Social participation experiences of older adults with an early-onset physical disability: a systematic review protocol.

OBJECTIVE: The objective of this review is to assess and synthesize the available qualitative evidence on the experiences of social participation of older adults with an early-onset physical disability. INTRODUCTION: Understanding the experiences of social participation among older adults with a physical disability acquired earlier in life can guide the development of interventions and policies. It will also help with fostering meaningful community participation and aid in improving the quality of their social participation. INCLUSION CRITERIA: This review will consider primary studies that explore the experiences of social participation of older adults with an early-onset physical disability. The review will focus on qualitative data, including methods such as phenomenology, grounded theory, ethnography, action research, and feminist research. Studies in French or English will be considered for inclusion, and there will be no limitation on publication dates. METHODS: A keyword search strategy will be carried out in MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Web of Science, and the Cochrane Library. ProQuest Dissertations and Theses (ProQuest) will be searched for unpublished articles. Two independent reviewers will perform the screening and inclusion process, assess the quality of the evidence, and complete data extraction. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis (meta-aggregation) will be used. The ConQual approach will be used to establish confidence in the synthesized findings. REVIEW REGISTRATION: PROSPERO CRD42022371027.

Providing community services for persons with disabilities during the COVID-19 pandemic: A scoping review.

Community organisations and municipalities support people with disabilities by providing resources and services that are essential for their engagement in the community. Their services were particularly impacted by restrictions related to the COVID-19 pandemic. The aim of the study is to identify scientific literature that examines how community organisations and municipalities adapted services and resources provided to people with disabilities as a result of the COVID-19 pandemic. A scoping review was conducted by searching the databases Medline, Embase, CINAHL, PsycINFO and Web of Science Core Collection in January 2021. Fifteen studies were included from the initial search strategy of 7651 individual studies. Most of the studies were quantitative studies (73.3%; n = 11) and aimed at describing the adaptations put in place during the COVID-19 pandemic (66.7%; n = 10). Most services and resources involved some form of preventive healthcare (66.7%; n = 10). The adaptation of modalities for delivering resources and services varied widely across organisations (e.g. online or a combination of online and in-person) but mostly led to an improvement of the studied outcome (e.g. social skills, quality of life). Barriers (e.g. need for a reliable internet connection, lack of technology literacy from the member) and facilitators (e.g. flexibility and planning from the organisations) for these adaptations have been identified, but there is little information surrounding their cost. The results highlight that the delivery of online services has increased since the inception of the COVID-19 pandemic with valuable outcomes. However, further research is needed to better identify the barriers, facilitators and outcomes of remote services to better face future large-scale disasters like the COVID-19 pandemic and to better support individuals who cannot reach in-person services.

Measurement properties of wheelchair use assessment tools in adults with autosomal recessive spastic ataxia of Charlevoix-Saguenay.

PURPOSE: To establish the reliability and construct validity of two French-Canadian versions of assessment tools for manual (MWC) and powered wheelchair (PWC) users with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS): the Wheelchair Skills Test Questionnaire (WST-Q-F) version 5.0 and the Wheelchair Use Confidence Scale (WheelCon-F) Short Form. METHODS: We recruited 32 MWC and PWC users with ARSACS aged between 34 and 64 years. Participants completed measures twice within 2 weeks for test-retest reliability and to determine the standard error of measurement. Construct validity was established by verifying hypothesized relationships between wheelchair use scores and other variables regarding personal factors, body functions, and activities. Participants' scores were also compared with those of MWC and PWC users with other diagnoses to explore known-groups validity. RESULTS: Adequate to excellent test-retest reliability values were found for all questionnaires (intraclass correlation coefficients between 0.506 and 0.995). SEMs were acceptable, ranging from 3.3 to 9.1 on the WST-Q-F and from 0.7 to 1.2 on the WheelCon-F. Moderate to excellent correlations supported construct validity for the WST-Q-F and the WheelCon-F. Compared with other populations, adults with ARSACS reported limited wheelchair skills, but similar wheelchair confidence. CONCLUSIONS: The WST-Q-F and the WheelCon-F have excellent test-retest reliability, acceptable measurement errors, and support for construct validity in adults with ARSACS. This study was the first to evaluate these assessment tools in this population, and the results support a need to implement wheelchair skills training interventions in this population.IMPLICATIONS FOR REHABILITATIONThe WST-Q-F version 5.0 and the WheelCon-F Short Form are reliable and valid assessment tools to measure manual and powered wheelchair skills and self-efficacy in adults with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS).The WST-Q-F version 5.0 and the WheelCon-F Short Form can be used to evaluate and describe wheelchair skills and wheelchair use self-efficacy in clinical practice and are recommended for future research in adults with ARSACS. These outcome tools may be especially useful to measure the effects of a wheelchair training program.

Prioritization of patients access to outpatient augmentative and alternative communication services in Quebec: a decision tool.

PURPOSE: A large number of people living with a chronic disability wait a long time to access publicly funded rehabilitation services such as Augmentative and Alternative Communication (AAC) services, and there is no standardized tool to prioritize these patients. We aimed to develop a prioritization tool to improve the organization and access to the care for this population. METHODS: In this sequential mixed methods study, we began with a qualitative phase in which we conducted semi-structured interviews with 14 stakeholders including patients, their caregivers, and AAC service providers in Quebec City, Canada to gather their ideas about prioritization criteria. Then, during a half-day consensus group meeting with stakeholders, using a consensus-seeking technique (i.e. Technique for Research of Information by Animation of a Group of Experts), we reached consensus on the most important prioritization criteria. These criteria informed the quantitative phase in which used an electronic questionnaire to collect stakeholders' views regarding the relative weights for each of the selected criteria. We analyzed these data using a hybrid quantitative method called group based fuzzy analytical hierarchy process, to obtain the importance weights of the selected eight criteria. RESULTS: Analyses of the interviews revealed 48 criteria. Collectively, the stakeholders reached consensus on eight criteria, and through the electronic questionnaire they defined the selected criteria's importance weights. The selected eight prioritization criteria and their importance weights are: person's safety (weight: 0.274), risks development potential (weight: 0.144), psychological well-being (weight: 0.140), physical well-being (weight: 0.124), life prognosis (weight: 0.106), possible impact on social environment (weight: 0.085), interpersonal relationships (weight: 0.073), and responsibilities and social role (weight: 0.054). CONCLUSION: In this study, we co-developed a prioritization decision tool with the key stakeholders for prioritization of patients who are referred to AAC services in rehabilitation settings.IMPLICATIONS FOR REHABILIATIONStudies in Canada have shown that people in Canada with a need for rehabilitation services are not receiving publicly available services in a timely manner.There is no standardized tool for the prioritization of AAC patients.In this mixed methods study, we co-developed a prioritization tool with key stakeholders for prioritization of patients who are referred to AAC services in a rehabilitation center in Quebec, Canada.

Barriers and facilitators for implementation of a patient prioritization tool in two specialized rehabilitation programs.

INTRODUCTION AND AIMS: Prioritization tools aim to manage access to care by ranking patients equitably in waiting lists based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool (PPT) with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a PPT in rehabilitation programs. METHODS: We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on the Consolidated Framework for Implementation Research. RESULTS: Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes for patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process. CONCLUSION: This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers' perspective.

A systematic review of patient prioritization tools in non-emergency healthcare services.

BACKGROUND: Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. METHODS: We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. RESULTS: We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two-thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. CONCLUSIONS: This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107205.

Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation.

BACKGROUND: In order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up. OBJECTIVE: This study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians. METHODS: On the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts. RESULTS: A total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up. CONCLUSIONS: On the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype.

Patient prioritization tools and their effectiveness in non-emergency healthcare services: a systematic review protocol.

BACKGROUND: Waiting lists should be managed as fairly as possible to ensure that patients with greater or more urgent needs receive services first. Patient prioritization refers to the process of ranking referrals in a certain order based on various criteria with the aim of improving fairness and equity in the delivery of care. Despite the widespread use of patient prioritization tools (PPTs) in healthcare services, the existing literature on this subject has mainly focused on emergency settings. Evidence has not been synthesized with respect to all the non-emergency services. METHODS: This review aims to perform a systematic synthesis of published evidence concerning (1) prioritization tools' characteristics, (2) their metrological properties, and (3) their effect measures across non-emergency services. Five electronic databases will be searched (Cochrane Library, Ovid/MEDLINE, Embase, Web of Science, and CINAHL). Eligibility criteria guiding data selection will be (1) qualitative, quantitative, or mixed methods empirical studies; (2) patient prioritization in any non-emergency setting; and (3) discussing characteristic, metrological properties, or effect measures. Data will be sought to report tool's format, description, population, setting, purpose, criteria, developer, metrological properties, and outcome measures. Two reviewers will independently screen, select, and extract data. Data will be synthesized with sequential exploratory design method. We will use the Mixed Methods Appraisal Tool (MMAT) to assess the quality of articles included in the review. DISCUSSION: This systematic review will provide much-needed knowledge regarding patient prioritization tools. The results will benefit clinicians, decision-makers, and researchers by giving them a better understanding of the methods used to prioritize patients in clinical settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107205.

Mapping review of accessible pedestrian infrastructures for individuals with physical disabilities.

BACKGROUND: Due to the ageing population and higher prevalence of individuals living with physical disabilities, there is a critical need for inclusive practices when designing accessible pedestrian infrastructures for ensuring social participation and equal opportunities. PURPOSE: Summarize the physical characteristics of current pedestrian infrastructure design for individuals with physical disabilities (IPD - motor, visual and hearing) found in the scientific literature and assess its quality. MATERIALS AND METHODS: A mapping review of the existing literature on pedestrian infrastructures specifically built for individuals with physical disabilities identifying measurable physical characteristics for their design was done using online databases (Urban Studies Abstracts, Geobase, PubMed, and Cairn and secondary research). Information about accessibility (physical characteristics) of existing pedestrian infrastructures was extracted. The quality of the evidence was assessed using the Guidelines for critical review form - Quantitative studies and Qualitative studies version 2.0 (SAGE Publications, Inc., Thousand Oaks, CA). RESULTS: Of the 1131 articles identified, forty-one articles examined access to bus stops, curb ramps, lighting, pedestrian crossings, ramps, shared spaces, sidewalks and steps. Six articles reported on more than one physical disability. Quality scores were generally low (quantitative: 2-11/15 and qualitative: 1-22/23). Recommended design features differed for the same infrastructure. CONCLUSIONS: While there were a fair number of articles (n = 41) documenting accessible design features of pedestrian infrastructures, the quality of the evidence was low. The review identified knowledge gaps. Although specific design solutions exist, they have not yet been tested among individuals with various or multiple types of physical disabilities to ensure access to pedestrian infrastructures by all. Implications for Rehabilitation Pedestrian infrastructures still pose problems to mobility, limiting social participation and quality of life outcomes for individuals with physical disabilities (motor, visual and hearing). The results of this mapping review show that few articles are concerned with the accessibility of pedestrian infrastructures for more than one type physical disability, which might lead to recommendations that are inadequate for individuals with differing disabilities, few recommendations have been compared, most studies have been performed in environments not representative of northern countries and their quality score was generally low. Health professionals and State Parties have a complementary expertise that should be put to use in the determination and implementation of best design solutions to ensure the respect of the needs of individuals with physical disabilities. This review can thus help them have an idea of what has already been done to identify what needs to be achieved to fill the gap of knowledge required to insure access for individuals with motor, visual as well as hearing disabilities. Rehabilitation profesionals should take part in the assessment of the proposed solutions as well as the development of new designs to fill knowledge gaps.

Measurement properties of the WheelCon for powered wheelchair users.

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

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.

Health, Personal, and Environmental Predictors of Wheelchair-Use Confidence in Adult Wheelchair Users.

BACKGROUND: There are no predictive models of wheelchair-use confidence. Therefore, clinicians and researchers are limited in their ability to screen for and identify wheelchair users who may be more prone to low wheelchair-use confidence and may benefit from clinical intervention. OBJECTIVE: The purpose of this study was to identify health-related, personal, and environmental factors that predict perceived wheelchair-use confidence in community-dwelling adults who use manual wheelchairs. DESIGN: A cross-sectional study was conducted. METHODS: Community-dwelling manual wheelchair users (N=124) were included in the study if they were ≥50 years of age, had ≥6 months of wheelchair use experience, and had no cognitive impairment. The Wheelchair Use Confidence Scale was used to assess wheelchair-use confidence. The sociodemographic information form, Functional Comorbidity Index, Seating Identification Tool, Interpersonal Support and Evaluation List, and Home and Community Environment Instrument captured the independent variables. Blocks of health, personal, and environmental variables were sequentially entered into the regression model. RESULTS: Five personal variables (age, standardized beta [ß]=-0.18; sex, ß=-0.26; daily hours of wheelchair occupancy, ß=0.20; wheelchair-use training, ß=0.20; and wheelchair-use assistance, ß=-0.34) and one environmental variable (need for seating intervention, ß=-0.18) were statistically significant predictors, explaining 44% of the confidence variance. LIMITATIONS: The sample comprised volunteers and, therefore, may underrepresent or overrepresent particular groups within the population. The study's cross-sectional research design does not allow for conclusions to be made regarding causality. CONCLUSION: Older women who use wheelchairs and who require assistance with wheelchair use may have low wheelchair-use confidence. The same is true for individuals who have no formal wheelchair-use training, who are in need of a seating intervention, and who report few hours of daily wheelchair use. These wheelchair users may require clinical attention and benefit from intervention.

A description of manual wheelchair skills training: current practices in Canadian rehabilitation centers.

PURPOSE: To describe current practices for manual wheelchair (MWC) skills training in Canadian rehabilitation centers. METHODS: An online survey was sent to practice leaders in occupational (OT) and physical therapy (PT) at 87 Canadian rehabilitation centers. Responses were solicited from individuals who could report about wheelchair skills training at facilities with at least 10 beds designated for rehabilitation. Thirty-four questions asked about: (1) demographics, (2) components of MWC training, (3) amount of MWC skills training, (4) use of validated programs and (5) perceived barriers to using validated programs. Data were analyzed using summary statistics. RESULTS: About 68/87 responses were received primarily from OTs (42/68). Basic MWC skills training (e.g. wheel-locks) was consistently part of clinical practice (45/68), while advanced skills training (e.g. curb-cuts) was rare (8/68). On an average, 1-4 h of training was done (29/68). Validated training programs were used by 16/68, most of whom used them "rarely" (7/16). Common barriers to using validated programs were lack of time (43/68) and resources (39/68). CONCLUSIONS: Learning to use a wheelchair is important for those with ambulation impairments because the wheelchair enables mobility and social participation. Providing opportunities for advanced wheelchair skills training may enhance mobility and social participation in a safe manner. Implications for Rehabilitation There is evidence confirming the benefits of a validated wheelchair skills program, yet most clinicians do no not use them. A variety of perceived barriers may help to explain the limited use of existing programs, such as time, resources and knowledge. Effective knowledge translation efforts may help alleviate some of these barriers, and novel wheelchair training approaches may alleviate some burden on clinicians to help accommodate the increasing number of older wheelchair users.

A description of manual wheelchair skills training curriculum in entry-to-practice occupational and physical therapy programs in Canada.

PURPOSE: To describe the curriculum for manual wheelchair (MWC) skills training in entry-to-practice occupational (OT) and physical therapy (PT) programs in Canada. METHODS: An online survey was sent to 28 directors of entry-to-practice OT and PT programs in Canadian universities. Responses were solicited from individuals who could report about wheelchair skills training. Fourteen survey questions asked about: (1) demographic information, (2) specific curriculum content for MWC skills training, (3) teaching methods used, (4) instructional methods and estimated time used to teach MWC skills and (5) whether validated wheelchair skills training programs were used in curriculum development. RESULTS: Responses received from 21/28 programs, (OT-11/14; PT-10/14). About 16 of 21 programs included curriculum for MWC skills training. Informal hands-on instruction was the most common method used for teaching wheelchair skills (13/21), while multiple lectures were used the least (5/21). Only 8/21 used a validated wheelchair skills training program in curriculum development. CONCLUSION: Despite the public availability of a validated wheelchair skills program, there is little use of the program in entry-to-practice curriculum. Integrating online training programs into existing curricula or the development of post-professional training modules may help clinicians to better accommodate the mobility needs of the substantially increasing population with disabilities. Implications for Rehabilitation Current clinical curriculum includes basic wheelchair skills training, but not necessarily training in the advanced wheelchair skills that are needed for optimal wheelchair mobility. There is evidence for a standardized approach for providing wheelchair skills training, that may be administered through curriculum, online or through post-graduate training modules.

Association between self-efficacy and participation in community-dwelling manual wheelchair users aged 50 years or older.

BACKGROUND: Self-efficacy with using a wheelchair is an emerging construct in the wheelchair-use literature that may have implications for the participation frequency in social and personal roles of wheelchair users. OBJECTIVES: The aim of this study was to investigate the direct and mediated effects of self-efficacy on participation frequency in community-dwelling manual wheelchair users aged 50 years or older. DESIGN: A cross-sectional study was conducted. METHODS: Participants were community-dwelling wheelchair users (N=124), 50 years of age or older (mean=59.7 years), with at least 6 months of experience with wheelchair use. The Late-Life Disability Instrument, the Wheelchair Use Confidence Scale, the Life-Space Assessment, and the Wheelchair Skills Test-Questionnaire Version measured participation frequency, self-efficacy, life-space mobility, and wheelchair skills, respectively. Multiple regression analyses with bootstrapping were used to investigate the direct and mediated effects. The International Classification of Functioning, Disability and Health was used to guide the analyses. RESULTS: Self-efficacy was a statistically significant determinant of participation frequency and accounted for 17.2% of the participation variance after controlling for age, number of comorbidities, and social support. The total mediating effect by life-space mobility, wheelchair skills, and perceived participation limitations was statistically significant (point estimate=0.14; bootstrapped 95% confidence interval=0.04, 0.24); however, the specific indirect effect by the wheelchair skills variable did not contribute to the total effect above and beyond the other 2 mediators. The mediated model accounted for 55.0% of the participation variance. LIMITATIONS: Causality cannot be established due to the cross-sectional nature of the data, and the self-report nature of our data from a volunteer sample may be influenced by measurement bias or social desirability, or both. CONCLUSION: Self-efficacy directly and indirectly influences the participation frequency in community-dwelling manual wheelchair users aged 50 years or older. Development of interventions to address low self-efficacy is warranted.

Reliability and validity of the French-Canadian Late Life Function and Disability Instrument in community-living wheelchair-users.

OBJECTIVE: To examine the test-retest reliability, standard error of measurement, minimal detectable change, construct validity, and ceiling and floor effects in the French-Canadian Late Life Function and Disability Instrument (LLFDI-F). METHOD: The LLFDI-F is a measure of activity (i.e. physical functioning of upper and lower extremities), and participation (i.e. frequency of and limitations with). The measure was administered over the telephone to a sample of community-living wheelchair-users, who were 50 years of age and older, in this 10-day retest methodological study. The sample (n = 40) was mostly male (70%), had a mean age of 62.2 years, and mean experience with using a wheelchair of 20.2 years. Sixty-five percent used a manual wheelchair. RESULTS: The test-retest intraclass correlation coefficients (ICC2,1) for the participation component ranged from 0.68 to 0.90 and from 0.74 to 0.97 for the activity component. Minimal detectable changes ranged from 7.18 to 22.56 in the participation component and from 4.71 to 16.19 in the activity component. Mann-Whitney U-tests revealed significant differences between manual and power wheelchair-users in the personal and instrumental role domains, and all areas in the activity component. CONCLUSION: There is support for the test-retest reliability and construct validity of the LLFDI-F in community-living wheelchair-users, 50 years of age and older. However, because the majority of items in the lower-extremity domains of the activity component do not account for assistive device use, they are not recommended for use with individuals who have little or no use of their lower-extremities.

The development of the spinal cord injury participation and quality of life (PAR-QoL) tool-kit.

PURPOSE: Accurate descriptions of the impact of spinal cord injury (SCI)-related secondary health conditions (SHCs) on quality of life (QoL) are important to help guide the direction of resources and evaluation of therapies. However, selecting an appropriate outcome tool can be a challenge due to several clinical, theoretical and measurement issues. In order to help improve practices related to QoL measurement, a web-based Participation and QoL (PAR-QoL) tool-kit was designed to support researchers and clinicians with the outcome measure selection process. METHOD: The content of the PAR-QoL website ( www.parqol.com ) was developed through a series of systematic reviews of the SHC literature. Outcome tools identified in the studies were classified using Dijker's (2005) theoretical framework. RESULTS: A total of 199 studies were identified and categorized across eight different SHCs. Measures from the studies were extrapolated, and details regarding their [1] sensitivity to SHC impact [2], psychometric properties for SCI and [3] underlying QoL constructs were summarized onto a website. CONCLUSIONS: A better understanding of SHC impact on QoL will improve the quality of research, which in turn may provide better evidence for securing the necessary resources to help persons with SCI manage their health.

Perceived impacts of a first wheelchair on social participation.

PURPOSE: To document perceived impacts in users' daily activities and social roles (social participation) following the acquisition of a first manual or powered wheelchair. METHODS: A qualitative design with a phenomenological approach was used. Semi-structured interviews were conducted. An interview guide was developed based on the 12 social participation categories in the Disability Creation Process (DCP) conceptual model as themes underlying the questions: 'What has changed in your daily life since you got your new wheelchair?' and 'What has not changed in your daily life that you thought you would do differently with your new wheelchair?' RESULTS AND DISCUSSION: The average age of the ten participants was 64.3 years (±16.3) and 90% had received a manual wheelchair. Four main themes emerged from the detailed analysis: changes in daily activities, expectations not met, impacts on social roles and emotional changes. The participants considered the changes in daily activities to be generally positive. Expectations not met mainly related to outdoor mobility. The participants had not anticipated the impacts on social roles and emotional changes, which demonstrate the complexity of human occupation. CONCLUSION: Getting a wheelchair is a major and complex event in a person's life.

Assessment of joystick control during the performance of powered wheelchair driving tasks.

BACKGROUND: Powered wheelchairs are essential for many individuals who have mobility impairments. Nevertheless, if operated improperly, the powered wheelchair poses dangers to both the user and to those in its vicinity. Thus, operating a powered wheelchair with some degree of proficiency is important for safety, and measuring driving skills becomes an important issue to address. The objective of this study was to explore the discriminate validity of outcome measures of driving skills based on joystick control strategies and performance recorded using a data logging system. METHODS: We compared joystick control strategies and performance during standardized driving tasks between a group of 10 expert and 13 novice powered wheelchair users. Driving tasks were drawn from the Wheelchair Skills Test (v. 4.1). Data from the joystick controller were collected on a data logging system. Joystick control strategies and performance outcome measures included the mean number of joystick movements, time required to complete tasks, as well as variability of joystick direction. RESULTS: In simpler tasks, the expert group's driving skills were comparable to those of the novice group. Yet, in more difficult and spatially confined tasks, the expert group required fewer joystick movements for task completion. In some cases, experts also completed tasks in approximately half the time with respect to the novice group. CONCLUSIONS: The analysis of joystick control made it possible to discriminate between novice and expert powered wheelchair users in a variety of driving tasks. These results imply that in spatially confined areas, a greater powered wheelchair driving skill level is required to complete tasks efficiently. Based on these findings, it would appear that the use of joystick signal analysis constitutes an objective tool for the measurement of powered wheelchair driving skills. This tool may be useful for the clinical assessment and training of powered wheelchair skills.