Abstract
BackgroundPhysical activity (PA) must be performed regularly to accrue health benefits. However, the majority of manual wheelchair users do not meet PA recommendations. Existing community-based PA programs for manual wheelchair users appear to work, but effect sizes are small and retention is low. Existing PA programs may not fully implement some psychosocial factors that are strongly linked with PA (eg, autonomy). The use of peers and mobile phone technology in the Smartphone Peer PA Counseling (SPPAC) program represents a novel approach to cultivating a PA-supportive environment for manual wheelchair users.ObjectiveThe primary objective is to compare change in objective PA between the experimental (SPPAC) and control groups from baseline to postintervention (10 weeks) and follow-up (3 months). Changes in and relationships between subjective PA, wheelchair skills, motivation, self-efficacy (for overcoming barriers to PA for manual wheelchair use), satisfaction of psychological needs for PA, and satisfaction with PA participation will be explored (secondary outcome). Program implementation will be explored (tertiary objective).MethodsA total of 38 community-living manual wheelchair users (≥18 years) will be recruited in a randomized controlled trial (RCT). Participants in both the control and experimental groups will receive existing PA guidelines. Participants in the experimental group will also receive the SPPAC program: 14 sessions (~30 min) over a 10-week period delivered by a peer trainer using a mobile phone. PA activities will be based on individuals’ preferences and goals. Implementation of important theoretical variables will be enforced through a peer-trainer checklist. Outcomes for objective PA (primary) and subjective PA, wheelchair skills, motivation, self-efficacy, satisfaction of psychological needs, and satisfaction with participation will be collected at three time points (baseline, postintervention, follow-up). Multiple imputations will be used to treat missing data. A mixed-model ANCOVA will be conducted, controlling for covariates (primary and secondary objectives). The strength and direction of the relationships between the primary and secondary outcomes will be explored (secondary objective). Descriptive and content analysis will be used to appraise program implementation (tertiary objective).ResultsFunding has been obtained from the Craig Neilsen Foundation and the Canadian Disability Participation Project, with additional funds being sought from the Canadian Institute for Health Research and Fonds de Recherche du Québec-Santé. Pilot evaluation of intervention implementation is currently underway, with enrollment anticipated to begin early 2018.ConclusionsThere may be substantial benefits for the SPPAC program including limited burden on health care professionals, decreased barriers (eg. accessibility, transportation), development of peer social supports, and potential cost savings related to physical inactivity. Before conducting a large and expensive multisite RCT within a small heterogeneous population of manual wheelchair users, a pilot study affords a prudent step to establishing an adequate study protocol and implementation strategies.Trial RegistrationClinicalTrials.gov NCT02826707; https://clinicaltrials.gov/ct2/show/NCT02826707 (Archived by WebCite at http://www.webcitation.org/6pqIc14dU)
Highlights
Despite numerous physical, psychological, and social benefits of physical activity (PA) [1], more than 55% of adults (18-74 years) and 90% of older adults (≥60 years) who use wheelchairs are not physically active enough to accrue health benefits [2,3]
Funding has been obtained from the Craig Neilsen Foundation and the Canadian Disability Participation Project, with additional funds being sought from the Canadian Institute for Health Research and Fonds de Recherche du Québec-Santé
There may be substantial benefits for the Smartphone Peer Physical activity (PA) Counseling (SPPAC) program including limited burden on health care professionals, decreased barriers, development of peer social supports, and potential cost savings related to physical inactivity
Summary
Despite numerous physical (eg, functioning), psychological (eg, quality of life), and social (eg, inclusion) benefits of physical activity (PA) [1], more than 55% of adults (18-74 years) and 90% of older adults (≥60 years) who use wheelchairs are not physically active enough to accrue health benefits [2,3]. Successful community-based programs have addressed many of these facilitators and barriers for manual wheelchair users using various behavioral approaches (eg, Workout on Wheels [10]), and individuals with spinal cord injury, who account for approximately 80% of manual wheelchair users (eg, Get in Motion [11] and home visits [12]) with variable effects on PA. Two randomized controlled trials (RCTs) of interventions that used health care professionals to prescribe PA (ie, Workout on Wheels and Get in Motion) had small effect sizes on PA [10,11]. Cofacilitation of a home-based strength-training program by a health care professional and peer trainer had a large effect on PA (ie, strength training), findings of this study are limited by a small sample size and lack of a control group [12]. Existing community-based PA programs for manual wheelchair users appear to work, but effect sizes are small and retention is low. The use of peers and mobile phone technology in the Smartphone Peer PA Counseling (SPPAC) program represents a novel approach to cultivating a PA-supportive environment for manual wheelchair users
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