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.

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.

Measurement properties of the late life disability index among individuals who use power wheelchairs as their primary means of mobility.

OBJECTIVE: To examine the reliability, validity, and factor structure of the Late Life Disability Instrument (LLDI) in individuals who use power wheelchairs as their primary means of mobility. DESIGN: A 4-week, test-retest study design. SETTING: Five Canadian cities. PARTICIPANTS: The validity sample included 115 new and experienced power mobility users, and the reliability sample included 85 experienced users (N=115). These volunteer samples included individuals who were aged ≥50 years and independently used power mobility as their primary means of mobility. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The LLDI measures participation in 2 dimensions of 16 life activities: frequency and perceived limitations. Validity measures included the Wheelchair Skills Test-power version, the Assistive Technology Outcomes Profile for Mobility, the Hospital Anxiety and Depression Scale, the Power Mobility Wheelchair Confidence Measure, and the Life Space Assessment. RESULTS: For the reliability sample, raw intraclass correlational coefficients for limitation and frequency dimension scores ranged from .855 (95% confidence interval .781-.905) to .883 (95% confidence interval, .822-.924), respectively. For the validity sample, scores on the LLDI were correlated as hypothesized with scores on validity measures. The factor structure that was identified with the original sample was not replicated among power wheelchair users. For LLDI frequency, exploratory factor analysis indicated that 5 of the original 16 items did not perform similarly among power wheelchair users. For LLDI limitations, a 1-factor, rather than a 2-factor, solution was identified. CONCLUSIONS: The study provides evidence in support of the reliability and validity of the measure but suggests that the original subscale scores may not be applicable to power wheelchair users.

Seniors' perceptions of vehicle safety risks and needs.

The investigation of vehicle safety needs for older drivers and passengers is integral for their safe transportation. A program of research on safe transportation for seniors was launched through AUTO21, a Canadian Network of Centres of Excellence. This national research network focuses on a wide range of automotive issues, from materials and design to safety and societal issues. An inductive qualitative inquiry of seniors' driving experiences, safety feature use, and strategies to prevent injury and manage risks was a first step in this program. We conducted interviews and focus groups with 58 seniors without disabilities and 9 seniors with disabilities. We identified a lack of congruity between the vehicle and safety feature design and seniors' needs. Seniors described strategies to manage their safety and that of others. Specific aspects of vehicle design, safety features, and action strategies that support safer use and operation of a vehicle by seniors are outlined.

Services, systems, and policies affecting mobility device users' community mobility: A scoping review: Services, systèmes et politiques influençant la mobilité dans la communauté des utilisateurs d'aides à la mobilité : examen de la portée.

BACKGROUND: Opportunities to travel from one place to another in the community, or community mobility, are especially important for mobility device users' ability to participate fully in society. However, contextual challenges to such mobility exist. PURPOSE: This study summarizes the literature on existing community mobility barriers and facilitators of mobility device users created by services, systems, and policies as defined by the International Classification of Functioning, Disability, and Health (ICF). METHOD: Arksey and O'Malley's approach for scoping studies was used for the review. The extraction chart was organized following the ICF, and frequency counts were used to report the data. FINDINGS: The findings suggest that certain factors, such as transportation, open-space planning, and architecture and construction, influence community mobility opportunities. However, little attention has been paid to services, systems, and policies in the research literature, limiting the knowledge on the subject. IMPLICATIONS: Further research is needed to examine the relationship between specific services, systems, and policies and mobility device users' mobility within their communities.

Multisource feedback systems for quality improvement in the health professions: assessing occupational therapists in practice.

INTRODUCTION: The objective was to develop and psychometrically evaluate (feasibility, reliability, validity) a questionnaire-based multisource feedback (MSF) system for quality improvement (QI) for occupational therapists (OTs). METHODS: Surveys were developed for assessment of OTs by clients, co-workers, and themselves, respectively, using 5-point scales with an "unable to assess" category. A sample of 238 OTs participated. RESULTS: The number of respondents for the co-worker questionnaire was 2621, and for the client questionnaire it was 2881. The mean ratings ranged from 4 to 5 for each item on each scale. All of the instruments' full scales had very high Cronbach's alpha > 0.92. The factor analyses revealed a 7-factor solution (66.3% of the total variance) for the co-worker survey, and a 4-factor solution for the client questionnaire (73.2% of the variance). DISCUSSION: An MSF system employing surveys that have high reliability, validity, and feasibility was developed to provide feedback to OTs on core competencies and skills. It is suggested that similar MSF systems are feasible for health professionals in general.

Consumer-based approaches used in the development of an adaptive toileting system for children with positioning problems.

A research and development project was initiated to address concerns that existing commercial toileting systems are generally cumbersome to use, costly, and do not effectively support children in the best biomechanical and physiological position for independent toileting. Others have found that "homemade" adaptations are often necessary to improve the fit of these systems. To address these problems, a research and development project was initiated to develop a better toileting system. A multiphase research project involving a series of focus groups with parents, therapists, and other rehabilitation professionals (phase 1), classroom trials to evaluate a fitting prototype (phase 2), and home trials of a functional version (phase 3) was undertaken in the design of a better toileting system. Consumer feedback from these trials was used to develop a commercial version. This paper reviews each phase of the design process and discusses how consumer perspectives and clinical feedback were integrated into the design of the final product. In addition, features of the final product are described.