Best Krista L, Routhier François, Sweet Shane N, Arbour-Nicitopoulos Kelly P, Borisoff Jaimie F, Noreau Luc, Martin Ginis Kathleen A
Department of Rehabilitation, Université Laval, Quebec City, QC, Canada.
Centre for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Quebec City, QC, Canada.
JMIR Res Protoc. 2017 Apr 26;6(4):e69. doi: 10.2196/resprot.7280.
Physical activity (PA) must be performed regularly to accrue health benefits. However, the majority of manual wheelchair users do not meet PA recommendations. Existing community-based PA programs for manual wheelchair users appear to work, but effect sizes are small and retention is low. Existing PA programs may not fully implement some psychosocial factors that are strongly linked with PA (eg, autonomy). The use of peers and mobile phone technology in the Smartphone Peer PA Counseling (SPPAC) program represents a novel approach to cultivating a PA-supportive environment for manual wheelchair users.
The primary objective is to compare change in objective PA between the experimental (SPPAC) and control groups from baseline to postintervention (10 weeks) and follow-up (3 months). Changes in and relationships between subjective PA, wheelchair skills, motivation, self-efficacy (for overcoming barriers to PA for manual wheelchair use), satisfaction of psychological needs for PA, and satisfaction with PA participation will be explored (secondary outcome). Program implementation will be explored (tertiary objective).
A total of 38 community-living manual wheelchair users (≥18 years) will be recruited in a randomized controlled trial (RCT). Participants in both the control and experimental groups will receive existing PA guidelines. Participants in the experimental group will also receive the SPPAC program: 14 sessions (~30 min) over a 10-week period delivered by a peer trainer using a mobile phone. PA activities will be based on individuals' preferences and goals. Implementation of important theoretical variables will be enforced through a peer-trainer checklist. Outcomes for objective PA (primary) and subjective PA, wheelchair skills, motivation, self-efficacy, satisfaction of psychological needs, and satisfaction with participation will be collected at three time points (baseline, postintervention, follow-up). Multiple imputations will be used to treat missing data. A mixed-model ANCOVA will be conducted, controlling for covariates (primary and secondary objectives). The strength and direction of the relationships between the primary and secondary outcomes will be explored (secondary objective). Descriptive and content analysis will be used to appraise program implementation (tertiary objective).
Funding has been obtained from the Craig Neilsen Foundation and the Canadian Disability Participation Project, with additional funds being sought from the Canadian Institute for Health Research and Fonds de Recherche du Québec-Santé. Pilot evaluation of intervention implementation is currently underway, with enrollment anticipated to begin early 2018.
There may be substantial benefits for the SPPAC program including limited burden on health care professionals, decreased barriers (eg. accessibility, transportation), development of peer social supports, and potential cost savings related to physical inactivity. Before conducting a large and expensive multisite RCT within a small heterogeneous population of manual wheelchair users, a pilot study affords a prudent step to establishing an adequate study protocol and implementation strategies.
ClinicalTrials.gov NCT02826707; https://clinicaltrials.gov/ct2/show/NCT02826707 (Archived by WebCite at http://www.webcitation.org/6pqIc14dU).
必须定期进行体育活动（PA）才能获得健康益处。然而，大多数手动轮椅使用者未达到PA建议标准。现有的针对手动轮椅使用者的社区PA项目似乎有效果，但效应量较小且留存率较低。现有的PA项目可能未充分落实一些与PA密切相关的心理社会因素（如自主性）。在智能手机同伴PA咨询（SPPAC）项目中使用同伴和移动电话技术，为手动轮椅使用者营造支持PA的环境提供了一种新方法。
主要目的是比较实验组（SPPAC）和对照组从基线到干预后（10周）及随访（3个月）客观PA的变化。将探索主观PA、轮椅技能、动机、自我效能（克服手动轮椅使用PA障碍的能力）、PA心理需求满意度以及PA参与满意度的变化及其相互关系（次要结果）。将探索项目实施情况（第三目的）。
在一项随机对照试验（RCT）中招募38名社区居住的手动轮椅使用者（≥18岁）。对照组和实验组的参与者都将获得现有的PA指南。实验组的参与者还将接受SPPAC项目：在10周内由同伴培训师通过移动电话进行14次课程（约30分钟）。PA活动将根据个人偏好和目标进行。重要理论变量的实施将通过同伴培训师检查表来执行。将在三个时间点（基线、干预后、随访）收集客观PA（主要）以及主观PA、轮椅技能、动机、自我效能、心理需求满意度和参与满意度的结果。将使用多重填补法处理缺失数据。将进行混合模型协方差分析，控制协变量（主要和次要目的）。将探索主要和次要结果之间关系的强度和方向（次要目的）。将使用描述性和内容分析来评估项目实施情况（第三目的）。
已从克雷格·尼尔森基金会和加拿大残疾参与项目获得资金，正在向加拿大卫生研究院和魁北克卫生研究基金寻求额外资金。目前正在对干预实施情况进行试点评估，预计2018年初开始招募参与者。
SPPAC项目可能有诸多益处，包括对医疗保健专业人员负担有限、减少障碍（如可达性、交通）、发展同伴社会支持以及与身体活动不足相关的潜在成本节约。在小型异质性手动轮椅使用者群体中进行大规模且昂贵的多中心RCT之前，进行试点研究是建立适当研究方案和实施策略的谨慎步骤。
ClinicalTrials.gov NCT02826707；https://clinicaltrials.gov/ct2/show/NCT02826707（由WebCite存档于http://www.webcitation.org/6pqIc14dU）
