Development of a French-Canadian version of the Life-Space Assessment (LSA-F): content validity, reliability and applicability for power mobility device users

Assessing the measurement properties of life-space mobility measures in community-dwelling older adults: a systematic review

BACKGROUND

Preserving and enhancing mobility is an important part of healthy ageing. Life-space mobility is a construct that captures actual mobility within the home and the community. The objective of this systematic review was to synthesise the measurement properties and interpretability of scores produced by life-space mobility measures in community-dwelling older adults.

METHODS

This systematic review followed Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Multiple databases were searched to identify potentially relevant articles. Data extraction and assessment of methodological quality was conducted by two independent reviewers. When possible, results were quantitatively pooled for each measurement property. If studies could not be combined quantitatively, then findings were summarised qualitatively using means and percentage of confirmed hypothesis. Synthesised results were assessed against the COSMIN criteria for good measurement properties.

RESULTS

A total of 21 full text articles were included in the review. The University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA) was the most evaluated life-space mobility measure. The LSA demonstrated content validity, internal consistency (Cronbach's alpha 0.80-0.92), reliability [intra-class correlation value 0.89 (95% confidence interval (CI): 0.80, 0.94)] and convergent validity with measures of physical function in community-dwelling older adults.

CONCLUSION

This systematic review summarised the measurement properties of life-space mobility measures in community-dwelling older adults following COSMIN guidelines. The LSA has been translated into multiple languages and has sufficient measurement properties for assessing life-space mobility among community-dwelling older adults.

Effectiveness of the miWe Simulator Training on Powered Wheelchair-driving Skills: A Randomized Controlled Trial

OBJECTIVES

To evaluate the effectiveness of a home-based simulator training, in comparison with a videogame-based training, in terms of powered wheelchair driving skills, skills use in a real-world setting, and driving confidence.

DESIGN

Single-blinded randomized controlled trial.

SETTING

Community.

PARTICIPANTS

New powered wheelchair users (N=47) randomly allocated to simulator group (n=24, 2 drop-out) and control group (n=23, 3 drop-out).

INTERVENTIONS

The miWe wheelchair simulator (simulator group) or a kart driving videogame (control group) was setted-up at participants' homes (computer + joystick). They were instructed to use it at least 20 minutes every 2 days, during a period of 2 weeks.

PRIMARY OUTCOME MEASURE(S)

Assessments were done at baseline (T1) and post-training (T2) using the Wheelchair Skills Test Questionnaire (WST-Q, version 4.1), Wheelchair Confidence Scale (WheelCon), Assistive Technology Outcomes Profile for Mobility, and Life-Space Assessment (LSA). The time necessary to complete 6 WST tasks was measured with a stopwatch.

RESULTS

Participants of the simulator group significantly increased their WST-Q capacity score at T2 by 7.5% (P<.05), whereas the control group remained at the same score (P=.218). Participants of both groups rolled backward and went through a door significantly faster at T2 (P=.007; P=.016), but their speed did not change for the other skills. The WheelCon score significantly increased after training (+4% for the control group and +3.5% for the simulator group, P=.001). There was no T1-T2 difference between groups for the WST-Q performance scores (P=.119), the ATOP-Activity (P=.686), the ATOP-Participation scores (P=.814), and the LSA score (P=.335). No adverse events or side effects were reported during data collection or training.

CONCLUSIONS

Participants of both groups improved some skills and their wheelchair driving confidence. The simulator training group also demonstrated a modest post-training gain in their WST-Q capacity, but more studies would be needed to explore the long-term effects of the McGill immersive wheelchair simulator (miWe) simulator on driving skills.

Developing a One-Stop Platform Transportation Planning Service to Help Older Adults Move Around in Their Community Where, When, and How They Wish: Protocol for a Living Lab Study

Background

 Multiple mobility-related challenges frequently appear with aging. As a result, many older adults have difficulty getting around, to go, for example, to doctors’ appointments or leisure activities. Although various means of transportation are currently available, older adults do not necessarily use them, partly because they do not know which ones are adapted to their needs and preferences. To foster older adults’ autonomy and freedom in their decision-making about transportation, it is crucial to help them make informed decisions about the means that suit them best.

Objective

Our aim is to develop Mobilainés, a one-stop platform transportation planning service combining different transport modes and services to help older adults move around in their community where, when, and how they wish. More specifically, we aim to (1) define older adults’ mobility needs and preferences in order to conceptualize a one-stop platform; (2) cocreate a prototype of the one-stop platform; and (3) test the prototype with users in a real-life context.

Methods

This ongoing study uses a “Living Lab” co-design approach. This approach differs from traditional research on aging by facilitating intersectoral knowledge sharing and innovative solutions by and with older adults themselves. A steering committee of 8 stakeholders from the public, scientific, and private sectors, as well as older citizens, will meet quarterly throughout the study. The design comprises three phases, each with several iterative subphases. Phase 1 is exploration: through co-design workshops and literature reviews, members of the intersectoral committee will define older adults’ mobility needs and preferences to support the conceptualization of the one-stop platform. Phase 2 is experimentation: 4 personas will be produced that reflect the different needs and preferences of typical older adult end users of the platform; for development of a prototype, scenarios and mockups (static designs of the web application) will be created through co-design sessions with older adults (N=12) embodying these personas. Phase 3 is evaluation: we will test the usability of the prototype and document changes in mobility, such as the ability to move around satisfactorily and to participate in meaningful activities, by and with older adults (N=30) who use the prototype. The steering committee will identify ways to support the adoption, implementation, and scaling up of Mobilainés to ensure its sustainability. Qualitative and quantitative data will be triangulated according to each subphase objective.

Results

 The first phase began in September 2019. The study is scheduled for completion by mid-2023.

Conclusions

 This innovative transportation planning service will merge existing transportation options in one place. By meeting a wide variety of older adults’ needs and preferences, Mobilainés will help them feel comfortable and safe when moving around, which should increase their participation in meaningful activities and reduce the risk of social isolation.

International Registered Report Identifier (IRRID)

DERR1-10.2196/33894

Assessing life-space mobility : A systematic review of questionnaires and their psychometric properties

BACKGROUND

Life-space mobility (LSM), as the extent of mobility within one's environment, is a key for successful aging and has become a relevant concept in gerontology and geriatric research. Adequate assessment instruments are needed to identify older persons with LSM restrictions, and to initiate, adapt or evaluate intervention strategies.

OBJECTIVE

To systematically identify, describe and analyze the psychometric properties of LSM questionnaires, with a special focus on their availability in the German language.

METHODS

A systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library, CINAHL, and Web of Science. Studies that examined at least one psychometric property of LSM questionnaires published up to August 2021 were included and evaluated based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines.

RESULTS

This study included 37 validation studies describing 13 different LSM questionnaires. Methodological quality and comprehensiveness of validations were heterogeneous. Based on comprehensive and high-quality results, four LSM questionnaires stood out: the University of Alabama at Birmingham life-space assessment (UAB-LSA), life-space assessment in persons with cognitive impairment (LSA-CI), interview-based and proxy-based versions of the life-space assessment in institutionalized settings (LSA-IS), all of them available in the German language.

CONCLUSION

This systematic review provides a concise overview of available LSM questionnaires and their psychometric properties to facilitate the selection for use in clinical practice and research. The UAB-LSA and LSA-CI for community settings and the interview-based or proxy-based LSA-IS for institutional settings were found to be the most appropriate LSM questionnaires.

Psychometric properties testing of a Cantonese version of the Life-Space Assessment in people with stroke

The Life-Space Assessment (LSA) advances measurements of mobility by determining the extent of the spatial area in which a person moves in real life. Yet there is no Cantonese version of the LSA. This study aimed to translate and culturally adapt the LSA into Cantonese (C-LSA) and examine its psychometric properties in people with stroke. Psychometric properties were examined in 112 people with stroke. The life-space of stroke survivors was compared with that of healthy older people with and without depressive symptoms. The content validity of the C-LSA was good. The Cronbach’s α was 0.73. The test–retest reliability was 0.95. The standard error of measurement was 4.21 and the minimal detectable change was 11.66, without any ceiling or floor effects in the C-LSA composite score. The composite score correlated significantly with the Fugl-Meyer Assessment of lower extremities score (r_s = 0.31), the Five Times Sit-To-Stand time (r_s =  − 0.43), and the Frenchay Activities Index score (r_s = 0.48). People with stroke had significantly lower C-LSA composite scores than healthy older people. Depressive symptoms worsened the composite and assisted life-space scores only of people with stroke. The C-LSA is a reliable and valid tool for measuring life-space in stroke populations.

Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults

OBJECTIVES

To develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past 4 weeks and to evaluate its construct validity for urban and rural populations of older adults.

DESIGN

Cross-sectional validation study.

SETTING

Two study centres in urban and rural German outpatient hospital settings.

PARTICIPANTS

In total, N=83 community-dwelling older adults were recruited (n=40 from urban and n=43 from rural areas; mean age was 78.5 years (SD=5.4); 49.4% men).

PRIMARY AND SECONDARY OUTCOME MEASURES

The final version of the translated LSA-D was related to limitations in activities and instrumental activities of daily living (ADL/iADL) as primary outcome measure (primary hypothesis); and with sociodemographic factors, functional mobility, self-rated health, balance confidence and history of falls as secondary outcome measures to obtain construct validity. Further descriptive measurements of health included hand grip strength, screening of cognitive function, comorbidities and use of transportation. To assess construct validity, correlations between LSA-D and the primary and secondary outcome measures were examined for the total sample, and urban and rural subsamples using bivariate regression and multiple adjusted regression models. Descriptive analyses of LSA-D included different scoring methods for each region. All parameters were estimated using non-parametric bootstrapping procedure.

RESULTS

In the multiple adjusted model for the total sample, number of ADL/iADL limitations (β=-0.26; 95% CI=-0.42 to -0.08), Timed Up and Go Test (β=-0.37; 95% CI=-0.68 to -0.14), shared living arrangements (β=0.22; 95% CI=0.01 to 0.44) and history of falls in the past 6 months (β=-0.22; 95% CI=-0.41 to -0.05) showed significant associations with the LSA-D composite score, while living in urban area (β=-0.19; 95% CI=-0.42 to 0.03) and male gender (β=0.15; 95% CI=-0.04 to 0.35) were not significant.

CONCLUSION

The LSA-D is a valid tool for measuring life-space mobility in German community-dwelling older adults within the past 4 weeks in ambulant urban and rural settings.

TRIAL REGISTRATION NUMBER

DRKS00019023.

Wheelchair mobility, motor performance and participation of adult wheelchair users with ARSACS: a cross-sectional study

PURPOSE

Although approximately 45% of adults with Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) are permanent wheelchair users, this sub population has been less studied. The purpose of this study was to document wheelchair mobility, motor performance, and participation in a cohort of adult wheelchair users with ARSACS.

METHODS

We recruited 36 manual and powered wheelchair users with ARSACS, aged between 34 and 64 years, for this cross-sectional study. Participants completed measures regarding wheelchair mobility (Wheelchair Skills Test Questionnaire [WST-Q-F], Wheelchair Use Confidence Scale [WheelCon-F] and Wheelchair Outcome Measure [WhOM-F]), motor performance (Scale for the Assessment and Rating of Ataxia [SARA], Disease Severity Index for adults with ARSACS [DSI-ARSACS], Upper Extremity Performance Test for the Elderly [TEMPA], Standardised Finger to Nose Test [SFNT], grip strength, pinch strength, Lower Extremity Motor Coordination Test [LEMOCOT], Berg Balance Scale [BBS], Timed Up and Go [TUG] and 10-meter Walk Test [10mWT]), and participation (Barthel Index, LSA-F and LIFE-H). Results were compared between age groups (≤49 years and ≥50 years), types of wheelchair used, and available reference values. Correlations were computed between wheelchair mobility, upper limb function, and participation.

RESULTS

Participants presented limitations regarding wheelchair skills, motor performance, and participation in daily activities. Despite preserved upper limb strength, wheelchair skills, upper and lower limb coordination, standing balance, and functional independence were generally more impaired after 50 years of age and among powered wheelchair users. Significant moderate correlations were found between wheelchair skills and self-efficacy, upper limb strength and coordination, and participation in daily and social activities.

CONCLUSIONS

This study provided the first data sets describing specific characteristics of manual and powered wheelchair users with ARSACS. It supports a need to offer wheelchair skills training interventions to adults with ARSACS, which could increase their daily and social participation.IMPLICATIONS FOR REHABILITATIONAdult wheelchair users with ARSACS present with limited wheelchair skills, significantly impaired motor performance, and reduced participation that generally decreases with age. This profile may serve as comparative data for clinicians to anticipate disease progression.This study provides the first data on distinguishing characteristics between PWC users and MWC users with ARSACS. The main characteristics of PWC users include more severe functional limitations and motor impairments, as well as limited grip strength that contrasts with the general preservation of this function among other adults with ARSACS.There is a need to offer and evaluate wheelchair skills training interventions in the future for adults with ARSACS. The general preservation of grip and pinch strength observed in this population suggests a potential for improvement. Considering the associations found between wheelchair mobility and participation, such interventions may increase users' daily and social participation.

Translation and Validation of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale for French Paediatric Populations

Purpose: Physical activity level is a prognostic variable for patients with injuries. Self-report questionnaires exist to obtain these measures; however, they are not accessible to all populations because of language barriers. Therefore, the purpose of this study was to translate and validate the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) for francophones. Method: We translated the HSS Pedi-FABS using the forward–reverse translation approach and validated it among bilingual adults and an expert panel before administering it to a paediatric population. A repeated-measures crossover design was used: forty-three middle school students, aged 13.1 (SD 0.75) years, were randomly administered either the English or the French questionnaire. Two days later, all participants completed the other version. The translated questionnaire was assessed for its convergent validity (Spearman’s r correlation coefficients [ rs]), internal consistency (Cronbach’s α), and reliability (standard error of measurement [SEM]). Results: All assessments had a significance level of p < 0.001 with an excellent Spearman’s r correlation coefficient between the participants’ total scores on the translated questionnaires ( rs = 0.911). The overall scores for the questionnaire and the individual items of the questionnaire revealed excellent internal consistency (α = 0.868) and reliability (SEM = 0.334). Conclusions: The validated and reliable translated questionnaire can be used by researchers and clinicians to assess physical activity levels in French paediatric populations.

Life-Space Mobility in the Elderly: Current Perspectives

Life-space mobility (LSM) is a concept for assessing patterns of functional mobility over time. LSM is gaining traction in the research of geriatric population health. Several instruments have been developed to measure LSM, such as the University of Alabama at Birmingham Life-Space Assessment (LSA) or the Nursing Home Life-Space Diameter instrument. There has been exponential growth in the use of instruments measuring LSM in studies of older adults since the concept was introduced in 1985. In response to the increased volume of publications with clinical applicability to those working in geriatric health or conducting population-based research in older adults, we conducted a narrative review: a) to provide a summary of the articles that have assessed validation of the University of Alabama at Birmingham LSA instrument, the most widely used instrument to assess LSM in older adults; and b) to provide a summary of the research articles that have examined LSM as independent or outcome variable. Studies for this review were obtained with an organized search format and were included if they were published in the past 20 years, written in English, published in peer-reviewed literature, and included LSM as an independent or outcome variable. Seventy-nine articles were identified: 36 that employed a cross-sectional design and 22 that employed a longitudinal/prospective design to examine LSM as outcome variable; 17 longitudinal/prospective design articles that examined LSM as primary independent variable; 3 review articles; and 1 systematic review. Areas of research included physical function, cognitive function, sensory impairment, mental health, falls, frailty, comorbidities, healthcare use, mortality, and social/environmental factors. These studies showed that LSM instruments can accurately predict morbidity, mortality, and healthcare use.

Life-Space and Cognitive Decline in Older Adults in Different Social and Economic Contexts: Longitudinal Results from the IMIAS Study

Psychosocial, socioeconomic and sociocultural aspects can influence cognitive function among community-dwelling older adults. Life-space restriction is potentially related to cognitive status. We examined the longitudinal association between life-space mobility and changes in cognitive function in community-dwelling older adults in different social settings of North and South America and Europe. We used data from 1486 participants of the International Mobility in Aging Study (IMIAS) conducted at five sites: Tirana (Albania), Natal (Brazil), Manizales (Colombia), Kingston and Saint-Hyacinthe (Canada). Life-space mobility was assessed using the Life-Space Assessment (LSA) questionnaire at baseline (2012), and the Leganes Cognitive Test was used to evaluate cognitive function at baseline and follow-up (2016). The Quantile regressions (QR) were used to evaluate the factors associated with cognitive score in 2016 by adjusting for the cognitive score in 2012, with two distinct models for analyzing variables. A decrease in the cognitive function was observed at all research sites, except in Manizales. Participants with more restricted life-space at baseline had a decrease in their cognitive function 4 years later (β = -0.79, 95% CI: -1.400 to -0.18, p value<0.01) compared to those with the highest level. This decrease was independent of gender, age, research site, education, income sufficiency, social support, depression, cognitive function at baseline, chronic conditions and physical performance. Restriction in life-space is an important prognostic factor for cognitive function. Maintaining life-space can be a goal in public policies aimed at encouraging healthy aging, and might be useful in clinical practice to promote health status and to monitor older people at higher risk of cognitive decline.

Applicability of the 48/6 Model of Care as a Health Screening Tool, and its Association with Mobility in Community-Dwelling Older Adults

BACKGROUND

The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults.

METHODS

This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA.

RESULTS

A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = -10.567, P < 0.001), dysphagia (β = -9.610, P = 0.021), and pain (β = -7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age.

CONCLUSION

The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.

The Life-Space Assessment Measure of Functional Mobility Has Utility in Community-Based Physical Therapist Practice in the United Kingdom

BACKGROUND

The Life-Space Assessment (LSA) has demonstrable validity and reliability among people sampled from nonclinical settings. Its properties in clinical settings, especially physical therapy services, are less well established.

OBJECTIVE

The aim of this study was to test the construct/convergent validity, responsiveness, and floor/ceiling effects of the LSA among patients who had musculoskeletal, orthopedic, neurological, or general surgical presentations and were receiving individually tailored, community-based physical therapist interventions to address gait/balance impairments in an urban location in the United Kingdom.

DESIGN

A prospective, repeated-measures, comparative cohort design was used.

METHODS

Two hundred seventy-six community-dwelling, newly referred patients were recruited from three cohorts (outpatients; domiciliary, nonhospitalized; and domiciliary, recent hospital discharge). Data were collected from the LSA and the Performance-Oriented Mobility Assessment (POMA1) at initial assessment and discharge. Two hundred twenty-eight participants were retained at follow-up.

RESULTS

The median age was 80.5 years, 73.6% were women, and the median number of physical therapist contacts over 53 days was five. LSA scores at assessment and changes over treatment distinguished between cohorts, even after adjustment for covariates. Weak correlations (0.14-0.41) were found between LSA and POMA1 scores. No LSA floor/ceiling effects were found. Significant improvements in the LSA score after the intervention were found for each cohort and for the sample overall. For the whole sample, the mean change in the LSA score was 10.5 points (95% CI = 8.3-12.8).

LIMITATIONS

The environmental demands participants faced were not measured. Caregivers answered the LSA questions on behalf of participants when necessary. Assessors were not always masked with regard to the measurement point.

CONCLUSIONS

The LSA has utility as an outcome measure in routine community-based physical therapist practice. It has satisfactory construct validity and is sensitive to change over a short time frame. The LSA is not a substitute for the POMA1; these measures complement each other, with the LSA bringing the added value of measuring real-life functional mobility.

A Danish version of the life-space assessment (LSA-DK) - translation, content validity and cultural adaptation using cognitive interviewing in older mobility limited adults

BACKGROUND

Identification and prevention of mobility limitations in older adults is important to reduce adverse health outcomes. The Life-Space Assessment (LSA) provides a single measure of mobility including environmental and social resources of the older adult. Availability of the LSA for non-English speaking countries is still sparse. Therefore, we translated the LSA into Danish and performed a content validity analysis of the translation in older adults with mobility limitations.

METHODS

After translation into Danish, the Danish version (LSA-DK) was content validated using cognitive interviewing in older mobility limited adults (+ 65) from an outpatient rehabilitation center (n = 12), medical wards at a university hospital (n = 11), and an assisted living facility (n = 7). The interviews were transcribed and analyzed according to the four stages of the Information Processing Model. Based on the analyses, recommendations for changes to the LSA-DK and to the manual were made and presented to the developers of the LSA.

RESULTS

Consensus was reached on the LSA-DK. Thirty cognitive interviews were carried out. A wide range of sources of error primarily related to the comprehension, memory and decision process were identified. The frequency and type of error sources were most prevalent among assisted living facility informants and included difficulties in defining the geographical extension of neighborhood, town and outside town. The results led to adaptations to the questionnaire and manual to support implementation of the LSA-DK in clinical practice.

CONCLUSIONS

The Life-Space Assessment was translated into Danish and content validated based on cognitive interviews. Adaptations were made to support that the Danish version can be implemented in clinical practice and used in the assessment of mobility in older Danish adults.

Influence of Lifestyle Redesign® on Health, Social Participation, Leisure, and Mobility of Older French-Canadians

IMPORTANCE

Developed in California to enable community-dwelling older adults to maintain healthy and meaningful activities, Lifestyle Redesign^® is a well-known cost-effective preventive occupational therapy intervention. The impact of a newly adapted French version on older French-Canadians was, however, unknown.

OBJECTIVE

To explore the influence of Lifestyle Redesign on older French-Canadians' health, social participation, leisure, and mobility.

DESIGN

A mixed-methods design included a preexperimental component (questionnaires administered before and after the intervention and 3 and 6 mo postintervention) and an exploratory descriptive qualitative clinical study. Individual semidirected interviews were digitally audiotaped and transcribed, then underwent thematic content analysis using mix extraction grids.

SETTING

Community.

PARTICIPANTS

Sixteen volunteers (10 women) aged 65-90 yr (mean = 76.4, standard deviation = 7.6), 10 without and 6 with disabilities. Inclusion criteria were age ≥65 yr, normal cognitive functions, residence in a conventional or senior home, and French speaking.

INTERVENTION

French-Canadian 6-mo version of Lifestyle Redesign.

OUTCOMES AND MEASURES

Health, social participation, leisure, and mobility were measured using the 36-item Short Form Health Survey, Social Participation Scale, Leisure Profile, and Life-Space Assessment, as well as a semistructured interview guide.

RESULTS

The French-Canadian Lifestyle Redesign had a beneficial effect on participants' mental health (p = .02) and interest in leisure (p = .02) and, in those with disabilities, social participation (p = .03) and attitudes toward leisure (p = .04). Participants reported positive effects on their mental health, leisure, mobility, and social participation, including frequency and quality of social interactions, and indicated that having an occupational routine fostered better health. None of the participants reported no effect.

CONCLUSION AND RELEVANCE

The translated and culturally adapted Lifestyle Redesign is a promising occupational therapy intervention for community-dwelling older French-Canadians.

WHAT THIS ARTICLE ADDS

This study sheds light on the influence of the French-Canadian version of the intervention not only on older adults' health and social participation but also on their leisure activities and life-space mobility, two important outcomes not addressed in previous Lifestyle Redesign studies. Moreover, this study provides an in-depth understanding of the Lifestyle Redesign experience of French-Canadian older adults with and without disabilities, including participants with significant communication and mobility disabilities.

Frailty and its association with the Mediterranean diet, life-space, and social participation in community-dwelling older people

Frailty is a common and vulnerable state in older people, which leads to a higher risk of adverse health outcomes. This cross-sectional study examined the association between frailty and its phenotypic components with the Mediterranean diet, life-space, and social participation in community-dwelling older people. 263 community-dwelling older people recruited from three community centers in Hong Kong completed the study (robust = 85, pre-frail = 120, frail = 58). The results showed that the Mediterranean diet (OR = 0.29), life-space (OR = 0.32), and social participation (OR = 0.31) were associated with frailty. All factors were preferentially associated with slowness. The Mediterranean diet and social participation were additionally associated with weakness and low activity, respectively. To reduce the risk of frailty among diverse populations of older people in community settings, eliminating foods considered detrimental in the Mediterranean diet is advocated. Older people's satisfaction with social participation should be taken into consideration. Environmental designs should accommodate slow-walking older people to maximize their life-space.

A study of measurement properties of the Life-Space Assessment questionnaire in older adults with chronic obstructive pulmonary disease

OBJECTIVE

To test the measurement properties (reliability, interpretability, and validity) of the Life-Space Assessment questionnaire for older adults with chronic obstructive pulmonary disease.

DESIGN

Clinimetric study.

SETTING

Pneumology service, ambulatory care, São Paulo, SP, Brazil.

PARTICIPANTS

Consecutive sample of older adults ( n = 62; 38 (61%) men, 24 (39%) women) with chronic obstructive pulmonary disease.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Life-Space Assessment questionnaire assesses five space levels visited by the older adult in four weeks prior to the assessment. We tested the following measurement properties of this questionnaire: reliability (reproducibility assessed by a type-2,1 intraclass correlation coefficient (ICC_2,1); internal consistency assessed by the Cronbach's alpha; measurement error by determining the standard error of measurement (SEM)), interpretability (minimum detectable change with 90% confidence (MDC₉₀); ceiling and floor effects by calculating the proportion of participants who achieved the minimum and maximum scores), and validity by Pearson's correlation test between the Life-Space Assessment questionnaire scores and number of daily steps assessed by accelerometry.

RESULTS

Reproducibility (ICC_2,1) was 0.90 (95% confidence interval (CI): 0.84-0.94), and internal consistency (Cronbach's α) was 0.80 (range = 0.76-0.80 for each item deleted). SEM was 3.65 points (3%), the MDC₉₀ was 0.20 points, and we observed no ceiling (2%) or floor (6%) effects. We observed an association between the score of the Life-Space Assessment questionnaire and daily steps ( r = 0.43; P = 0.01).

CONCLUSION

Life-Space Assessment questionnaire shows adequate measurement properties for the assessment of life-space mobility in older adults with chronic obstructive pulmonary disease.

Pain, fatigue, function and participation among long-term manual wheelchair users partnered with a mobility service dog

PURPOSE

To assess the effects of a mobility service dog (MSD) on pain, fatigue, wheelchair-related functional tasks, participation and satisfaction among manual wheelchair users over a nine-month period.

METHOD

A longitudinal study with repeated assessment times before and three, six and nine months after intervention was achieved. Intervention consisted in partnering each participant with a MSD. The setting is a well-established provincial service dog training school and participants homes. A convenience sample of 24 long-term manual wheelchair users with a spinal cord injury was involved. Outcome measures were: Wheelchair User's Shoulder Pain Index (WUSPI), Rate of Perceived Exertion (RPE), vitality scale from the SF-36, grip strength, Wheelchair Skills Test (WST), Canadian Occupational Performance Measure (COPM), Reintegration to Normal Living Index (RNLI), Life Space Assessment, Psychosocial Impact of Assistive Devices Scale (PIADS) and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0).

RESULTS

Shoulder and wrist pain as well as fatigue decreased significantly over time with the use of a MSD as evidenced by scores from WUSPI, RPE and SF-36 (feeling less worn out). Manual wheelchair propulsion skills (steep slopes, soft surfaces and thresholds) improved significantly over time as confirmed by the WST. Participation increased significantly over time as revealed by the COPM (for five occupations) and the RNLI (for five items). Satisfaction with the MSD was high over time (QUEST: nine items) and with a high positive psychosocial impact (PIADS: 10 items).

CONCLUSION

MSD represents a valuable mobility assistive technology option for manual wheelchair users. IMPLICATIONS FOR REHABILITATION   For manual wheelchair users partenered with mobility service dog  • Shoulder pain and fatigue significantly decreased and continued to decrease between the third and sixth month and the ninth month.   • Performance with propelling the wheelchair up steep slopes increased from 41 to 88% and on soft surfaces increased from 53 to 100% after 3 months, respectively.   • Occupational performance satisfaction was significantly increased for mobility in relation with the transfers, navigating in a natural environment and picking up objects.   • High satisfaction towards psychosocial competency, psychosocial adequacy and self-esteem were reported at months three, six and nine.

Life Space Assessment in Stroke Patients

Objective

To evaluate the reliability of the practical life space in post-stroke patients using the Korean version of the Life-Space Assessment (K-LSA) questionnaire and to assess the relationships between the K-LSA and physical function, daily activity, quality of life, and post-stroke depression.

Methods

The LSA questionnaire was translated into Korean, and the translated version was authorized by the author of the LSA questionnaire. In a cross-sectional study, the performance of the K-LSA was evaluated in 34 stroke patients (20 males and 14 females; mean age 65.11±2.39 years) who were receiving physical and occupational therapy at the outpatient clinic in the rehabilitation medicine department of a university medical center at the time of evaluation. Performances were assessed twice by one examiner at a 2-week interval to test the reliability. The patients were evaluated using the Functional Ambulation Category (FAC) scale, Functional Independence Measure (FIM) scale, and mobility subscale of the FIM to assess their relationships with the K-LSA. They were also evaluated using the EuroQol 5 Dimensions questionnaire (EQ-5D) and Geriatric Depression Scale (GDS) to determine the relationship with quality of life and post-stroke depression.

Results

Test-retest reliability at the first (62.20±32.14) and second (63.15±32.22) assessment was 0.993 (p<0.01). The K-LSA showed significant correlations with the FAC (r=0.848, p<0.01), FIM (r=0.765, p<0.01), mobility category of the FIM (r=0.764, p<0.01), GDS (r=-0.657, p<0.01), and EQ-5D (r=0.506, p<0.01).

Conclusion

This study suggests that the practical life space of post-stroke patients, assessed by the K-LSA, has a significant correlation with patients' functional mobility, independence in daily activity, quality of life, and depression.

Measurement properties of the WheelCon for powered wheelchair users

PURPOSE

To evaluate the measurement properties of the Wheelchair Use Confidence Scale for power wheelchair users (WheelCon-P).

DESIGN

One-month test-retest design, using data from a longitudinal study of power wheelchair use.

PARTICIPANTS

Volunteer sample of 73 community dwelling, older adult experienced power wheelchair users who had a mean age of 60.5 ± 7.1 years.

METHODS

Participants completed the WheelCon-P twice to assess retest reliability. Concurrent validity was assessed by evaluating hypothesized relationships between the WheelCon-P and relevant variables.

RESULTS

The baseline mean (standard deviation) WheelCon-P score was 78.8 ± 14.5. Cronbach's α was 0.92. The one-month test-retest intraclass correlation coefficient was 0.85 (CI 0.77-0.90). Correlations ranging from r = 0.26 (social support) to r = 0.49 (wheelchair skills) were found between the WheelCon-P and the validation outcome measures.

CONCLUSION

The WheelCon-P has high internal consistency, strong retest reliability and evidence supporting its validity. Although further work is needed, the WheelCon-P may serve as a useful clinical and research tool for measuring power wheelchair confidence. Implications for rehabilitation The WheelCon-P is a reliable and valid outcome measure for assessing wheelchair confidence. This tool can be used to identify individuals with low power wheelchair confidence who require a confidence-enhancing intervention.

Feasibility of a Systematic, Comprehensive, One-to-One Training (SCOOT) program for new scooter users: study protocol for a randomized control trial

Background

Mobility scooters can facilitate community participation among individuals with mobility limitations. However, accidents are a serious concern with scooter use. Scooter training has been recommended to improve safety, but there are currently few validated programs available. Therefore, we developed a Systematic, Comprehensive, One-to-One Training (SCOOT) program for scooter users. We will conduct a study to evaluate the outcomes produced by the provision SCOOT.

Methods

This feasibility study will use a mixed-methods, rater-blinded, randomized control trial, with a two-step wedge design. The study has two arms: an immediate intervention group, which will receive the intervention directly after baseline assessments, and a delayed intervention group, which will receive the intervention after a 6-week period. Forty participants, who will be stratified based on whether or not participants have previously held a driver’s license, will be randomly assigned to each arm. The intervention for this study consists of 6 weeks of one-to-one scooter training by an experienced occupational therapist, who will provide training once or twice per week over the 6 weeks. The primary outcome measure is subjective scooter skills, measured using the Wheelchair Skills Test for scooters. Secondary outcomes include objective scooter skills, confidence, mobility, and satisfaction with selected participation activities. Descriptive measures include cognitive status, functional status, hearing, vision, physical accessibility of the home and community, and visual attention and task switching. Qualitative interviews will be conducted with the first ten willing participants from each group to learn about their scooter use and experiences with SCOOT.

Discussion

The results of this study will inform a larger randomized control trial. If the intervention is proven to be effective in this larger study, it may have important implications for policy and practice.

Trial registration

ClinicalTrials.gov identifier: NCT02696213. Registered on 23 February 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1963-y) contains supplementary material, which is available to authorized users.

Strategic Variations in Fitts' Task: Comparison of Healthy Older Adults and Cognitively Impaired Patients

The present study aimed at investigating how healthy older adults (HOA) and cognitively impaired patients (CIP) differ in a discrete Fitts' aiming task. Four levels of task difficulty were used, resulting from the simultaneous manipulation of the size of the target and its distance from home position. We found that movement times (MTs) followed Fitts' law in both HOA and CIP, with the latter being significantly slower and more affected by increased task difficulty. Moreover, correlation analyses suggest that lower information processing speed (IPS) and deficits in executive functions (EFs) are associated with decline of sensorimotor performance in Fitts' task. Analyses of strategic variations showed that HOA and CIP differed in strategy repertoire (which strategies they used), strategy distribution (i.e., how often they used each available strategy), and strategy execution (i.e., how quick they were with each available strategy). These findings further our understanding of how strategic variations used in a sensorimotor task are affected by cognitive impairment in older adults.

Concurrent validity of the Swedish version of the life-space assessment questionnaire

Background

The Life-Space Assessment (LSA), developed in the USA, is an instrument focusing on mobility with respect to reaching different areas defined as life-spaces, extending from the room where the person sleeps to mobility outside one’s hometown. A newly translated Swedish version of the LSA (LSA-S) has been tested for test-retest reliability, but the validity remains to be tested. The purpose of the present study was to examine the concurrent validity of the LSA-S, by comparing and correlating the LSA scores to other measures of mobility.

Method

The LSA was included in a population-based study of health, functioning and mobility among older persons in Sweden, and the present analysis comprised 312 community-dwelling participants. To test the concurrent validity, the LSA scores were compared to a number of other mobility-related variables, including the Short Physical Performance Battery (SPPB) as well as “stair climbing”, “transfers”, “transportation”, “food shopping”, “travel for pleasure” and “community activities”. The LSA total mean scores for different levels of the other mobility-related variables, and measures of correlation were calculated.

Results

Higher LSA total mean scores were observed with higher levels of all the other mobility related variables. Most of the correlations between the LSA and the other mobility variables were large (r = 0.5–1.0) and significant at the 0.01 level. The LSA total score, as well as independent life-space and assistive life-space correlated with transportation (0.63, 0.66, 0.64) and food shopping (0.55, 0.58, 0.55). Assistive life-space also correlated with SPPB (0.47). With respect to maximal life-space, the correlations with the mobility-related variables were generally lower (below 0.5), probably since this aspect of life-space mobility is highly influenced by social support and is not so dependent on the individual’s own physical function.

Conclusion

LSA was shown to be a valid measure of mobility when using the LSA total, independent LS or assistive LSA.

Wheeled-mobility correlates of life-space and social participation in adult manual wheelchair users aged 50 and older

PURPOSE

To characterize the life-space mobility and social participation of manual wheelchair users using objective measures of wheeled mobility.

METHOD

Individuals (n = 49) were included in this cross-sectional study if they were aged 50 or older, community-dwelling and used their wheelchair on a daily basis for the past 6 months. Life-space mobility and social participation were measured using the life-space assessment and late-life disability instrument. The wheeled mobility variables (distance travelled, occupancy time, number of bouts) were captured using a custom-built data logger.

RESULTS

After controlling for age and sex, multivariate regression analyses revealed that the wheeled mobility variables accounted for 24% of the life-space variance. The number of bouts variable, however, did not account for any appreciable variance above and beyond the occupancy time and distance travelled. Occupancy time and number of bouts were significant predictors of social participation and accounted for 23% of the variance after controlling for age and sex.

CONCLUSIONS

Occupancy time and distance travelled are statistically significant predictors of life-space mobility. Lower occupancy time may be an indicative of travel to more distant life-spaces, whereas the distance travelled is likely a better reflection of mobility within each life-space. Occupancy time and number of bouts are significant predictors of participation frequency. Implications for rehabilitation Component measures of wheelchair mobility, such as distance travelled, occupancy time and number of bouts, are important predictors of life-space mobility and social participation in adult manual wheelchair users. Lower occupancy time is an indication of travel to more distant life-spaces, whereas distance travelled is likely a better reflection of mobility within each life-space. That lower occupancy time and greater number of bouts are associated with more frequent participation raises accessibility and safety issues for manual wheelchair users.

Life Space Assessment in Spinal Cord Injury

Objectives: To examine the Life Space Assessment (LSA) in persons with spinal cord injury (SCI), exploring its psychometric properties, differences between persons with cervical versus thoracolumbar injuries, and cutoff score differentiating a restricted from an unrestricted life space. Method: We conducted a test-retest reliability study in a community setting involving 50 persons with SCI (25 injured above C7, 25 injured below T1). Data were collected in 2 phone interviews approximately 9 days apart using the LSA. Results: Mean LSA scores were 66 ± 25 (n = 50): 62 ± 23 for the cervical group, and 70 ± 25 for the thoracolumbar group. Scores were not significantly different between phone interviews [t(49) = 0.379, p = .706] or between groups [t(48) = -1.214, p = .231]. Test-retest reliability intraclass correlation coefficient (ICC) was 0.876 (95% CI, 0.792-0.928). Spearman's rho correlations between the LSA and Reintegration to Normal Living Index total and subscores ranged from .509 to .538 (p < .001). LSA scores were normally distributed. The minimum detectable change was approximately 23 points. A cutoff score of 78.5 (sensitivity 76.9%, specificity 81.1%) differentiated between persons with a restricted from an unrestricted life space if equipment and personal assistance were not needed for mobility. If equipment was needed, the cutoff score was found to be 49 (sensitivity of 90%, specificity of 90%). Conclusions: The LSA is a reliable and valid measure of life space in persons with SCI and can be used to identify persons with a restricted life space who may be at increased risk of mobility disability.

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial

OBJECTIVES

To test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation centers and communities.

PARTICIPANTS

Powered wheelchair users (N=116).

INTERVENTION

Five 30-minute WSTP training sessions.

MAIN OUTCOME MEASURES

Assessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA).

RESULTS

There was no significant t2-t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3.

CONCLUSIONS

Powered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

Exploratory Validation of a Multidimensional Power Wheelchair Outcomes Toolkit

OBJECTIVE

To evaluate the relation among the measures in a power wheelchair outcomes toolkit.

DESIGN

We performed path analysis of cross-sectional data from self-report questionnaires and 1 objective measure.

SETTING

Six sites.

PARTICIPANTS

A convenience sample of power wheelchair users (N=128). Most (n=69; 53.9%) participants were women. Multiple sclerosis and spinal cord injury/disease were the most common diagnoses.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The power wheelchair version of the Wheelchair Skills Test version 4.1 was used to carry out an objective evaluation of capacity to perform 32 wheelchair skills. The Late-Life Disability Index measured frequency of participation in 16 life activities. The Life-Space Assessment measured independence, extent, and frequency of mobility. The Assistive Technology Outcomes Profile for Mobility was used to assess perceived difficulty performing activity and participation using assistive technology. The Wheelchair Use Confidence Scale for powered wheelchair users captured users' self-efficacy with wheelchair use.

RESULTS

Wheelchair confidence was independently associated with less difficulty with activity (β=.028, P=.002) and participation (β=.225, P<.001), increased life space (β=.095, P<.003), and greater wheelchair skills (β=.30, P<.001). Less perceived difficulty with activity was independently associated with increased frequency of participation (β=.55, P<.001). Life-space mobility was independently associated with increased frequency of participation (β=.167, P<.001). Less difficulty with participation was independently associated with greater life-space mobility (β=.59, P<.001) and greater frequency of participation (β=.13, P<.001).

CONCLUSIONS

This study provides empirical support for the measures included as part of the power wheelchair outcomes toolkit. They appear to provide complementary information on a variety of constructs related to power wheelchair use.

A critical analysis of the internal logic in the Life-Space Assessment (LSA) composite score and suggested solutions

BACKGROUND

An individual's ability to live independently is commonly measured in health research interested in identifying risk factors associated with disablement processes. In order to inform clinical practice, population research has attempted to identify the contraction of "lived-space" by using various survey instruments.

PROBLEM

Studies assessing habitual movements over the environment with the Life-Space Assessment (LSA) survey instrument should carefully consider how the LSA Composite Score (LSA-CS) is computed. Until now, no publication has carefully delineated the assumptions guiding the internal logic used in the computation of the LSA-CS.

CORE ARGUMENT

Because the internal logic of the LSA may need further justification, a non-data-editing scoring algorithm should be considered.

SOLUTION

Compute LSA-CS by only using non-edited data.

SPECIFIC AIM

Paper first delineates the logic guiding the algorithm used in the formation of the LSA-CS and explains how the scoring creates and changes participant responses when they conflict with its internal logic. An easy-to-use SAS® 9.3 program for estimating a Non-Data-Edited LSA-CS (NDE-LSA-CS) is also presented.

CONCLUSION

Researchers interested in assessing lived-space should carefully consider if the internal logic of the LSA-CS is warranted. Clinicians should know it is important to understand the strengths and weaknesses of outcome measures used when deciding on whether to apply the results of research to direct clinical practice.

Randomized controlled trial protocol feasibility: The Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU)

BACKGROUND

Manual wheelchairs (MWCs) can improve mobility and social participation for individuals who experience difficulty walking; however, older adults receive little training for wheelchair use. The Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU) research program provides peer-led training that may positively influence wheelchair use while reducing clinician burden.

PURPOSE

The purpose of this study is to evaluate the feasibility and clinical outcomes of WheelSeeU.

METHOD

A randomized control trial (RCT) recruits and randomly assigns 40 MWC users (55+ years). Feasibility indicators assessing process, resource, management, and treatment issues are measured, and clinical outcomes (wheelchair skills, safety, confidence, mobility, social participation, quality of life, health utility) are collected at three time points.

IMPLICATIONS

WheelSeeU provides an innovative approach for teaching wheelchair skills to an aging population that may improve wheelchair use and decrease clinician burden. Since RCTs are expensive and challenging in rehabilitation, establishing feasibility prior to larger effectiveness trials is prudent.

Influences of wheelchair-related efficacy on life-space mobility in adults who use a wheelchair and live in the community

BACKGROUND

Self-efficacy has important implications for health and functioning in people with limited mobility. However, the influence of self-efficacy on mobility in adults who use wheelchairs has yet to be investigated.

OBJECTIVE

The study objective was to: (1) estimate the direct association between wheelchair use self-efficacy and life-space mobility and (2) investigate an indirect effect through wheelchair skills.

DESIGN

This was a cross-sectional study.

METHODS

Participants (N=124) were adults who use a wheelchair, live in the community, and were 50 years of age and older (X̅=59.67, range=50-84), with at least 6 months of experience with manual wheelchair use; 60% were men. The 20-item Life-Space Assessment, the 65-item Wheelchair Use Confidence Scale, and the 32-item Wheelchair Skills Test-Questionnaire were used to measure life-space mobility, self-efficacy, and wheelchair skills, respectively.

RESULTS

Self-efficacy had a statistically significant association with life-space mobility (nonstandardized regression coefficient=0.23, 95% confidence interval=0.07, 0.39) after controlling for sex, number of comorbidities, geographic location, and assistance with using a wheelchair. This model accounted for 37.1% of the life-space mobility variance, and the unique contribution of self-efficacy was 3.5%. The indirect effect through wheelchair skills was also statistically significant (point estimate=0.21, 95% bootstrapped confidence interval=0.05, 0.43) and accounted for 91.3% of the direct effect of self-efficacy on life-space mobility. This model accounted for 39.2% of the life-space mobility variance.

LIMITATIONS

Causality could not be established because of the study design. The self-report nature of data from volunteers may be influenced by recall bias, social desirability, or both.

CONCLUSIONS

Wheelchair use self-efficacy had both direct and indirect associations with life-space mobility after controlling for confounding variables. Interventions targeted toward improving self-efficacy may lead to improvements in life-space mobility.

Measurement properties of the late life disability index among individuals who use power wheelchairs as their primary means of mobility

OBJECTIVE

To examine the reliability, validity, and factor structure of the Late Life Disability Instrument (LLDI) in individuals who use power wheelchairs as their primary means of mobility.

DESIGN

A 4-week, test-retest study design.

SETTING

Five Canadian cities.

PARTICIPANTS

The validity sample included 115 new and experienced power mobility users, and the reliability sample included 85 experienced users (N=115). These volunteer samples included individuals who were aged ≥50 years and independently used power mobility as their primary means of mobility.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The LLDI measures participation in 2 dimensions of 16 life activities: frequency and perceived limitations. Validity measures included the Wheelchair Skills Test-power version, the Assistive Technology Outcomes Profile for Mobility, the Hospital Anxiety and Depression Scale, the Power Mobility Wheelchair Confidence Measure, and the Life Space Assessment.

RESULTS

For the reliability sample, raw intraclass correlational coefficients for limitation and frequency dimension scores ranged from .855 (95% confidence interval .781-.905) to .883 (95% confidence interval, .822-.924), respectively. For the validity sample, scores on the LLDI were correlated as hypothesized with scores on validity measures. The factor structure that was identified with the original sample was not replicated among power wheelchair users. For LLDI frequency, exploratory factor analysis indicated that 5 of the original 16 items did not perform similarly among power wheelchair users. For LLDI limitations, a 1-factor, rather than a 2-factor, solution was identified.

CONCLUSIONS

The study provides evidence in support of the reliability and validity of the measure but suggests that the original subscale scores may not be applicable to power wheelchair users.

Life-space mobility assessment in older people in Finland; measurement properties in winter and spring

Background

Life-space mobility refers to the spatial area an individual moves through, the frequency and need for assistance. Based on the assumption that measurement scale properties are context-specific, we tested the scale distribution, responsiveness, and reproducibility of the 15-item University of Alabama at Birmingham Study of Aging Life-Space Assessment in older people in Finland, specifically accounting for season.

Methods

Community-dwelling older men and women in central Finland aged 75-90 years were interviewed to determine life-space mobility (score range 0-120). Baseline (January-June 2012) and one-year follow-up data (January-June 2013; n = 806) from the cohort study “Life-space mobility in old age” were used to investigate the scale distribution and responsiveness over a period of one year. In addition, with a sub-sample in conjunction with the one-year follow-up, we collected data to study the two-week test-retest reproducibility (n = 18 winter and n = 21 spring 2013).

Results

The median life-space mobility score at baseline was 64. The median change in score over the one-year follow-up was zero. However, participants reporting a decline in health (repeated measures ANOVA p = .016) or mobility (p = .002) status demonstrated a significantly larger decrease in life-space mobility score than those reporting no or positive changes over the year. The two-week intra-class correlation (ICC) coefficient was .72. Lower ICC was found in the winter than in the spring sample and for items that represent higher life-space levels.

Conclusions

The test-retest reproducibility of the Life-Space Assessment was fair but somewhat compromised in the winter. Mobility of older people at the life-space levels of “town” and “beyond town” may be more variable. Life-space mobility was responsive to change, regardless of season. Further study is warranted to obtain insight in the factors contributing to seasonal effects.

Test-retest reliability of the Swedish version of the Life-Space Assessment Questionnaire among community-dwelling older adults

OBJECTIVE

To examine the test-retest reliability of the Swedish version of the Life-Space Assessment Questionnaire.

DESIGN

Test-retest reliability study.

SUBJECTS

A total of 298 community-dwelling subjects between 75 and 90 years of age.

METHODS

The Life-Space Assessment Questionnaire was translated into Swedish. By personal interviews during home visits and two weeks later by telephone interviews the subjects were asked about their life-space mobility during the past four weeks, and how often and whether they were independent or needed assistance from another person or equipment to reach different life-space levels.

RESULTS

None of the four scoring methods showed significant difference between test sessions. The mean (SD) total scores were 65 (22) and 65 (23) out of the maximum possible score of 120 at the two sessions. High levels were found for independent, assisted, and maximal life-space at both sessions. Intraclass correlation coefficients and weighted Kappa-values between 0.84-0.94 were found for the total score, the independent, and the assisted life-space levels, indicating good to excellent reliability. A lower Kappa-value was observed for the maximal life-space level, mainly owing to skewed distributions. The method error values showed that a change of 10 in the total score and a change of one level in any of the three life-space levels can be considered to indicate a real change in clinical practice.

CONCLUSION

The Swedish version of the Life-Space Assessment Questionnaire can be reliably used among community-dwelling older adults.

Feasibility of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) program: study protocol for a randomized controlled trial

Background

Many older adults rely on a manual wheelchair for mobility but typically receive little, if any, training on how to use their wheelchair effectively and independently. Standardized skill training is an effective intervention, but limited access to clinician trainers is a substantive barrier. Enhancing Participation in the Community by Improving Wheelchair Skills (EPIC Wheels) is a 1-month monitored home training program for improving mobility skills in older novice manual wheelchair users, integrating principles from andragogy and social cognitive theory. The purpose of this study is to determine whether feasibility indicators and primary clinical outcome measures of the EPIC Wheels program are sufficiently robust to justify conducting a subsequent multi-site randomized controlled trial.

Methods

A 2 × 2 factorial randomized controlled trial at two sites will compare improvement in wheelchair mobility skills between an EPIC Wheels treatment group and a computer-game control group, with additional wheelchair use introduced as a second factor. A total of 40 community-dwelling manual wheelchair users at least 55 years old and living in two Canadian metropolitan cities (n = 20 × 2) will be recruited. Feasibility indicators related to study process, resources, management, and treatment issues will be collected during data collection and at the end of the study period, and evaluated against proposed criteria. Clinical outcome measures will be collected at baseline (pre-randomization) and post-intervention. The primary clinical outcome measure is wheelchair skill capacity, as determined by the Wheelchair Skills Test, version 4.1. Secondary clinical outcome measures include wheelchair skill safety, satisfaction with performance, wheelchair confidence, life-space mobility, divided-attention, and health-related quality of life.

Discussion

The EPIC Wheels training program offers several innovative features. The convenient, portable, economical, and adaptable tablet-based, home program model for wheelchair skills training has great potential for clinical uptake and opportunity for future enhancements. Theory-driven design can foster learning and adherence for older adults. Establishing the feasibility of the study protocol and estimating effect size for the primary clinical outcome measure will be used to develop a multi-site randomized controlled trial to test the guiding hypotheses.

Trial registration

Clinical Trials NCT01740635.

Use of an innovative model to evaluate mobility in seniors with lower-limb amputations of vascular origin: a pilot study

BACKGROUND

The mobility of older individuals has often been only partially assessed, without considering all important aspects such as potential (available) versus effective (used) mobilities and the physical and psychosocial factors that modulate them. This study proposes a new model for evaluating mobility that considers all important aspects, applied here to lower-limb amputees with vascular origin. This model integrates the concepts of potential mobility (e.g. balance, speed of movement), effective mobility (e.g. life habits, movements in living areas) and factors that modulate these two types of mobility (e.g. strength, sensitivity, social support, depression). The main objective was to characterize potential and effective mobility as well as mobility modulators in a small sample of people with lower-limb amputations of vascular origin with different characteristics. The second objective of this pilot study was to assess the feasibility of measuring all variables in the model in a residential context.

METHODS

An observational and transversal design was used with a heterogeneous sample of 10 participants with a lower-limb amputation of vascular origin, aged 51 to 83, assessed between eight and 18 months after discharge from an acute care hospital. A questionnaire of participant characteristics and 16 reliable and valid measurements were used.

RESULTS

The results show that the potential mobility indicators do not accurately predict effective mobility, i.e., participants who perform well on traditional measures done in the laboratory or clinic are not always those who perform well in the real world. The model generated 4 different profiles (categories) of participants ranging from reduced to excellent potential mobility and low to excellent effective mobility, and characterized the modulating factors. The evaluations were acceptable in terms of the time taken (three hours) and the overall measurements, with a few exceptions, which were modified to optimize the data collected and the classification of the participants. For the population assessed, the results showed that some of the negative modulators (particularly living alone, no rehabilitation, pain, limited social support, poor muscle strength) played an important role in reducing effective mobility.

CONCLUSION

The first use of the model revealed interesting data that add to our understanding of important aspects linked to potential and effective mobility as well as modulators. The feasibility of measuring all variables in the model in a residential context was demonstrated. A study with a large number of participants is now warranted to rigorously characterize mobility levels of lower-limb amputees with vascular origin.

A conceptual framework of outcomes for caregivers of assistive technology users

OBJECTIVE

To develop and validate the content of a conceptual framework concerning outcomes for caregivers whose recipients are assistive technology users.

DESIGN

The study was designed in four stages. First, a list of potential key variables relevant to the caregivers of assistive technology users was generated from a review of the existing literature and semistructured interviews with caregivers. Second, the variables were analyzed, regrouped, and partitioned, using a conceptual mapping approach. Third, the key areas were anchored in a general stress model of caregiving. Finally, the judgments of rehabilitation experts were used to evaluate the conceptual framework.

RESULTS

An important result of this study is the identification of a complex set of variables that need to be considered when examining the experience of caregivers of assistive technology users. Stressors, such as types of assistance, number of tasks, and physical effort, are predominant contributors to caregiver outcomes along with caregivers' personal resources acting as mediating factors (intervening variables) and assistive technology acting as a key moderating factor (effect modifier variable).

CONCLUSIONS

Recipients' use of assistive technology can enhance caregivers' well being because of its potential for alleviating a number of stressors associated with caregiving. Viewed as a whole, this work demonstrates that the assistive technology experience of caregivers has many facets that merit the attention of outcomes researchers.