R. Lee Kirby, Paula W. Rushton, Francois Routhier, Louise Demers, Laura Titus, Jan Miller-Polgar, William C. Miller, Cher Smith, Bonita Sawatzky, Delphine Labbé, Mike McAllister, Chris Theriault, Kara Matheson, Kim Parker
Dalhousie University, Halifax, NS (Kirby, Theriault, Matheson, McAllister); Nova Scotia Health Authority, Halifax, NS (Smith, Parker);
Université Laval, Quebec City, PQ (Routhier); Université de Montréal, Montreal, PQ (Demers, Rushton); University of Western Ontario, London, ON (Titus, Miller-Polgar); University of British Columbia, Vancouver, BC (Miller, Sawatzky, Labbé)
ABSTRACT
Our objective was to test the hypothesis that caregivers and powered wheelchair users working together have higher levels of wheelchair skills capacity and confidence than wheelchair users performing alone. This was a multi-center cross-sectional study. The project was approved by the research ethics boards of the participating institutions and all participants provided written informed consent. We studied 150 participants – 75 caregivers and 75 wheelchair users. Wheelchair users had used their powered wheelchairs for a median (inter-quartile range) of 10.0 (16) years and spent a mean (SD) of 9.4 (4.6) hours per day in them. As outcome measures, we used Version 4.3 of the Wheelchair Skills Test, Objective (WST) and Questionnaire (WST-Q) versions. For each individual skill, we recorded data about the wheelchair user “alone” and in combination with the caregiver (“blended”). The mean (SD) total WST capacity scores alone and blended were 79 (9)% and 93 (6)% (p < 0.0001); the mean (SD) WST-Q capacity scores were 77 (11)% and 93 (6)% (p < 0.0001); and the mean (SD) WST-Q confidence scores were 76 (13)% and 93 (7)% (p < 0.0001). Caregivers enhance wheelchair-skills capacity by relative improvements of 18-21% and wheelchair-skills confidence by 22%. Despite the need for further study, this project has answered important questions about how caregivers provide mobility assistance to the users of powered wheelchairs.
INTRODUCTION
There has been some published work on the wheelchair skills of powered wheelchair users1-3 and also on a variety of issues affecting their caregivers.4-8 However, the extent to which caregivers assist with wheelchair skills has received little attention.
The objective of this study was to test the hypothesis that caregivers and powered wheelchair users working together have higher levels of wheelchair skills capacity and confidence than wheelchair users performing alone.
METHODS
This was a multi-center cross-sectional study. The project was approved by the research ethics boards of the participating institutions. All participants (caregivers and the wheelchair users with whom they worked) provided written informed consent.
By interview, we recorded demographic and wheelchair-related data regarding the caregivers and wheelchair users. Specifics about the powered wheelchairs used were recorded by observation.
We assessed the extent to which the caregiver enhanced the WST-Q and WST scores, using matched-pairs Sign tests to compare the wheelchair-user and blended total percentage WST-Q and WST scores.
RESULTS
We studied 150 participants – 75 caregivers and 75 wheelchair users. The mean (SD) ages were 57.0 (15.1) and 56.1 (14.7) years respectively. Of the caregivers and wheelchair users, 28 (37.3%) and 39 (52.0%) were male. The majority of caregivers were family members. Caregivers spent a median (IQR) of 20.0 (38.5) hours per week with the wheelchair users. Only 14 (18.7%) of the caregivers had ever received any formal training in wheelchair use, whereas 47(62.7%) of the wheelchair users had. Wheelchair users had used their powered wheelchairs for a median (IQR) of 10.0 (16) years and reported spending a mean (SD) of 9.4 (4.6) hours per day in them. The proportion of powered wheelchairs that were rear-, mid- and front-wheel drive were 37 (49.3%), 34 (45.3%) and 4 (5.3%); almost all wheelchairs (74 [98.7%]) were joystick-controlled.
The mean (SD) WST capacity scores alone and blended were 79 (9)% and 93 (6)%, with a mean difference of 14 (9)% (p < 0.0001). The mean (SD) WST-Q capacity scores alone and blended were 77 (11)% and 93 (6)%, with a mean difference of 16 (10)% (p < 0.0001). The mean (SD) WST-Q confidence scores alone and blended were 76 (13)% and 93 (7)%, with a mean difference of 17 (12)% (p < 0.0001). The extent of the added value provided by caregivers varied among the 30 individual skills.
DISCUSSION
We achieved our objective, corroborating the hypothesis that caregivers and powered wheelchair users working together have higher levels of wheelchair skills capacity and confidence than wheelchair users performing alone. We documented the extent of the enhancements – relative improvements over baseline of 18%, 21% and 22% for the three outcome measures. Further study is needed to explore caregiver effects on individual skills and how the caregiver effect might be enhanced by training.
CONCLUSIONS
Caregivers enhance wheelchair-skills capacity by relative improvements of 18-19% and wheelchair-skills confidence by 21%. Despite the need for further study, this project has answered important questions about how caregivers provide mobility assistance to the users of powered wheelchairs.REFERENCES
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2. Mountain A, Kirby RL, Smith C, Eskes G, Thompson K. Powered wheelchair skills training for persons with stroke: a randomized controlled trial. Am J Phys Med Rehabil 2014;93:1031-43.
3. Kirby RL, Miller WC, Routhier F, Demers L, Mihailidis A, Polgar JM, Rushton PW, Titus L, Smith C, McAllister M, Theriault C, Thompson K, Sawatzky B. Effectiveness of a wheelchair skills training program for powered wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil 2015; 96:2017-26.e3.
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5. Reid D, Laliberte-Rudman D, Hebert D. Impact of wheeled seated mobility devices on adult users’ and their caregivers’ occupational performance: a critical literature review. Can J Occup Ther 2002;69:261-80.
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7. Smith C, McCreadie M, Unsworth J. Prescribing wheelchairs: the opinions of wheelchair users and their carers. Clin Rehabil 1995;9:74-80.
8. Taylor DH, Hoenig H. The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement. J Am Geriatr Soc 2004;52:72-9.
9. Wheelchair Skills Test dynamic link. http://www.wheelchairskillsprogram.ca/eng/publications.php. Accessed January 4, 2017.
10. RL Kirby. Wheelchair Skills Assessment and Training. CRC Press, Taylor and Francis, Florida, 2016 (released November 22, 2016). Hard cover ISBN #9781498738811. E-Book ISBN #9781498738828. https://www.crcpress.com/Wheelchair-Skills-Assessment-and-Training/Kirby/p/book/9781498738811.ACKNOWLEDGEMENTS
We thank Deborah Stewart for study coordination and the research assistants for data collection. Funding for this study was provided by a grant from the Canadian Institutes for Health Research CanWheel team in Wheeled Mobility for Older Adults (AMG-100925).