Training Programs for Mobility Impairment

(SKILL Trial)

Overseen By Debbie Harrington

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Disqualifiers: Confident teaching, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

240 Participants Needed

Trial Summary

What is the purpose of this trial?

The objective of this study is to determine the effectiveness of remote manual wheelchair skills training program for clinicians. The study will use three-group approach: intervention with remote feedback (Group 1), control group (Group 2), and structured self-study (Group 3). This demonstrates how the intervention compares not only to a control, but also to the next "best alternative" - therapists sourcing web-based training materials and learning independently.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment for mobility impairment?

Research shows that wheelchair skills training programs can significantly improve wheelchair skills performance and capacity. These programs are safe and can enhance skill performance, confidence, and frequency of wheelchair use, especially for individuals with lower limb amputation. ^{1 2 3 4 5}

Is the wheelchair skills training program safe for humans?

Research indicates that wheelchair skills training programs are generally safe for humans, as studies have tested their safety and found them to be safe during rehabilitation. ^{1 2 4 5 6}

How is the Training Programs for Mobility Impairment treatment different from other treatments?

This treatment is unique because it combines app-based self-training and teleconference peer-led training, allowing users to learn wheelchair skills remotely using a computer tablet. This approach addresses the limitations of traditional in-person training, such as cost and accessibility, and is particularly beneficial during situations like social distancing. ^{3 5 7 8 9}

Research Team

Lynn Worobey, PhD/DPT

Principal Investigator

University of Pittsburgh

Eligibility Criteria

This trial is for clinicians who work with manual wheelchair users. Participants should be interested in improving their skills in providing wheelchair training and education.

Inclusion Criteria

Speaks English

I work with clients who use wheelchairs.

I am willing and able to learn how to use a wheelchair.

Exclusion Criteria

I am confident in teaching and can complete over half of the skills needed.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants receive the training intervention, which includes educational videos and practice-feedback loops for wheelchair skills

8 weeks

Remote sessions with asynchronous feedback

Crossover

Participants cross over to receive the alternative intervention and continue training

6 months

Follow-up

Participants are monitored for changes in wheelchair skills and training effectiveness

12 months

Follow-up assessments at 2, 6, 8, and 12 months

Treatment Details

Interventions

• Intervention A
• Intervention B

Trial Overview The study tests a remote manual wheelchair skills program, comparing it to both a control group receiving no intervention and a self-study group using web-based materials.

Participant Groups

Group I: Group 4: rehab professionals, not therapists Experimental Treatment 2 Interventions

Group 4 will mirror Group 3 but receive access to both interventions at the same time.

Group II: Group 3 Experimental Treatment 2 Interventions

Groups 3 will mirror Group 1 but for intervention A will only complete Part 1 of the training and then be cued weekly to practice.

Group III: Group 2 Experimental Treatment 3 Interventions

Group 2 will complete the control intervention (intervention B) of education on wheelchair provision. They will cross-over to receive the active intervention (intervention A) of remote wheelchair skills training at 6 months.

Group IV: Group 1: therapists Experimental Treatment 3 Interventions

Group 1 will receive the active intervention (intervention A) of remote wheelchair skills training. They will cross-over to receive the control intervention (intervention B) of education on wheelchair provision at 6 months.

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

Dalhousie University

Collaborator

Trials

177

Recruited

402,000+

National Institute on Disability, Independent Living, and Rehabilitation Research

Collaborator

Trials

83

Recruited

10,500+

Findings from Research

A wheelchair skills training program significantly improves manual wheelchair skills capacity in the short term, with a 13.26% increase in skills test scores compared to control groups in randomized controlled trials and a 23.44% increase in non-randomized studies.

While the training shows short-term benefits, the long-term effectiveness of manual wheelchair skills training and the effectiveness of powered wheelchair skills training remain unclear, with insufficient evidence to support lasting advantages.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review. Tu, CJ., Liu, L., Wang, W., et al.[2022]

A randomized controlled trial with 35 wheelchair users showed that a formalized Wheelchair Skills Training Program (WSTP) is safe and leads to significant improvements in wheelchair skills performance, with the treatment group achieving a 25% increase in skills compared to an 8% increase in the control group.

The WSTP specifically enhanced skills such as gravel and high-curb descent, indicating that targeted training can greatly improve independent mobility for new wheelchair users, suggesting a need for its inclusion in rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. MacPhee, AH., Kirby, RL., Coolen, AL., et al.[2022]

The pilot study involving 11 participants with lower limb amputations demonstrated significant improvements in wheelchair skill performance, confidence, and usage frequency after completing a structured training program, with 91% of participants achieving or exceeding their goals.

Qualitative feedback highlighted key themes such as motivators for learning and the importance of training structure, indicating that the program not only enhances practical skills but also boosts participants' confidence and safety in wheelchair use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study. Charlton, K., Murray, C., Boucaut, R., et al.[2022]

A feasibility study is being conducted with 32 older adults with mild to moderate cognitive impairment to evaluate a powered-wheelchair training program that uses errorless learning strategies and shared control technology.

The program aims to improve powered-wheelchair skills, suggesting that this method could effectively address the learning needs of older adults who struggle with traditional training methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility RCT protocol evaluating a powered-wheelchair training program for older adults. Smith, EM., Miller, WC., Mortenson, WB., et al.[2019]

The TEAM Wheels program, which combines app-based self-training and peer-led teleconference sessions, aims to improve skills training for manual wheelchair users, addressing the challenges of traditional in-person training methods.

This randomized control trial will evaluate the program's effectiveness in enhancing mobility, participation, and quality of life for individuals transitioning to wheelchair use, with outcomes measured at baseline, post-treatment, and 6 months later.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of the TEAM Wheels eHealth manual wheelchair training program: Study protocol for a randomized controlled trial. Giesbrecht, E., Faieta, J., Best, K., et al.[2021]

A study involving 10 participants (5 experienced powered wheelchair users and 5 expert clinicians) identified 110 distinct skills and abilities necessary for safe indoor powered wheelchair use, highlighting the complexity of this task.

The research revealed that about 50% of these skills are mental functions, and it emphasized the need for training programs to cover a wide range of skills and knowledge, including understanding oneself, the environment, the wheelchair, and the specific tasks involved.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding the task demands for powered wheelchair driving: a think-aloud task analysis. Smith, EM., Mortenson, WB., Mihailidis, A., et al.[2022]

The mHealth wheelchair skills training program for manual wheelchair users aged 55 and older was found to be feasible, with a high retention rate of 94% and 78% of participants completing the minimum training requirement over four weeks.

Participants reported significant satisfaction with the program, indicating a 98% agreement on perceived benefits, suggesting that this approach could enhance community participation and quality of life for older adults with mobility challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized control trial feasibility evaluation of an mHealth intervention for wheelchair skill training among middle-aged and older adults. Giesbrecht, EM., Miller, WC.[2020]

Both the In-person and Hybrid training methodologies significantly improved wheelchair service knowledge among 81 participants in India and Mexico, with both groups achieving scores above the passing cutoff after training.

The In-person training method was found to be more effective, yielding a greater increase in knowledge and higher satisfaction levels compared to the Hybrid course, suggesting that face-to-face training may enhance learning outcomes in wheelchair service provision.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing the effectiveness of a hybrid and in-person courses of wheelchair service provision knowledge: A controlled quasi-experimental study in India and Mexico. Burrola-Mendez, Y., Bonilla-Escobar, FJ., Goldberg, M., et al.[2020]

An 18-year-old female with severe cerebral palsy improved her power mobility skills after participating in a training program using a Power Wheelchair Trainer, as indicated by higher scores on the Power Mobility Screen and CPCHILD assessments.

The intervention allowed the participant to engage in power mobility training in a supportive environment, promoting self-exploration and skill development, which suggests the Trainer could be beneficial for individuals with similar impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting self-exploration and function through an individualized power mobility training program. Kenyon, LK., Farris, J., Brockway, K., et al.[2015]

References

1. England pubmed.ncbi.nlm.nih.gov

Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. [2022]

3. Australia pubmed.ncbi.nlm.nih.gov

Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Feasibility RCT protocol evaluating a powered-wheelchair training program for older adults. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Impact of the TEAM Wheels eHealth manual wheelchair training program: Study protocol for a randomized controlled trial. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Understanding the task demands for powered wheelchair driving: a think-aloud task analysis. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

A randomized control trial feasibility evaluation of an mHealth intervention for wheelchair skill training among middle-aged and older adults. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

Comparing the effectiveness of a hybrid and in-person courses of wheelchair service provision knowledge: A controlled quasi-experimental study in India and Mexico. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Promoting self-exploration and function through an individualized power mobility training program. [2015]