Impact of an mHealth wheelchair skills training program for older adults: a feasibility randomized controlled trial

Abstract Objective To evaluate the impact of an mHealth wheelchair skills training program on clinical outcomes among older adult MWC users. Design 2 x 2 factorial randomized controlled trial Setting Community setting in two Canadian cities Participants Convenience sample of manual wheelchair users 50 years of age and older living in the community who were able to self-propel with both hands and communicate in English. Participants (n=18) were randomized into either a mHealth treatment (n=10) or tablet gaming control (n=8) group. Interventions All participants received two in-person sessions with their trainer and engaged in a 4-week monitored home training program with a computer tablet. The EPIC Wheels program provided wheelchair skills training; the control program included nine dexterity and cognitive training games. Main Outcome Measures The primary outcome was wheelchair skill capacity. Secondary outcomes included safety, self-efficacy, activity participation, mobility, divided-attention, and health-related quality of life. Results Data collection was blinded to group allocation. Capacity improved by two skills, but with no statistically significant between-group difference. The mHealth training program had a significant impact on participation ( p =0.03) and self-efficacy ( p =0.06) with large effect sizes (η p 2 = 0.22-0.29). Mobility, safety with skill performance, and divided attention measures demonstrated medium effect size changes, but only safety with skill performance was statistically significant. The program was more beneficial for participants with less than one year of wheelchair experience. Conclusion EPIC Wheels participants demonstrated good program adherence and clinical benefits were evident in community participation and wheelchair self-efficacy. Wheelchair safety and mobility were positively impacted, while skill capacity showed a small, non-significant improvement. Future study should investigate benefit retention over time.