To examine the measurement properties of the French-Canadian version of the Life-Space Assessment questionnaire (LSA-F) for power mobility device (PMD) users.
Content validity, test-retest reliability of telephone interviews (2-week interval) and applicability were examined with PMD users presenting neurological, orthopedic or medically complex conditions. Translation/back-translation from English to French and cultural adaptation was performed and pretested with five bilingual users. Test-retest reliability was examined with 40 French-speaking users, age 50 and over, who had been using a subsidized PMD for 2-15 months. Audio-taped interviews were coded to judge content validity and applicability.
Content validity results confirmed equivalent meaning for most questions. The test-retest reliability was excellent for the composite score (intra-class correlation coefficient = 0.87) and revealed moderate to substantial concordance for 18/20 items (k = 0.47-0.73; P(a) > 57.5%). The applicability of the LSA-F is satisfactory considering an acceptable burden of assessment, low refusal of the telephone interview format (8%; n = 4), reasonable administration time (9.2 +/- 3.9 min) and a normally distributed composite score.
The LSA-F is a valid measure with regards to its content, stable over a period of 2 weeks and applicable for a population of middle-aged and older French-Canadian speaking adults who use PMDs.
To test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months.
Three rehabilitation centers in Montréal, Quebec, Canada.
Manual wheelchair users (N=39), a sample of convenience.
Participants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min).
The French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2).
At t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by =0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P=.017 at a Bonferroni-adjusted a level of .005).
WSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months.
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In 1998, 11.8% of the Quebec population over 15 years showed mobility problems and 2.3% of that group revealed that their needs were not met. The same year, the Régie de l'assurance-maladie du Québec distributed more than 4,500 wheelchairs and repaired some 30,000 others, at a cost of over $20 million. The recycling of wheelchairs is seen as a solution for improving this situation. This paper presents an evaluation of a wheelchair recycling program.
Three groups of participants involved in the recycling of wheelchairs contributed to the gathering of information. These were: personnel (n = 9), occupational therapists in the community (n = 5) and users of refurbished wheelchairs (n = 20).
A participative and qualitative research approach was conducted with the 1st group. The results outline the inefficacy of the process on the structural level (e.g. not enough resources to collect unused wheelchairs), operational level (e.g. absence of norms to recycle), strategic level (e.g. absence of policy to encourage people to give back their unused wheelchair) and systemic level (e.g. the state is not imputable). A quantitative approach with the 2nd and 3rd groups revealed high satisfaction with regard to the efficacy, appearance, safety, durability and comfort as well as the delivery and follow-up services rendered.
The evaluation procedure herein proposed can be customized to fit other contexts and provides policy-makers with quick access to field data to help them choose the appropriate course of action.
The aim of this study was to examine the application of new Environmental Control Systems (ECSs) in the homes of users and caregivers. The research questions were: (1) Can new ECS applications improve the activities of daily living (ADL) of people with significant functional limitations who require personal assistance? (2) Can new ECS applications replace home services and lessen caregiver burden? To answer these questions, user satisfaction regarding ECS applications, impact on ADL, technical performance, and caregiver burden were examined. This collaborative investigation involving a local community health care center, a telephone monitoring service, an industrial partner, and a university research team used a case study approach. Five users with moderate cognitive problems or significant functional limitations who required personal assistance were chosen, along with their caregivers, for a 3-month in-home trial to test new ECS alternatives. The ECS in the study featured remote control functions (e.g., door lock release, outside intercom), specific verbal reminders (e.g., reminders to turn off stove elements), and automatic functions (e.g., night-lights in the bathroom and hallway). Information was collected in the users' homes with three standardized questionnaires and a company-designed questionnaire. The overall technical performance of the ECS was found to be in most cases moderately efficient. Participant satisfaction revealed that ECS alternatives needed improvement with respect to the service aspects such as follow-up services and repair/servicing. Caregiver burden was lessened for psychological aspects but not for physical tasks. Users seemed to have a positive perception of the impact of the ECS on many of their ADL. We learned six lessons from this 15-month case study, namely: (1) the use of remote control by people with moderate cognitive impairments was difficult; (2) verbal reminders were greatly appreciated; (3) the automatic ECS applications needed more adjustment; (4) reactions varied depending on the participant's perspective; (5) other assessment tools might have been better suited to mild cognitive problems; and (6) removal of a beneficial product at the conclusion of the evaluation phase raised ethical considerations.
To examine the test-retest reliability, standard error of measurement, minimal detectable change, construct validity, and ceiling and floor effects in the French-Canadian Late Life Function and Disability Instrument (LLFDI-F).
The LLFDI-F is a measure of activity (i.e. physical functioning of upper and lower extremities), and participation (i.e. frequency of and limitations with). The measure was administered over the telephone to a sample of community-living wheelchair-users, who were 50 years of age and older, in this 10-day retest methodological study. The sample (n = 40) was mostly male (70%), had a mean age of 62.2 years, and mean experience with using a wheelchair of 20.2 years. Sixty-five percent used a manual wheelchair.
The test-retest intraclass correlation coefficients (ICC2,1) for the participation component ranged from 0.68 to 0.90 and from 0.74 to 0.97 for the activity component. Minimal detectable changes ranged from 7.18 to 22.56 in the participation component and from 4.71 to 16.19 in the activity component. Mann-Whitney U-tests revealed significant differences between manual and power wheelchair-users in the personal and instrumental role domains, and all areas in the activity component.
There is support for the test-retest reliability and construct validity of the LLFDI-F in community-living wheelchair-users, 50 years of age and older. However, because the majority of items in the lower-extremity domains of the activity component do not account for assistive device use, they are not recommended for use with individuals who have little or no use of their lower-extremities.
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