Do Exercise Programs Improve Fitness, Mobility, and Functional Capacity in Adults With Lower Limb Amputation? A Systematic Review on the Type and Minimal Dose Needed.

OBJECTIVE: To answer the following questions: (1) Do physical activity (PA) and exercise improve fitness, mobility, and functional capacity among adults with lower limb amputation (LLA) and (2) What is the type and minimum dose of PA (frequency, intensity and duration) needed? DESIGN: Systematic review. SETTING: Outpatient intervention, outside of the prosthetic rehabilitation phase. PARTICIPANTS: Adults with lower limb amputation living in the community. INTERVENTION: Any physical activity or exercise intervention. OUTCOMES AND MEASURES: Any fitness, mobility, or functional capacity indicators and measurements. RESULTS: Twenty-three studies were included, totaling 408 adults with LLA. Studies evaluated the effect of structured PA sessions on fitness, mobility, and functional capacity. The highest evidence is for mixed exercise programs, that is, programs combining aerobic exercise with strengthening or balance exercise. There is moderate confidence that 1-3 sessions of 20-60 minutes of exercise per week improves balance, walking speed, walking endurance, and transfer ability in adults with LLA above the ankle. As for flexibility, cardiorespiratory health, lower-limb muscles strength, and functional capacity, there was low confidence that exercise improves these fitness components because of the lack of studies. CONCLUSION: Exercise 1-3 times per week may improve balance, walking speed, walking endurance, and transfer ability in adults with LLA, especially when combining aerobic exercises with lower limb strengthening or balance exercises. There is a need for most robust studies focusing on the effect of PA on cardiorespiratory health, muscles strength, flexibility, and functional status.

Feasibility and Utility of a Fitbit Tracker Among Ambulatory Children and Youth With Disabilities.

PURPOSE: To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities. METHOD: Participants (4-17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group. RESULTS: Participants (N = 157; median age = 10 y; 71% boys; 71% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95% CI, 15.5 to 39.7) and adolescents (mean difference = -21.2; 95% CI, -33.6 to -8.7) than children. More daily steps were taken by boys than girls (mean difference = -1040; 95% CI, -1465 to -615) and individuals with a nonphysical disability than a physical disability (mean difference = -1120; 95% CI, -1474 to -765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school. CONCLUSION: The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention.

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).

Influence of Peer-led Wheelchair Training on Wheelchair Skills and Participation in Older Adults: Clinical Outcomes of a Randomized Controlled Feasibility Trial.

OBJECTIVE: To estimate treatment effect size of a peer-led Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU) program on objective wheelchair skills (primary); and on perceived wheelchair skills capacity and performance, wheelchair use self-efficacy, satisfaction with participation, life-space mobility, and participation frequency (secondary); and to evaluate retention 6 months later (secondary). DESIGN: Randomized controlled trial. SETTING: Rehabilitation centers and communities. PARTICIPANTS: Community-living older adults (N=40). INTERVENTION: WheelSeeU comprised six 90-minute peer-led sessions of customized training (in pairs) according to participants' goals. A support-trainer provided spotting. The control group comprised six 90-minute professional-led didactic information sessions (in pairs). MAIN OUTCOME MEASURES: The Wheelchair Skills Test (WST), Wheelchair Skills Test Questionnaire (WST-Q), Wheelchair Use Confidence Scale for Manual Wheelchair Users-Short Form (WheelCon-M-SF), Wheelchair Outcomes Measure (WhOM), Life-Space Mobility (LSA), and Late Life Function and Disability Index (LLFDI) were collected at baseline (T1), postintervention (T2), and 6 months postintervention (T3). RESULTS: Of 121 screened, 39 individuals did not meet the inclusion criteria and 41 declined to participate. Forty participants (64.5 years of age; 60% men) were randomized, 38 completed the intervention, and 35 completed T3 assessments. There were no adverse effects. WheelSeeU did not have a statistically significant greater effect on objective WST (primary) or WST-Q capacity, WheelCon, LSA, and LLFDI at T2 compared to the control group. Effect sizes were statistically significant and large for WST-Q performance (Cohen's d=0.72) and the WhOM (Cohen's d=0.82) at T2, and effects were retained at T3. CONCLUSION: Compared to an active control group, WheelSeeU did not have a greater effect on wheelchair skills capacity. However, WheelSeeU should not be prematurely dismissed as an approach to potentially improve wheelchair skills performance and satisfaction with participation in meaningful activities. Sex and depression are important when designing interventions for older adults.

Balance Confidence: A Predictor of Perceived Physical Function, Perceived Mobility, and Perceived Recovery 1 Year After Inpatient Stroke Rehabilitation.

OBJECTIVE: To estimate the effect of balance confidence measured at 1 month poststroke rehabilitation on perceived physical function, mobility, and stroke recovery 12 months later. DESIGN: Longitudinal study (secondary analysis). SETTING: Multisite, community-based. PARTICIPANTS: Community-dwelling individuals (N=69) with stroke living in a home setting. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Activities-specific Balance Confidence scale; physical function and mobility subscales of the Stroke Impact Scale 3.0; and a single item from the Stroke Impact Scale for perceived recovery. RESULTS: Balance confidence at 1 month postdischarge from inpatient rehabilitation predicts perceived physical function (model 1), mobility (model 2), and recovery (model 3) 12 months later after adjusting for important covariates. The covariates included in model 1 were age, sex, basic mobility, and depression. The covariates selected for model 2 were age, sex, balance capacity, and anxiety, and the covariates in model 3 were age, sex, walking capacity, and social support. The amount of variance in perceived physical function, perceived mobility, and perceived recovery that balance confidence accounted for was 12%, 9%, and 10%, respectively. CONCLUSIONS: After discharge from inpatient rehabilitation poststroke, balance confidence predicts individuals' perceived physical function, mobility, and recovery 12 months later. There is a need to address balance confidence at discharge from inpatient stroke rehabilitation.

Pilot Study of a Peer-Led Wheelchair Training Program to Improve Self-Efficacy Using a Manual Wheelchair: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the effect of a peer-led wheelchair training program on self-efficacy of manual wheelchair (MWC) use and to explore influences of the intervention on MWC skills, life-space mobility, and satisfaction with participation. DESIGN: Pilot randomized controlled trial. SETTING: Rehabilitation center and community. PARTICIPANTS: Community-living MWC users (N=28; mean MWC experience, 13y; mean age, 49y; 6 [21%] women). INTERVENTIONS: The experimental group (n=16) received six 1.5-hour sessions of a peer-led self-efficacy-enhanced wheelchair training program (WheelSee). On the basis of individualized goals, peer trainers administered WheelSee to pairs of MWC users. The control group (n=12) received no intervention. MAIN OUTCOME MEASURES: The primary outcome--wheelchair use self-efficacy--was assessed using the Wheelchair Use Confidence Scale (WheelCon) version 3.0. Secondary outcomes included wheelchair skills capacity and performance (Wheelchair Skills Test Questionnaire version 4.1), life-space mobility (Life Space Assessment), and satisfaction with participation (Wheelchair Outcome Measure). RESULTS: Controlling for baseline scores, an analysis of covariance revealed that WheelSee had a large statistically significant effect on MWC use self-efficacy in community-living adult MWC users (Cohen d=1.4; P=.002) than in a control group. WheelSee also had a large statistically significant effect on MWC skills capacity (Cohen d=1.3; P=.003) and performance (Cohen d=1.0; P=.02). There were no statistically significant differences in life-space mobility or satisfaction with participation scores between the groups. CONCLUSIONS: A peer-led MWC training program improves wheelchair use self-efficacy in adult MWC users and had a positive influence on other wheelchair-related outcomes. WheelSee may offer a promising intervention strategy to accommodate the training needs of community-living MWC users.

Systematic Review and Meta-Analysis of Peer-Led Self-Management Programs for Increasing Physical Activity.

PURPOSE: Approximately 85 % of Canadians are not physically active enough to achieve health benefits. Peer-led self-management programs are becoming an increasingly popular strategy for modifying health behaviors, including physical activity. The purpose of this study was to systematically review and meta-analyze the effect of peer-led self-management interventions on physical activity. METHODS: PubMed, MEDLINE, PsycINFO, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews databases were systematically searched to identify all relevant randomized controlled trials that evaluated the effect of peer-led self-management on physical activity. The studies were described and effect size data were included in meta-analyses. Subgroup analyses were performed according to type of physical activity outcome (i.e., duration, frequency, other). RESULTS: Twenty-one studies were included in the review and 14 reported statistically significant improvements in physical activity. A meta-analysis of 17 studies showed a statistically significant moderate pooled effect (standardized mean difference (SMD) = 0.4, p < 0.001) of peer-led self-management programs on physical activity immediately post-intervention. The intervention had a large statistically significant effect based on the four studies that included follow-up measures (SMD = 1.5, p = 0.03). Meta-analysis of nine studies that used similar outcomes (i.e., minutes of physical activity) revealed a statistically significant small effect (SMD = 0.2, p < 0.001). CONCLUSION: Peer-led self-management programs appear to be effective at increasing weekly duration of physical activity in various populations, but the effect size is small. Training peers to encourage increased physical activity may provide an effective method for reaching various clinical and non-clinical populations. More research is needed using validated and consistent physical activity outcomes.

Randomized controlled trial protocol feasibility: The Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU).

BACKGROUND: Manual wheelchairs (MWCs) can improve mobility and social participation for individuals who experience difficulty walking; however, older adults receive little training for wheelchair use. The Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU) research program provides peer-led training that may positively influence wheelchair use while reducing clinician burden. PURPOSE: The purpose of this study is to evaluate the feasibility and clinical outcomes of WheelSeeU. METHOD: A randomized control trial (RCT) recruits and randomly assigns 40 MWC users (55+ years). Feasibility indicators assessing process, resource, management, and treatment issues are measured, and clinical outcomes (wheelchair skills, safety, confidence, mobility, social participation, quality of life, health utility) are collected at three time points. IMPLICATIONS: WheelSeeU provides an innovative approach for teaching wheelchair skills to an aging population that may improve wheelchair use and decrease clinician burden. Since RCTs are expensive and challenging in rehabilitation, establishing feasibility prior to larger effectiveness trials is prudent.

Exploring the Influence of Structured Familiarization to an Adjustable, Passive Load-Bearing Exoskeleton on Oxygen Consumption and Lower Limb Muscle Activation During Walking.

Walking patterns are modified during load carriage, resulting in an increased activation of lower limb muscles and energy expenditure. Negative effects of load carriage could be minimized by wearing an exoskeleton, but evidence on the effects are conflicting. The objectives of this study were to describe the influence of an adjustable, passive load-bearing exoskeleton on the metabolic cost of walking (MCW) and associated muscle activations, and to explore changes in MCW after a familiarization process. Thirteen participants walked on a treadmill with a 22.75 kg payload at six preselected speeds (from 0.67 to 1.56 m/s) under three walking conditions: 1) without exoskeleton (NoExo); 2) with exoskeleton before familiarization (ExoPre); and 3) with exoskeleton after familiarization (ExoPost). Metabolic data was normalized to walking speed to provide MCW. Multi-muscle surface electromyography (EMG) was time and amplitude normalized to the gait cycle to provide muscle activation patterns. The familiarization occurred over three weeks including exposure to the exoskeleton. Differences in MCW and muscle activations were compared using a nonparametric analysis of longitudinal data. There were statistically significant increases in MCW for all speeds in the ExoPre and ExoPost conditions compared the NoExo. The average muscle activation showed an increase during ExoPre and ExoPost for the three speeds evaluated. Post-hoc analysis showed no significant effect of the familiarization period on metabolic data. In conclusion, a first exposure to the adjustable exoskeleton increased MCW and muscle activations, but the familiarization process did not provide any benefits toward a reduction in MCW or reduction in muscle activations at all speeds evaluated.

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.

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.

Wheelchair skills training to improve confidence with using a manual wheelchair among older adults: a pilot study.

OBJECTIVE: To examine the effects of wheelchair skills training on confidence in older adults who are inexperienced wheelchair users. DESIGN: Parallel group, single-blind randomized controlled trial. SETTING: Research laboratory in a rehabilitation hospital. PARTICIPANTS: Participants (N=20) who were community-living older adults at least 65 years old (mean age, 70y), 50% women, and who had no experience of using a wheelchair were randomly allocated to an intervention (n=10) or control (n=10) group. INTERVENTIONS: The intervention group received two 1-hour training sessions that followed the Wheelchair Skills Training Program (WSTP) protocol. The control group received a single socialization contact. MAIN OUTCOME MEASURE: The Wheelchair Use Confidence Scale-Manual (WheelCon-M) was used to evaluate confidence with using a manual wheelchair. The WheelCon-M is a self-report questionnaire that comprises 65 items in 6 conceptual areas. RESULTS: A 1-way between-groups analysis of covariance revealed a significant difference in postintervention WheelCon-M scores between the intervention and control groups (F1,17=10.9, P=.004) after controlling for baseline WheelCon-M scores. A large effect size was also observed (partial η(2)=.39). Secondary analyses revealed that the WSTP had greater effects on confidence in areas related to maneuvering around the physical environment, knowledge and problem solving, advocacy, and managing emotions than in areas related to performing activities and behaving in social situations. CONCLUSION: Two 1-hour WSTP sessions improve confidence with using a manual wheelchair among older adults who are inexperienced wheelchair users.

Influence of Roulez avec confiance, a peer-led community-based wheelchair skills training program, on manual wheelchair users.

PURPOSE: Few studies have demonstrated that peer-led manual wheelchair (MWC) skills training can increase MWC skills, MWC use self-efficacy and satisfaction with participation of MWC users. Limited information is available on MWC skills training in the community. The primary objective was to measure the influence of Roulez avec confiance (RAC, which translated to "Wheeling with confidence"), a peer-led community-based wheelchair skills training program, on satisfaction with participation. The secondary objectives were to explore the: (1) influence of RAC on MWC use self-efficacy, MWC skills, and quality of life; (2) experiences of the participants who completed RAC and (3) three-month retention of outcomes. METHODS: A parallel mixed design was used with validated questionnaires on satisfaction with participation (WhOM), MWC use self-efficacy (WheelCon-M), MWC skills (WST-Q), quality of life (SWLS) and a semi-structured interview on participants' experiences. Non-parametric longitudinal analyses of the questionnaires and thematic content analysis of the interviews were completed. RESULTS: Nineteen community-dwelling MWC users participated. There was a statistically significant increase (p < 0.0001) in all outcomes except quality of life (p = 0.16). Improvements were retained after three months. Participants mentioned their background influenced their experiences in RAC. Positive elements about RAC and areas for improvement were discussed. Participants reported overall positive social experiences and stated that the physical environment influenced RAC. Finally, participants spoke about what they learned and emotions they felt during RAC. CONCLUSIONS: Peer-led community-based MWC training influenced satisfaction with participation, MWC skills, and MWC use self-efficacy. This study was a first step in demonstrating the efficiency of RAC.IMPLICATIONS FOR REHABILITATIONLimited information is available on manual wheelchair skills training in the community.Peer-led community-based manual wheelchair training influenced satisfaction with participation, manual wheelchair skills and use self-efficacy.This study was a first step in demonstrating the efficiency of Roulez Avec Confiance.

Expert consensus for a digital peer-led approach to improving physical activity among individuals with spinal cord injury who use manual wheelchairs.

CONTEXT: Active Living Lifestyles for manual wheelchair users (ALLWheel) uses a digital peer-led approach to incorporate two behavior change theories to address a critical need for leisure-time physical activity (LTPA) programs for individuals with spinal cord injury (iSCI). OBJECTIVE: The objective of this study was to obtain expert opinion and consensus for the ALLWheel program. DESIGN: Mixed-methods (qualitative and quantitative) were used to gather expert opinion and consensus for the ALLWheel program using an action research approach. SETTING: Rehabilitation center. PARTICIPANTS: Experts in SCI and LTPA included iSCI who used manual wheelchairs, healthcare professionals, and community collaborators. PROCEDURES: Two, 90-minute focus groups were conducted and transcribed verbatim, analyzed thematically, and the results were used to create a Delphi survey. Delphi surveys were completed online using consecutive rounds until ≥70% consensus per item was attained. Cumulative percent concordances were calculated to determine consensus. RESULTS: Twelve experts in SCI and LTPA participated in focus groups. Four themes were generated: Need for LTPA programs; Important considerations; Perceptions about peer-coaches; and Feelings about smartphones, which were used to generate the Delphi survey. Consensus on the ALLWheel program was attained in two rounds. CONCLUSIONS: Experts established a need for fun and personalized community-based LTPA programs. Ensuring that healthcare professionals would be involved in the ALLWheel program alleviated safety concerns, and experts agreed there were benefits of peers delivering the program. Experts agreed that the ALLWheel program targeted important psychological factors (i.e. autonomy, relatedness, self-efficacy, and motivation) and affirmed the potential for a potentially large geographic reach.

Factors clinicians consider when providing pediatric wheelchair skills training: a modified think aloud study.

PURPOSE: Children who use a manual wheelchair (WC) or a power WC may not receive adequate WC skills training. Clinicians report knowledge as a barrier to the provision of paediatric WC skills training. The purpose of this study was to explore the breadth and depth of specific factors clinicians consider when providing WC skills training for children. METHODS: Data in this modified Think Aloud study were gathered via one-on-one, Zoom-based, audio-recorded Think Aloud Sessions. Sessions consisted of participants viewing four videos, each of different children performing a different WC skill while thinking aloud (verbally expressing) about the factors they recognized, observed, and considered while watching the video. After each video, participants also responded to questions regarding the specific WC skill and the provision of WC skills training for the child in the video. Factors participants reported were independently identified by three researchers through a deductive process of directed content analysis and categorized using the International Classification of Functioning, Disability and Health (ICF) coding system. RESULTS: Twenty-eight English-speaking clinicians participated in the study. A total of 1246 distinct factors were mapped to 352 unique ICF codes spanning all four ICF Domains. The largest number of identified factors mapped to codes within the Activities and participation Domain (42.25%). CONCLUSION: Participants reported considering multiple factors across the ICF in the provision of WC skills training for children. Providing paediatric WC skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities.IMPLICATIONS FOR REHABILITATIONProviding paediatric wheelchair (WC) skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities.Clinicians should consider the child's Mental Functions, Activities and Participation, and Environmental Factors when providing wheelchair skills training for children.A lack of wheelchair-specific International Classification of Functioning, Disability, and Health codes was noted. Revising these codes to better capture the diverse range of the benefits and challenges involved in learning to use and using a wheelchair would be beneficial.

Public Transport Accessibility for People With Disabilities: Protocol for a Scoping Review.

BACKGROUND: Transportation is essential for people of all ages and backgrounds to live a fulfilling and satisfying life. Public transport (PT) can facilitate access to the community and improve social participation. However, people with disabilities may encounter barriers or facilitators in the whole travel chain that can lead to negative or positive perceptions in terms of self-efficacy or satisfaction. These barriers may be perceived depending on the nature of the disability. Few studies have identified PT barriers and facilitators experienced by people with disabilities. However, findings were focused mainly on specific disabilities. Access requires broader considerations of barriers and facilitators for various types of disabilities. OBJECTIVE: This scoping review aims to describe the barriers and facilitators to the use of PT experienced by people with various disabilities in the whole travel chain and to explore perceived experiences, self-efficacy, and satisfaction when using PT. METHODS: A scoping review will be conducted using Arksey and O'Malley's framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The literature search will be conducted using the electronic databases MEDLINE, Transport Database, and PsycINFO via Ovid platform, Embase, and Web of Science from 1995 to 2022. Two reviewers will independently identify studies based on inclusion (published in English or French, outcomes on PT accessibility for people with disabilities, peer-reviewed or guideline reports or editorials) and exclusion (no full text, focused on a technology system, outcome validation study, study on no-fixed route PT accessibility, etc) criteria and extract the data. When a study has addressed the accessibility of multiple modes of PT, including fixed-route PT, it will be retained. However, only data on fixed-route PT will be extracted. Any related systematic reviews identified through the search will be retained, and the reference lists will be hand-searched and screened for inclusion criteria. RESULTS: The search we performed on July 21, 2022, in the databases mentioned above allowed us to retrieve 6399 citations. Of these citations, 31 articles were identified, and data extraction was performed. As of March 11, 2023, we have started data analysis. The findings will be synthesized narratively to summarize the barriers and facilitators to PT, perceived experiences with PT, self-efficacy for using PT, and satisfaction with PT according to the Human Development Model-Disability Creation Process conceptual framework. CONCLUSIONS: The results of this scoping review could lead to a better understanding of the potential barriers and facilitators to the use of PT by people with various types of disabilities and how negative or positive experiences throughout the travel may influence their self-efficacy and satisfaction. The results may be used to provide recommendations to PT providers and policy makers to work together to make PT accessible, usable, and inclusive for all people with disabilities. TRIAL REGISTRATION: Open Science Framework OSF.IO/2JDQS; https://osf.io/2jdqs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43188.

Feasibility of a remotely supervised home-based group eHealth Fitness and Mobility Exercise program for stroke: French-Canadian version preliminary study.

BACKGROUND: The numerous barriers to community-based physical activity programs have been exacerbated by the COVID-19 pandemic, especially among individuals with disabilities. eHealth programs may provide an alternative approach to address the physical activity needs of stroke survivors, but little is known about their feasibility or acceptance. OBJECTIVE: The aims of this study were to 1) evaluate the feasibility of a remotely supervised home-based group eHealth program called Fitness and Mobility Exercise (FAME@home); 2) explore the influence of FAME@home on physical condition, mobility, self-efficacy, depression and anxiety; and 3) describe participants' satisfaction and experiences. METHODS: A pre-post pilot study was used to recruit stroke survivors (>1 y post stroke) to complete a 12-week (2 days/week) eHealth program in small groups (n = 3). Feasibility indicators were assessed for process (e.g. inclusion criteria), resources (e.g. ability to use technology), management (e.g. major challenges), and treatment (e.g. influence on clinical outcomes and adverse events). RESULTS: Nine participants were recruited with a mean (SD) of 60 (13) years of age and 7 (4) years post-stroke; eight completed the program. FAME@home was feasible for indicators of process, management, and treatment. Minor considerations to improve resources were suggested (i.e. support for technology use). There were statistically significant improvements in mobility after completion of FAME@home and 100% of the participants reported satisfaction. No adverse events occurred. CONCLUSION: FAME@home was feasible to deliver as a remotely supervised group exercise program to community-dwelling stroke survivors, with high levels of retention and adherence. FAME@home improved accessibility to exercise and facilitated engagement by having a class schedule and social interaction.

Blind spot sensor systems for power wheelchairs: obstacle detection accuracy, cognitive task load, and perceived usefulness among older adults.

PURPOSE: Blind spot sensor systems can improve power wheelchair (PWC) safety. This research (1) compared accuracy of obstacle detection in the rear of a wheelchair with and without a sensor system, and (2) explored cognitive task load and perceived usability, safety, confidence and awareness in a laboratory setting, and (3) PWC users' perceptions in real-world settings. MATERIALS AND METHODS: A mixed-method design was used. PWC users were provided with the sensor system. In laboratory accuracy of obstacle detection with and without a sensor system, cognitive task load and perceived usability, safety, confidence and awareness were evaluated. Participants then used the sensor system at home for two-months before completing semi-structured interviews. Statistical and thematic analyses were conducted. RESULTS: Among 11 PWC users (age = 67.5 ± 7.5y), obstacles were detected more accurately with sensor system than without (p < 0.001). Using the sensor system required lower cognitive task loads (p = 0.005). The system was perceived by most users as easy to use (9/11) and its capabilities meeting their requirements (8/11). Most users did not perceive safety (9/11), confidence (9/11) or increased awareness (10/11) in the laboratory. Three themes emerged in the follow-ups: perceived usefulness, barriers to use, and recommendations. Four participants reported continued use after 2 months, reporting perceived increased awareness, convenience, and independence using the system. Those who discontinued use reported perceived lack of usefulness and technical issues. Recommendations included types of users who can benefit and sensor improvements. CONCLUSIONS: Sensor systems may improve obstacle detection accuracy while reducing cognitive task load. However, larger scale implementation should consider recommendations for PWC service provision.IMPLICATIONS FOR REHABILITATIONBlind spot sensors systems increased speed and accuracy of obstacle detection when using a power wheelchair.Technical and hardware issues encountered by PWC users highlight the need for training and support services.Technical support was out of scope for the current research project and will be explored in future research given the critical role it might play in the usability and adoption of assistive technologies.PWC users perceived there to be practical uses for blind spot sensor systems.

Examining long-term motivational and behavioral outcomes of two physical activity interventions.

OBJECTIVE: To examine possible impacts of two theory-based interventions - "Enhancing quality of life through exercise: A tele-rehabilitation approach (TEQ) and Active Living Lifestyles for individuals with SCI who use Wheelchair (ALLWheel)" - 12-18 months post-intervention on the satisfaction of psychological needs and motivation for leisure-time physical activity (LTPA), LTPA participation, and participation experience. DESIGN: A mixed-methods follow-up study. SETTING: Community. PARTICIPANTS: Sixteen TEQ and six ALLWheel participants completed questionnaires and a semi-structured interview, 12-18 months after completing the interventions. INTERVENTION: TEQ intervention participants received a weekly LTPA counseling session with a trained kinesiologist through videoconferencing for 8 weeks. ALLWheel participants interacted with a peer mentor who provided LTPA counseling using smartphones for 10 weeks. OUTCOME MEASURES: The Psychological Need Satisfaction in Exercise, and the Treatment Self-Regulation Questionnaire were used as primary outcome measures. The LTPA barrier self-efficacy scale, the Measure of Experiential Aspects of Participation, and the 7-day LTPA Questionnaire for Adults with SCI were used as secondary outcome measures. A coding framework was created and deductive thematic analyses were used to analyze the qualitative data. RESULTS: Medium to large effects were found for autonomous motivation (TEQ), competence (TEQ and ALLWheel), and barrier self-efficacy (TEQ and ALLWheel). LTPA remained higher for the TEQ intervention group compared to the control group at follow-up, while an increase in moderate-to-vigorous LTPA was found in ALLWheel participants. CONCLUSION: Community-based tele-rehabilitation and virtual rehabilitation approaches, informed by theory, may assist adults with SCI in implementing LTPA over the long term.