Giesbrecht Ed, Best Krista L, Miller William C, Routhier François, Harrison Kara-Lyn, Faieta Julie, Laberge Maude
Department of Occupational Therapy, Rady Faculty of Health Sciences, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Rehabilitation, Université Laval, Québec City, Quebec, Canada; Centre interdisciplinaire de recherche en readaptation et en integration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec City, Quebec, Canada.
Arch Phys Med Rehabil. 2025 Jun;106(6):821-827. doi: 10.1016/j.apmr.2024.12.011. Epub 2024 Dec 19.
To measure the effect of a community-based peer-led eHealth manual wheelchair (MWC) skills training program on community participation, wheelchair skills capacity and performance, wheelchair-specific self-efficacy, and health-related quality of life.
Randomized control trial with wait-list control group.
Community.
Community-dwelling MWC users aged 18 years or older who propel using both arms (N=50).
The 4-week MWC skills training intervention was comprised of 3 virtual sessions with a peer trainer and a self-directed eHealth home training application delivered via a computer tablet. Peer trainers were experienced MWC users who had received structured training for intervention delivery. Participants were provided with required equipment and encouraged to involve a care provider during home training. Peer trainers tailored the program to life activities participants identified as relevant. The control group were placed on a 4-week no intervention wait-list (reflecting typical clinical practice) and after postintervention data collection were offered the training program.
The primary outcome was community participation measured by the Wheelchair Outcome Measure. Secondary outcomes included skill capacity and performance on the Wheelchair Skills Test-Questionnaire, self-efficacy on the Wheelchair Use Confidence Scale, and health-related quality of life on the Short-Form 36 Health Survey Enabled.
The intention-to-treat (n=50) primary analysis revealed a statistically significant Time*Allocation interaction for community participation (mean P=.046 and η=0.09), increasing by 24%. Per protocol (n=42) secondary analyses indicated significant improvements of 16.1% in the skill capacity (P=.004), 11.4% in self-efficacy (P=.017), and 7% relative improvement in quality of life (P=.012).
The findings indicate that an eHealth MWC training program incorporating peer and tablet application training components was effective in improving community participation, skill capacity, self-efficacy, and quality of life for a wide range of MWC users. An eHealth delivery format offers considerable potential from both an access and resource perspective.
评估一项基于社区、由同伴主导的电子健康手动轮椅（MWC）技能培训项目对社区参与度、轮椅技能能力与表现、特定于轮椅的自我效能感以及健康相关生活质量的影响。
设有等待名单对照组的随机对照试验。
社区。
18岁及以上使用双臂推动轮椅的社区居家MWC使用者（N = 50）。
为期4周的MWC技能培训干预包括与同伴培训师进行的3次虚拟课程，以及通过平板电脑提供的自我指导电子健康家庭训练应用程序。同伴培训师是经验丰富的MWC使用者，他们接受过干预实施的结构化培训。为参与者提供所需设备，并鼓励他们在家庭训练期间让护理人员参与。同伴培训师根据参与者确定的相关生活活动调整培训项目。对照组被列入为期4周的无干预等待名单（反映典型临床实践），在干预后数据收集完成后提供培训项目。
主要结局是通过轮椅结局量表测量的社区参与度。次要结局包括轮椅技能测试问卷的技能能力与表现、轮椅使用信心量表的自我效能感，以及简易36项健康调查启用版的健康相关生活质量。
意向性分析（n = 50）显示，社区参与度在时间*分配上存在统计学显著交互作用（平均P = 0.046，η = 0.09），提高了24%。符合方案分析（n = 42）的次要分析表明，技能能力显著提高了16.1%（P = 0.004），自我效能感提高了11.4%（P = 0.017），生活质量相对提高了7%（P = 0.012）。
研究结果表明，结合同伴和平板电脑应用程序培训组件的电子健康MWC培训项目对于广泛的MWC使用者在改善社区参与度、技能能力、自我效能感和生活质量方面是有效的。从可及性和资源角度来看，电子健康交付形式具有相当大的潜力。
