同伴主导的轮椅训练对老年人轮椅技能和参与的影响：一项随机对照可行性试验的临床结局。
Influence of Peer-led Wheelchair Training on Wheelchair Skills and Participation in Older Adults: Clinical Outcomes of a Randomized Controlled Feasibility Trial.
机构信息
Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Research Institute, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada.
Department of Rehabilitation, Laval University, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Integrated Health and Social Services Center of the National-Capital, Institute of Rehabilitation in Physical Disability of Quebec, Quebec City, Quebec, Canada.
出版信息
Arch Phys Med Rehabil. 2019 Jun;100(6):1023-1031. doi: 10.1016/j.apmr.2018.10.018. Epub 2018 Nov 23.
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.
目的
评估基于同伴的轮椅自我效能增强（WheelSeeU）计划对客观轮椅技能（主要结果）以及对感知轮椅技能能力和表现、轮椅使用自我效能、参与满意度、生活空间移动性和参与频率（次要结果）的治疗效果大小；并评估 6 个月后的保留率（次要结果）。
设计
随机对照试验。
地点
康复中心和社区。
参与者
社区居住的老年人（N=40）。
干预措施
WheelSeeU 包括六次 90 分钟的同伴主导的个性化培训课程（每对一组），根据参与者的目标进行定制。一名支持培训师提供支撑。对照组包括六次 90 分钟的专业主导的理论信息课程（每对一组）。
主要结果测量
轮椅技能测试（WST）、轮椅技能测试问卷（WST-Q）、手动轮椅使用者轮椅使用信心量表-短表（WheelCon-M-SF）、轮椅结果测量（WhOM）、生活空间移动性（LSA）和晚年功能和残疾指数（LLFDI）在基线（T1）、干预后（T2）和 6 个月后（T3）进行收集。
结果
在 121 名筛查者中，有 39 人不符合纳入标准，有 41 人拒绝参与。40 名参与者（64.5 岁；60%为男性）被随机分配，38 名参与者完成了干预，35 名参与者完成了 T3 评估。没有不良反应。与对照组相比，WheelSeeU 在 T2 时对客观 WST（主要结果）或 WST-Q 能力、WheelCon、LSA 和 LLFDI 没有统计学上更大的效果。在 T2 时，WST-Q 表现（Cohen's d=0.72）和 WhOM（Cohen's d=0.82）的效应大小具有统计学意义且较大，并且在 T3 时保留了效应。
结论
与积极对照组相比，WheelSeeU 对轮椅技能能力没有更大的影响。然而，WheelSeeU 不应该被过早地否定为一种提高轮椅技能表现和参与有意义活动的满意度的方法。性别和抑郁在为老年人设计干预措施时很重要。
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