Effect of a Community-Based Peer-Led eHealth Wheelchair Skills Training Program: A Randomized Control Trial

Objective: 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. Design: Randomized control trial with wait-list control group. Setting: Community. Participants: Community-dwelling MWC users aged 18 years or older who propel using both arms (N=50). Interventions: 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. Main Outcome Measures: 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. Results: The intention-to-treat (n=50) primary analysis revealed a statistically significant Time*Allocation interaction for community participation (mean P=.046 and hp2=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). Conclusions: 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. Archives of Physical Medicine and Rehabilitation 2025;106:821-7 (c) 2024 by the American Congress of Rehabilitation Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)