate the relation among the measures in a power wheelchair outcomes toolkit. DESIGN: We performed path analysis of cross-sectional data from self-report questionnaires and 1 objective measure. SETTING: Six sites. PARTICIPANTS: A convenience sample of power wheelchair users (N=128). Most (n=69; 53.9%) participants were women. Multiple sclerosis and spinal cord injury/disease were the most common diagnoses. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The power wheelchair version of the Wheelchair Skills Test version 4.1 was used to carry out an objective evaluation of capacity to perform 32 wheelchair skills. The Late-Life Disability Index measured frequency of participation in 16 life activities. The Life-Space Assessment measured independence, extent, and frequency of mobility. The Assistive Technology Outcomes Profile for Mobility was used to assess perceived difficulty performing activity and participation using assistive technology. The Wheelchair Use Confidence Scale for powered wheelchair users captured users' self-efficacy with wheelchair use. RESULTS: Wheelchair confidence was independently associated with less difficulty with activity (ß=.028, P=.002) and participation (ß=.225, P<.001), increased life space (ß=.095, P<.003), and greater wheelchair skills (ß=.30, P<.001). Less perceived difficulty with activity was independently associated with increased frequency of participation (ß=.55, P<.001). Life-space mobility was independently associated with increased frequency of participation (ß=.167, P<.001). Less difficulty with participation was independently associated with greater life-space mobility (ß=.59, P<.001) and greater frequency of participation (ß=.13, P<.001). CONCLUSIONS: This study provides empirical support for the measures included as part of the power wheelchair outcomes toolkit. They appear to provide complementary information on a variety of constructs related to power wheelchair use.

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial.

OBJECTIVES: To test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation. DESIGN: Randomized controlled trial. SETTING: Rehabilitation centers and communities. PARTICIPANTS: Powered wheelchair users (N=116). INTERVENTION: Five 30-minute WSTP training sessions. MAIN OUTCOME MEASURES: Assessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA). RESULTS: There was no significant t2-t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3. CONCLUSIONS: Powered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

Trunk and glenohumeral joint adaptations to manual wheelchair propulsion over a cross-slope: An exploratory study.

BACKGROUND: Cross-slopes are often encountered by manual wheelchair users propelling within an urban setting. While propulsion over cross-slopes is more difficult than on level surfaces, little is known about how the users counter the downhill turning tendency of the wheelchair over cross-slopes. This study aimed to identify the adaptations of the manual wheelchair users to the presence of cross-slopes and examine how these might impact shoulder injury. METHODS: Nine manual wheelchair users propelled themselves across a cross-slope and over a level surface. The trunk and glenohumeral joint kinematics, as well as the handrim contact tangential force were compared between both conditions for the uphill and downhill limbs. FINDINGS: The uphill arm technique used to counter the downhill turning tendency varied greatly in terms of potential injury risk and efficiency between participants. Trunk flexion increased the turning tendency of the manual wheelchair, yet only one participant decreased his flexion when rolling over the cross-slope. Various potential pathomecanisms related to the trunk lateral flexion and the glenohumeral kinematics over a cross-slope were identified. INTERPRETATION: Both the uphill arm technique and trunk kinematics are important to propel over a cross-slope both efficiently and safely. Accordingly, tips about posture and kinematics are needed to teach this skill to manual wheelchair users. Additionally, as wheelchair positioning seems to influence the cross-slope skill, more research is needed to explore the impact of positioning devices (e.g., lateral supports) and wheelchair modifications (e.g., power assist wheels, handrim projections) on this skill.

Positive and negative experiences of caregivers helping power wheelchair users: a mixed-method study.

PURPOSE: This 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

User perceptions about resources based on the Wheelchair Skills Training Program for training indoor and community wheelchair skills in pediatrics: a descriptive qualitative study.

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.

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.

Wheeled mobility use outcomes: a systematic review of measurement properties protocol.

INTRODUCTION: Numerous tools have been developed to measure constructs related to wheelchair use. Currently, no toolkit comprehensively details assessments of wheeled mobility device use based on the quality of their measurement properties. The current review aims to systematically identify high-quality assessment tools that measure different aspects of wheeled mobility use. OBJECTIVE: The objectives are two-fold: (1) to synthesize outcome measures that assess use of wheeled mobility devices, and (2) to evaluate measurement properties of the assessment tools. INCLUSION CRITERIA: The populations of interest are manual wheelchair users, power wheelchair users, and scooter users of any age, diagnosis, or setting. Instruments of any type will be included. METHOD: The JBI methodology for systematic reviews of measurement properties will guide this review. A search strategy will be developed to search the following databases: MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), PsycTests (EBSCOhost), Web of Science, and Google Scholar. The article selection process, data extraction, and quality appraisal will be performed by 2 independent reviewers, with a third reviewer being consulted to achieve consensus. The methodological quality of the studies will be assessed through the Consensus Standards for the Selection of Measurement Instruments (COSMIN) Risk of Bias tool and the COSMIN Checklist. The quality of the pooled evidence and individual measurement properties will be graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the COSMIN Criteria for Good Measurement Properties recommendations. Measurement properties of each instrument will be described, with the goal of developing a toolkit that identifies appropriate assessment tools for wheeled mobility use outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD4202276169.

Exploration of pediatric manual wheelchair confidence among children, parents, and occupational therapists: a qualitative study.

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.IMPLICATIONS FOR REHABILITATIONThis 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.

French-Canadian translation, cultural adaptation, and preliminary evaluation of the wheelchair service provision - basic test validity among occupational therapy students.

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.IMPLICATIONS FOR REHABILITATIONThe 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.

The French-Canadian WheelCon for manual wheelchair users: paediatric adaptation and preliminary evaluation of its measurement properties.

PURPOSE: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: This study provides preliminary evidence of a valid and reliable WheelCon-M-F-P.IMPLICATIONS FOR REHABILITATIONThe 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.