School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada.
CHU Sainte-Justine Research Center, 5200 Bélanger Street, Montréal, Québec, H1T 1C9, Canada.
BMC Pediatr. 2021 Mar 1;21(1):103. doi: 10.1186/s12887-021-02564-9.
Backed by over 20 years of research development, the Wheelchair Skills Program (WSP) has proven to be a safe and effective program to improving wheelchair skills for adult wheelchair users. However, evidence is lacking for the pediatric population, which may help to explain the limited use of the WSP in pediatric settings. While additional evidence specific to the pediatric population is needed, concurrent implementation of the WSP into pediatric clinical practice is equally prudent to allow those users to benefit from the years of accumulated WSP evidence. To facilitate implementation of evidence-based programs into practice, adaptation is also often required to improve the fit between the program and the local context. Therefore, the objective of this study was to understand what adaptations, if any, are required for the WSP to be implementable in a pediatric setting.
A deductive qualitative descriptive study design was used, guided by the Knowledge to Action Framework and Consolidated Framework for Implementation Research (CFIR). Occupational Therapists (OTs) from a pediatric rehabilitation center and two specialized schools in Montreal, Canada were invited to participate in a 90-min focus group. The Framework Method was followed for the data analysis.
One focus group in each site (n = 3) was conducted with a total of 19 participants. From the OTs' perspectives, our analysis revealed benefits of WSP use and various issues (e.g. some skills seem unrealistic) affecting its uptake in relation to the constructs of the CFIR Intervention Characteristics domain. The results provided guidance for the recommendations of adaptations (e.g. addition of a caregiver assistance score) to enhance implementation of the WSP in pediatric rehabilitation settings and helped to identify the need for the production of new knowledge and knowledge translation (KT) tools.
Implementation of the WSP with the adaptations and KT tools proposed could allow pediatric manual wheelchair users to improve their wheelchair skills.
经过 20 多年的研究发展，轮椅技能计划（WSP）已被证明是提高成年轮椅使用者轮椅技能的安全有效的计划。然而，针对儿科人群的证据不足，这可能有助于解释 WSP 在儿科环境中的使用有限。虽然需要针对儿科人群的额外证据，但同时将 WSP 纳入儿科临床实践同样谨慎，以使这些用户受益于多年积累的 WSP 证据。为了将循证计划实施到实践中，适应通常也是必要的，以提高计划与当地环境的契合度。因此，本研究的目的是了解 WSP 在儿科环境中实施需要进行哪些适应（如果有）。
采用演绎定性描述研究设计，以知识转化框架和实施研究综合框架（CFIR）为指导。邀请来自加拿大蒙特利尔的一家儿科康复中心和两所特殊学校的职业治疗师（OTs）参加 90 分钟的焦点小组。采用框架方法进行数据分析。
在每个地点（n=3）进行了一次焦点小组，共有 19 名参与者。根据 OTs 的观点，我们的分析揭示了 WSP 使用的好处和各种问题（例如，一些技能似乎不切实际），这些问题与 CFIR 干预特征领域的结构有关。结果为建议进行适应性调整（例如，增加照顾者协助评分）提供了指导，以加强 WSP 在儿科康复环境中的实施，并有助于确定需要制作新知识和知识转化（KT）工具。
实施经过适应性调整和 KT 工具改进的 WSP 可以使儿科手动轮椅使用者提高他们的轮椅技能。
