Difficulty Walking Clinical Trial
Official title:
Enhancing Participation In the Community by Improving Wheelchair Skills (EPIC WheelS): A Feasibility Study
Many older adults have difficulty walking. A wheelchair can improve their participation but
older adults typically receive little wheelchair training. Structured training programs are
effective but rely on multiple 1:1 sessions with a skilled clinician. EPIC WheelS combines 2
brief training sessions and a 4-week home training program delivered using a portable
computer tablet and monitored by an expert trainer. This study investigates the feasibility
and potential for using EPIC WheelS with older adult novice wheelchair users in Vancouver and
Winnipeg, measuring the impact on wheelchair skill, safety and confidence compared to a
control group receiving only cognitive training.
Hypotheses: The investigators expect that the feasibility outcomes will be sufficiently
robust to support conducting a subsequent multi-site RCT. The investigators also expect the
EPIC WheelS training program will have a significant treatment effect with improvement in
wheelchair mobility, compared to a control group.
Many older adults rely on a manual wheelchair (MWC) for community mobility, but are not
provided with the skills for independent and effective use of their wheelchair. Suboptimal
use of the wheelchair results in substantial social costs such as reduced engagement in
meaningful activity, social isolation, and higher caregiver burden. This is a poor use of
financial resources, including the cost of wheelchair acquisition and requirements for
attendant care. Access to skills training is constrained by the expense and limited
availability of skilled therapists; demands of patient and/or clinician travel; and lack of
training programs designed specifically for older adults.
Enhancing Participation In the Community by improving Wheelchair Skills (EPIC WheelS) is an
individualized home-training program that optimizes learning for older adults while limiting
the time demands of expert trainers. Using an affordable mainstream computer tablet device,
EPIC WheelS provides a structured training program that can be customized for specific users
needs. The tablet is mobile, for in-chair or tabletop use, in home and community locations. A
touch screen operated audio-visual display features interactive training and practice
activities as well as video-recording capability. Wireless Internet enables user-trainer
communication and remote program monitoring and updating by the trainer. A monitored home
program that is effective and efficient for older adults has the potential for application to
other target groups, particularly those in rural and remote locations with limited access to
rehabilitation.
PURPOSE: The purpose is to evaluate the feasibility and effect size estimate of a 1-month
customized home training program (EPIC WheelS) for improving wheelchair mobility skills among
novice older adult manual wheelchair users compared to usual care. Despite the pervasive use
of wheelchairs as an intervention in rehabilitation, the evidence for training in effective
wheelchair use is still underdeveloped. Structured training has demonstrated excellent
potential, but the most effective and efficient means of providing that training remains
unclear. Larger multi-site clinical trials are required to establish evidence to inform and
direct clinical practice. The investigators propose that this 2-year feasibility trial is not
only critical, but also prudent, prior to moving forward with an expensive large multi-site
randomized controlled trial (RCT). Specifically the results of this study will address 1)
feasibility outcomes (i.e., recruitment and retention; trainer and subject burden; safety;
intervention administration and adherence; perceived benefit) and 2) clinical outcomes (i.e.,
effect size calculations for the primary and secondary measures). Although the principal
intent is feasibility, the sample size calculation is based on the primary clinical outcome
to provide a reasonable estimate of an effect size for planning the subsequent large scale
RCT.
HYPOTHESES: The investigators expect that the feasibility outcomes will be sufficiently
robust to support conducting a subsequent multi-site RCT. The investigators also expect the
EPIC WheelS training program will have a significant treatment effect with improvement in
wheelchair mobility, compared to a control group. The primary clinical endpoint will be
wheelchair skill capacity, as measured by the Wheelchair Skills Test (WST). Secondary
clinical outcomes will include wheelchair skill safety; confidence with wheelchair use;
mobility; and user evaluation of performance in participation-oriented activities.
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