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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine the effectiveness of remote training programs for clinicians working with wheelchair users. Participants are divided into groups: some receive remote feedback, others engage in self-study, and another group serves as a control. The trial seeks to identify which approach best aids therapists' learning. Rehabilitation professionals working with wheelchair users, who have internet access and a spotter, may be suitable candidates. As an unphased trial, this study provides an opportunity to contribute to innovative training methods that could enhance professional skills.

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 prior data suggests that this training program is safe for clinicians?

Past studies have shown that remote learning programs effectively improve wheelchair skills and boost confidence among healthcare providers. This method is safe and practical. Research shows that such training enhances the knowledge and skills needed for using a wheelchair without causing harm or significant side effects.

Intervention A focuses on remote training for wheelchair skills. Studies indicate that this training is safe and improves skills without any reported negative effects. Participants become more confident and skilled in using manual wheelchairs.

Intervention B involves learning about providing wheelchairs. Like Intervention A, research has shown that this educational approach safely improves healthcare providers' understanding and skills. The training is well-received, with no major safety concerns reported.

Both interventions aim to safely and effectively improve skills and knowledge, making them promising options for healthcare providers seeking to enhance their wheelchair training abilities. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial for training programs for mobility impairment because it explores innovative approaches to enhancing wheelchair skills. Unlike traditional methods that often rely on in-person training and education, this trial includes a remote skills training intervention, making it more accessible to participants. The trial also tests a flexible design where participants can switch between interventions, allowing researchers to assess the effectiveness of combining remote training with educational components. This approach could lead to more personalized and efficient rehabilitation programs, potentially improving mobility outcomes for individuals using wheelchairs.

What evidence suggests that this trial's treatments could be effective for mobility impairment?

Research has shown that remote training for manual wheelchair skills, which participants in this trial may receive as Intervention A, greatly improves both skills and confidence. One study found a 13.26% increase in test scores after this training. This approach is simple yet effective, utilizing knowledge about wheelchair use and basic movement skills.

For Intervention B, another treatment option in this trial, formal training for wheelchair skills results in small, short-term improvements, particularly for powered wheelchair users. Remote learning also enhances ability, confidence, and understanding of wheelchair skills. Both types of training have proven valuable in improving skills and outcomes for wheelchair users and healthcare providers. ^{1 2 3 5 6}

Who Is on the Research Team?

Lynn Worobey, PhD/DPT

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

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

Access to a spotter(s)

Access to an Internet-ready device with video capabilities

Speaks English

Exclusion Criteria

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

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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 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]

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 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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8204376/

Using remote learning to teach clinicians manual ... Remote learning can increase wheelchair skills capacity and confidence as well as knowledge about such training and assessment.

2. withpower.com withpower.com/trial/phase-wheelchair-skills-1-2023-12be0

Training Programs for Mobility Impairment (SKILL Trial) A wheelchair skills training program significantly improves manual wheelchair skills capacity in the short term, with a 13.26% increase in skills test scores ...

3. resna.org resna.org/sites/default/files/conference/2019/wheelchair_seating/Kirby.html

Effectiveness Of Remote Asynchronous Wheelchair Skills ... The Wheelchair Skills Training Program is a low-tech, high-impact training protocol that draws on both the wheelchair literature and principles of motor skill ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT03499951

NCT03499951 | Remote Wheelchair Skills Training Efficacy Individuals will receive remotely delivered wheelchair skills training, after which they will be assessed on their ability to teach the Wheelchair Skills ...

5. archives-pmr.org archives-pmr.org/article/S0003-9993(24)01408-4/fulltext

Effect of a Community-Based Peer-Led eHealth ... To address these challenges, MWC skills training programs have been developed to improve effectiveness and safety with wheelchair mobility.

6. clinicaltrials.gov clinicaltrials.gov/study/NCT01644292

Study Details | NCT01644292 | Enhancing Participation In ... EPIC WheelS is a user-centred program for wheelchair skills training that combines two structured 1-hour sessions with an expert trainer and four weeks of self- ...