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

International Society of Wheelchair Professionals' Basic Manual Wheelchair Service Provision Knowledge Test Version 2: Assessment of preliminary psychometric evidence

Valid and reliable assessment tools to test wheelchair service personnel/provider knowledge are needed to support good practice. The International Society of Wheelchair Professionals' Basic Manual Wheelchair Service Provision Test (Version 1) has been widely used across contexts and settings to assess the knowledge of personnel who provide manual wheelchair services. Test Version 2 has been recently developed according to current evidence. The objectives of this study were to assess the internal consistency reliability and construct validity for the Test Version 2. A convenience sample of 156 test-takers completed an online test with 170 multiple-choice questions. Internal consistency was measured using Cronbach's alpha, which ranged from 0.58 to 0.91 across different domains. Most questions (55.9%) were classified as "easy," while 28.2% were "medium" difficulty. Regression analysis showed that test-taker characteristics, particularly years of experience, explained nearly half of the variation in test scores (R2 = 0.47). The findings provide preliminary evidence supporting the test's reliability and construct validity.

Enabling local provision of assistive products in rural South India: an organisational survey of needs, barriers, and facilitators

OBJECTIVE

Access to assistive products (APs) is essential to maximising function, participation, and inclusion of persons with disabilities. Challenges to AP access in low- and middle-income countries include stigma, costs, supply, and rehabilitation capacity gaps. This study aimed to examine AT access in the context of a low-resource setting in rural South India. Objectives were to examine rehabilitation professionals' perceptions of AP needs, barriers and facilitators of AP provision, and AT knowledge.

METHODS

A descriptive study design with a 2-part online survey methodology was utilized. This study was conducted in April-September 2020 at a non-governmental organization (NGO) serving children and adults with disabilities in 3 districts of rural South India. Purposive sampling of NGO's multidisciplinary rehabilitation professionals (N=62) was used. The survey was developed based on WHO's Assistive Products List (APL). Barriers and facilitators were classified according to the principles of AT access. Analyses revealed acceptability, affordability, and availability as the top three barrier themes across disciplines, including poor acceptance by clients/families due to stigma, high AP costs, and a long waitlist for government-provided devices. Acceptability, affordability, and accessibility were the top three facilitator themes, including community awareness, availability of AP funding, client/family education, and AT service provision training.

IMPACT

Our study identified key enabling strategies for AT access, aimed at reducing reported barriers. Enabling AP provision was determined to be multi-factorial, aimed at users/ families, service providers, organizations, communities, and policymakers. Local stakeholder groups are crucial to understanding challenges and opportunities to AP provision within a low-resource context.

A Remote-Learning Course can improve the subjective wheelchair-skills performance and confidence of wheelchair service providers: an observational cohort study

PURPOSE

To test the hypothesis that a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence of wheelchair service providers, and to determine the participants' views on the Course.

METHODS

This was an observational cohort study, with pre-post comparisons. To meet the objectives of the six-week Course, the curriculum included self-study and weekly one-hour remote meetings. Participants submitted their Wheelchair Skills Test Questionnaire (WST-Q) (Version 5.3.1) "performance" and "confidence" scores before and after the Course. Participants also completed a Course Evaluation Form after the Course.

RESULTS

The 121 participants were almost all from the rehabilitation professions, with a median of 6 years of experience. The mean (SD) WST-Q performance scores rose from 53.4% (17.8) pre-Course to 69.2% (13.8) post-Course, a 29.6% relative improvement (p < 0.0001). The mean (SD) WST-Q confidence scores rose from 53.5% (17.9) to 69.5% (14.3), a 29.9% relative improvement (p < 0.0001). Correlations between performance and confidence were highly significant (p < 0.0001). The Course Evaluation indicated that most participants found the Course useful, relevant, understandable, enjoyable, "just right" in duration, and most stated that they would recommend the Course to others.

CONCLUSIONS

Although there is room for improvement, a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence scores of wheelchair service providers by almost 30%, and participants were generally positive about the Course.

The experiences and perceptions of health-care professionals regarding assistive technology training: A systematic review

Worldwide, there is an increasing demand for assistive technologies (ATs) that can support people to live independently for longer. Health-care professionals (HCPs) often recommend AT devices, however there exists a lack of availability of devices and appropriate training in the field. This systematic review aimed to synthesize the available evidence into the experiences and training needs of HCPs in relation to AT. Six electronic databases were searched without date restrictions: MEDLINE, PsycINFO, SPP, SSCI, CINAHL, and ASSIA. Journal handsearching, searching reference lists of included studies and relevant reviews, and contacting experts in the field of AT were also conducted. Findings were analyzed using narrative synthesis. Data from 7846 participants from 62 studies were synthesized, eliciting perceived challenges in access to and provision of training, resulting in knowledge gaps across disciplines and geographic locations. Mechanisms to mitigate these issues included ongoing support following training and tailoring education to meet individual needs since comprehensive training is essential to maintain and improve competence, knowledge, and confidence. Further research is required to explore the impact and effectiveness of AT training for HCPs to ensure that users of devices are supported to live independent and healthy lives.

Provision of paediatric wheelchairs in low resource settings: a scoping review

PURPOSE

Inadequate wheelchair provision in children can lead to delays in growth and development, poorer health, and decreased participation. Wheelchair provision for children can be challenging, especially in low-resource settings, due to limited resources. Therefore, the purpose of the scoping review was to gain an understanding of the current state of paediatric wheelchair provision in low resource settings and identify factors, strategies, and gaps that can lead to more successful wheelchair provision.

METHODS

This scoping review used literature published after 2010, related to paediatric wheelchair provision in low resource settings. We searched online databases and grey literature and extracted data based on categories from the World Health Organisation Guidelines to wheelchair provision in low resource settings.

RESULTS

34 articles were used to identify and analyse common themes and successful strategies related to wheelchair provision for children in low resource settings. Aspects of paediatric wheelchair provision were mentioned in the literature but were rarely the focus. End-user outcomes were the least represented category in the literature.

CONCLUSION

Based on the currently available evidence the overall state of a wheelchair for children is inadequate. Improvements in design and production, personnel capacity, and service delivery systems are recommended to promote best practices. The lack of child-focussed wheelchair provision and end-user involvement in the research process urgently needs to be addressed.Implications for RehabilitationIdentify best practiceIdentify gaps in knowledgeDetermine areas of need for future research.

Wheelchair service provision education for healthcare professional students, healthcare personnel and educators across low- to high-resourced settings: a scoping review protocol

PURPOSE

Appropriate wheelchair provision is necessary for addressing participation barriers experienced by individuals with mobility impairments. Health care professionals involved in the wheelchair service provision process require a specific set of skills and knowledge to enable wheelchair use that meets individual posture, mobility and daily living requirements. However, inconsistencies exist in academic programmes globally about providing comprehensive education and training programmes. The planned scoping review aims to review and synthesize the global literature on wheelchair service provision education for healthcare professional students, healthcare personnel and educators offered by universities, organizations and industries.

METHODS

This scoping review will be guided by the Joanna Briggs Institute (JBI) methodological framework. Comprehensive literature searches will be conducted on various global electronic databases on health to seek out how wheelchair service provision education is organized, integrated, implemented and evaluated. Two independent reviewers will perform eligibility decisions and key data extractions. Data from selected studies will be extracted and analysed using conventional content analysis. Information related to wheelchair service provision education including curriculum development, content, teaching methods, evaluation and models of integration will be synthesized.

IMPLICATIONS AND DISSEMINATION

The planned scoping review will be the first to examine all aspects of wheelchair service provision education across professionals, settings and countries. We anticipate that results will inform the content of a Wheelchair Educators' Package, and if appropriate, a follow-up systematic review. An article reporting the results of the scoping review will be submitted for publication to a scientific journal.Implications for RehabilitationA comprehensive examination of wheelchair service provision education could help develop strategies to address the unmet need for wheelchair services globally.Findings for this review will facilitate the planning and development of an evidence-based education package that could bridge the existing knowledge gaps related to safe and effective wheelchair service provision among health professionals involved.This review will also inform the potential barriers and enablers for effective integration and implementation of wheelchair service provision education worldwide.

Psychometric properties of the International Society of Wheelchair Professionals' basic manual wheelchair-service-provision knowledge Test Version 1 and development of Version 2

INTRODUCTION

Valid and reliable scores from measurement tools to test competency in basic manual wheelchair-service-provision are needed to promote good practice and support capacity building. The International Society of Wheelchair Professionals' (ISWP) Basic Test Version 1 in English, launched in 2015, is the most frequently used outcome measure tool to test basic manual wheelchair-service-provision knowledge and is part of an international certification process. Despite the wide acceptance and use of the test, its psychometric properties have not yet been established. The objectives of this study were 1) to evaluate the test's psychometric properties, 2) to develop the test's Version 2, and 3) to evaluate the content validity of the new version.

METHODS

For Objective 1, methods from the Classical Test Theory were used to obtain items' difficulty, item discrimination index and domains' reliability. For Objective 2, a team of experts in wheelchair service delivery and education conducted a systematic qualitative review of the questions' text and answers and updated them using evidence-based guidelines. For Objective 3, an external team reviewed the clarity, relevance and domain allocation of the developed items using a 4-point Likert scale. Descriptive statistics were used to describe and characterize the results for each objective. Item-content (I-CVI) and Scale-content (S-CVI) validity indexes were calculated to compute content validity.

RESULTS

For Objective 1, all domains in the test were below the threshold for acceptable internal consistency reliability; 80% of the total test pool (116 items from the total pool of 145) did not meet the thresholds for item difficulty and index of discrimination suggested in the literature. Of the items in the Test, 78% could be responded to intuitively and 66% did not distinguish between test-takers who were knowledgeable in the content area and those who were not. For Objective 2, experts found concerns such as items being grouped in the wrong domain, being repeated, not using person-first language, and using terms inconsistently. Thirty-four (23.4%) items were dropped and 111 (76.5%) were updated. In addition, 61 new items were developed. Members re-categorized the items and proposed a new classification of subdomains. For Objective 3, good agreement between subject-matter experts was found; the S-CVI calculated using the I-CVIs related to item clarity was 84% while using the I-CVIs related to item relevance was 98%. Only 7 items (4.1%) were deemed to be in the wrong domain and 4 items (2.3%) were considered irrelevant and dropped.

CONCLUSION

The psychometric evidence in support of ISWP Basic Test Version 1 in English is suboptimal. A new set of items developed by experts in the field has shown excellent content validity. Ongoing assessments will be needed as ISWP Basic Test Version 2 is implemented and monitored.

Wheelchair service provision education for healthcare professional students, healthcare personnel and educators across low- to high-resourced settings: a scoping review

PURPOSE

This review aimed to collate and summarize available research literature about wheelchair service provision education available to healthcare professional students, healthcare personnel and educators across low- to high-resourced settings.

METHODS

The Joanna Briggs Institute methodological steps for scoping reviews were followed. Included studies were mainly sourced from Medline, Embase, CINAHL, Scopus, Academic Search Complete and ProQuest. Independent title, abstract and full-text screening with defined inclusion and exclusion criteria was performed. All screening and extraction were performed independently by two authors. A thematic approach was used to synthesize results. Data extracted from included studies were charted according to a template that we created. The study quality was also appraised.

RESULTS

A total of 25 articles were included (11, 36% from high-income settings) with 12 (48%) observational studies and 13 (52%) experimental studies. The literature addressed three main topics: (1) assessing wheelchair service provision knowledge, (2) implementing training interventions using in-person, online and/or hybrid learning approaches and (3) describing current wheelchair service provision education globally. The most frequently reported training programs used were the Wheelchair Skills Program and the World Health Organization Wheelchair Service Training Package - Basic Level.

CONCLUSION

Limited information has been published about the integration of wheelchair content into the curricula of professional rehabilitation programs. Efforts to build international partnerships, improve the quality and currency of training programs and build resources that can assist educators in the integration of wheelchair-related content into professional rehabilitation programs should be prioritized.Implications for RehabilitationThis is the first review that examined and synthesized the current state of wheelchair service provision education for rehabilitation students and personnel across low- to high-income countries.Findings from this review indicate that there is limited information about the integration of wheelchair-related content into professional rehabilitation programs.Efforts to build international partnerships, standardize wheelchair service provision content and evaluation and integrate training into professional rehabilitation programs worldwide should be prioritized.

Using remote learning to teach clinicians manual wheelchair skills: a cohort study with pre- vs post-training comparisons

PURPOSE

To test the hypothesis that remote learning to teach clinicians manual wheelchair skills is efficacious.

MATERIALS AND METHODS

A convenience sample of therapists (physical and occupational) and students were enrolled in pairs in a cohort study with pre- versus post-training comparisons. The intervention was a hybrid of self-study and hands-on practice paired with remote feedback for ten intermediate and advanced manual wheelchair skills. Participants practiced with self-selected frequency and duration, uploading a session log and video(s) to an online platform. A remote trainer provided asynchronous feedback prior to the next practice session. Capacity and confidence in completing the ten skills were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q). Knowledge of wheelchair skills training and motor learning was assessed using a 62-item Knowledge Test. Secondary outcome measures included skill achievement, as confirmed by submitted video recordings, and participant feedback about the training.

RESULTS

Across 41participants, scores were higher at follow-up compared to baseline for WST-Q capacity (73.9 ± 19.1 vs 16.8 ± 15.6, p < 0.001), WST-Q confidence (80.1 ± 12.2 vs 47.6 ± 18.2, p = 0.003) and knowledge (70.8 ± 7.5 vs 67.0 ± 5.4, p = 0.004).

CONCLUSIONS

Remote learning can increase wheelchair skills capacity and confidence as well as knowledge about such training and assessment. This model should be further investigated as a delivery method for training rehabilitation professionals.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01807728.Implications for rehabilitationWheelchair skills training is one of the 8 steps of wheelchair provision as outlined by the World Health Organization.Wheelchair skills are not a core part of most clinical curriculums and many clinicians cite a lack of resources and uncertainty on how to implement wheelchair skills training into practice as major barriers to providing such training.Remote learning offers the benefits of structured wheelchair skills training with expert feedback on an individual's own schedule that is not afforded by one-day "bootcamp"-type courses or on-the-job training, which are how many clinicians currently learn wheelchair skills.In a sample of physical and occupational therapists and students, remote learning was effective at increasing capacity and confidence to perform manual wheelchair skills as well as knowledge of wheelchair training.

[Hybrid education in healthcare education : a systematic reviewEducación híbrida en la formación en salud: revisión sistemática]

Introduction

Given the need to restructure healthcare education institutions due to the COVID-19 pandemic, hybrid education has been identified as an alternative to reorganize educational activities. The objective of this study is to describe hybrid education development in healthcare education.

Materials and Methods

A systematic literature review was conducted based on the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guideline. A peerreviewed search was conducted across four electronic databases between July and September 2020. Descriptors used were "distance education", "learning", "health", "nursing", "medicine", "dentistry", "physical therapy" and "hybrid education". Selected articles were classified based on their level of evidence.

Results

49 articles were selected, including quantitative, qualitative and mixed methods studies. Experiences in the development of hybrid education in multiple healthcare courses were found. Hybrid education has been implemented based on the rotation model, a la carte model and Flex model.

Discussion

Hybrid education has been gaining more and more importance in the academic scenario of healthcare education. Based on this, students manage to stand out in their learning process as they become the main agent of this process by actively learning using multiple education tools provided by their teachers.

Conclusions

Successful hybrid education can be related to its innovative, flexible, cost-effective nature and the ability to turn students into key players in their teaching-learning process, which ends up influencing their own academic performance.

An exploratory analysis of global trends in wheelchair service provision knowledge across different demographic variables: 2017-2020

OBJECTIVE

To explore global trends in manual wheelchair service provision knowledge across geographic, professional, and socioeconomic domains.

DESIGN

A secondary analysis of a dataset from the International Society of Wheelchair Professionals' Wheelchair Service Provision Basic Knowledge Test was conducted.

SETTING

The dataset included test takers from around the world and was extracted from Test.com and International Society of Wheelchair Professionals' Wheelchair International Network.

PARTICIPANTS

2,467 unique test takers from 86 countries.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

International Society of Wheelchair Professionals' Wheelchair Service Provision Basic Knowledge Test.

RESULTS

We identified significant inverse associations between pass rate and the following variables: education (high school and some college), test taker motivation (required by academic program or employer), and country income setting (low and middle). There were significant positive associations between pass rate and the following variables: training received (offered by Mobility India or 'other NGO'), and age group served (early childhood).

CONCLUSION

Global wheelchair knowledge trends related to key variables such as training, occupation, and income setting have been preliminarily explored. Future work includes further validation of the primary outcome measure and recruitment of a larger sample size to further explore significant associations between additional test taker variables.

Efficacy of a Remote Train-the-Trainer Model for Wheelchair Skills Training Administered by Clinicians: A Cohort Study with Pre- vs. Post-Training Comparisons

OBJECTIVE

To test the hypotheses that remote training improves trainer confidence and, when these trainers train others, the capacity and confidence of the trainees improves.

DESIGN

Cohort study with pre- vs post-training comparisons.

SETTING

Four Spinal Cord Injury Model Systems Centers.

PARTICIPANTS

Convenience sample of 7 clinician trainers and 19 able-bodied trainees.

INTERVENTION

Part 1 focused on trainer skill acquisition with self-study of the Wheelchair Skills Program Manual and instructional videos focused on motor learning, spotting, and 10 intermediate and advanced wheelchair skills. Trainers practiced in pairs, receiving asynchronous feedback on video-recordings from a remote instructor. Part 2 included additional video modules targeted at "how to" assess and train others in four wheelchair skills: gets over obstacle, ascends low curb, ascends high curb with caregiver assistance, and performs stationary wheelie. Upon completion, the trainers each provided 1:1 in-person training for 2-3 trainees.

MAIN OUTCOME MEASURES

Trainer confidence was assessed using the Self-Efficacy on Assessing, Training, and Spotting (SEATS) Test for Manual Wheelchairs. Trainee capacity ("Can you do it?") and confidence ("How confident are you?") were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q).

RESULTS

Trainer confidence increased for assessment (p=0.003) and training (p=0.002), but not spotting (p=0.056). Trainee 4-item median [IQR] WST-Q scores significantly increased with training for capacity (13% [6,31] to 88% [75,88], p < 0.001) and confidence (13% [0,31] to 88% [81,100], p < 0.001).

CONCLUSIONS

Remote training improves trainers' confidence with respect to wheelchair-skills testing and training, and the wheelchair-skills capacity and confidence of their trainees.

Evaluating Usability in Blended Learning Programs Within Health Professions Education: a Scoping Review

Knowledge was mapped about how usability has been applied in the evaluation of blended learning programs within health professions education. Across 80 studies, usability was explicitly mentioned once but always indirectly evaluated. A conceptual framework was developed, providing a foundation for future instruments to evaluate usability in this context.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01295-x.

Understanding the Global Challenges to Accessing Appropriate Wheelchairs: Position Paper

Introduction: Appropriate wheelchairs are often essential for the health and wellbeing of people with mobility impairments to enhance fundamental freedoms and equal opportunity. To date, provision has mainly focused on just delivering the wheelchair instead of following an evidence-based wheelchair service delivery process. In addition, many governments have not committed to a national wheelchair provision policy. Approach: To prepare this position paper, a systemic development model, founded on the sustainable human security paradigm, was employed to explore the global challenges to accessing appropriate wheelchairs. Positions: I: Consideration of key perspectives of wheelchair provision across the life course is essential to meet the needs to children, adults, older people and their families; II: Comprehensive wheelchair service delivery processes and a competent workforce are essential to ensure appropriate wheelchair service provision; III: Evaluations on wheelchair product quality development, performance and procurement standards are key as wheelchair product quality is generally poor; IV: Understanding the economic landscape when providing wheelchairs is critical. Wheelchair funding systems vary across jurisdictions; V: Establishing wheelchair provision policy is a key priority, as specific policy is limited globally. Conclusion: The vision is to take positive action to develop appropriate and sustainable wheelchair service provision systems globally, for me, for you, for us.

Development, validation and feasibility study of a remote basic skills assessment for wheelchair service providers

AIM

The purpose of this study was to develop, validate and conduct a feasibility study of three remote basic skills assessment modalities for wheelchair service providers (WSP) including an online case study quiz (m1), an in-person skills assessment (m2) and a video conference skills assessment (m3).

METHODS

We conducted a literature review; developed and validated 3 basic skills assessments; and conducted a feasibility study of each modality.

RESULTS

The literature review revealed that a validated remote basic skills assessment for WSP that reflects all World Health Organization (WHO) 8 wheelchair service provision steps did not exist. We recruited a total of 12 participants for the feasibility study. Two participants dropped out of the study prior to completing a second testing modality. Related to test performance, the results show that our first hypothesis was rejected because only m1 mean score was comparable to the International Society of Wheelchair Professionals (ISWP) Basic Knowledge Test (SD = 0.44). This is in contrast with the Wilcoxon signed-rank test results that show a statistically significant difference between these two modalities. We are therefore not confident that the knowledge test was an appropriate comparison to m1 skills assessment. Hypothesis two was not rejected. The feasibility results reveal 86% success.

CONCLUSION

M1, 2 and 3 have the potential to serve as remote basic skills assessments. However, according to both test performance and feasibility criteria, we believe that m2 has the highest potential to be included in certification processes for basic wheelchair service providers, like the one offered by ISWP.IMPLICATIONS FOR REHABILITATIONA universal remote basic skills assessment that can be accessed across the globe, especially in remote locations where a skilled and experienced provider is not available, is needed.Such test can be an asset to training or professional organisations like ISWP as a way to test WSP competency or to warrant certification.WSP clinical knowledge and skills are essential for the prescription of an appropriate wheelchair to avoid physical harm, abandonment of the device and unnecessary expenses.Properly prescribed wheelchairs allow people with impaired mobility to gain increased ability to perform ADLs, participate in communities, and reduce secondary medical complications such as upper limb repetitive strain injuries, pain, and/or pressure sores.

Final Year Students' Knowledge on Basic Manual Wheelchair Provision: The State of Occupational Therapy Programs in Colombia

Access to personal mobility is a human right and as such, it implies the provision of wheelchair services for those with mobility impairments that need one. Lack of appropriately trained personnel is a major contributor to the gap in access to wheelchairs. Assistive technology provision is one of the core competencies of occupational therapists. The goal of this study was to assess the current wheelchair provision knowledge of final year occupational therapy students in Colombia as measured by the International Society of Wheelchair Professionals Basic Wheelchair Service Knowledge Test. A total of 83 students from 7 universities took the test. None of the students met the 70% passing threshold. The highest scores were in the assessment domain while the lowest in the fitting and user training domains. These results suggest that the current wheelchair provision education received in these programs do not meet the World Health Organization guidelines on appropriate wheelchair provision. The implementation of strategies to improve current wheelchair provision education in Colombian occupational therapy programs is granted.