Project 2: The natural history and measurement of power mobility among older adults

Project 2: The Natural History and Measurement of Power Mobility Among Older Adults CanWheelAGM at RESNAJune 2014Paula Rushton, OT, PhDTeam membersTeam Leads & MembersBill MillerLouise DemersJan Miller-PolgarAlex MihailidisFrancois RouthierCher SmithLee KirbyBen MortensonClaudine Auger

Research AssistantsKate KeetchSarah McCuaigJenn QuerquesLaura TitusFabrizio FarronatoElise BusilacchiMarie-Pierre JohnsonDeborah Stewart

P2: Natural Hx & Measurement

P2: Natural Hx & MeasurementProject I: Evaluating Needs & ExperiencesProject II:Measurement ofMobilityOutcomesProject V:Wheelchair Skills ProgramFor Powered MobilityProject IV:Data LoggerProject III:WheelchairInnovationProject I: Evaluating Needs & ExperiencesTo accomplish this goal, we are conducting 5 research projects organized under 2 themes to answer 3 questions. The 2 themes are measurement and intervention. Under the intervention theme we have 2 streams: skills training and assistive technology development. Our 3 questions are: (1) How are power wheelchairs used now?; (2) How can power wheelchairs be used better?; (3) How can power wheelchairs be better? The 5 projects include As you can see from our framework / schematic the results of each of the projects inform the others to varying degrees and also in varying ways. So now Ill briefly take you through the 5 research projects. Each are in a different phase, ranging from completed to early stages. First Ill address the Question of How are Power Wheelchairs Used Now? And take you through 3 projects3P2: Natural Hx & Measurement

Project I: Evaluating Needs & ExperiencesProject II:Measurement ofMobilityOutcomesProject V:Wheelchair Skills ProgramFor Powered MobilityProject IV:Data LoggerProject III:WheelchairInnovationProject II:Measurement ofMobilityOutcomesP2: Natural Hx & Measurement

Project I: Evaluating Needs & ExperiencesProject II:Measurement ofMobilityOutcomesProject V:Wheelchair Skills ProgramFor Powered MobilityProject IV:Data LoggerProject III:WheelchairInnovationProject III:WheelchairInnovationP2: Natural Hx & Measurement

Project I: Evaluating Needs & ExperiencesProject II:Measurement ofMobilityOutcomesProject V:Wheelchair Skills ProgramFor Powered MobilityProject IV:Data LoggerProject III:WheelchairInnovationProject IV:Data LoggerP2: Natural Hx & Measurement

Project I: Evaluating Needs & ExperiencesProject II:Measurement ofMobilityOutcomesProject V:Wheelchair Skills ProgramFor Powered MobilityProject IV:Data LoggerProject III:WheelchairInnovationProject V:Wheelchair Skills ProgramFor Powered MobilityPurposeObjective # 1: To assess the reliability and validity of a Power Wheelchair Outcomes Tool Kit.

Objective # 2: To describe the natural history of power wheelchair use over a 2 year period in older adults who use a power wheelchair and their caregivers.

P2: Natural Hx & MeasurementMETHODS

Multi-site, Multi-cohort, 2 Year Longitudinal Study P2: Natural Hx & Measurement

P2: Natural Hx & MeasurementSitesVancouverTorontoLondonMontralQubecHalifaxThis group has developed a program of research with the ultimate goal of improving the wheeled mobility of older adults. The team is funded by CIHR for a 6 year grant, of which Bill Miller is the PI. Five projects will be completed during this 6 yr period. Today Im going to talk to you about part of one of these projects, but if youre interested in learning more about this team and the work, website www.canwheel.ca.10Power Wheelchair Users (PWU)

CaregiversNewExperienced 50 years old 50 years old 19 years oldAble to operate power wheelchair independentlyAble to operate power wheelchair independentlyProvide a minimum of 2 hours of care on a weekly basis

1 month of experience 6 months experienceProvides care for a PWU that is 50 years oldAble to travel to testing site for 2/7 testing occasionsAble to travel to testing site for 2/7 testing occasionsBe an informal caregiverP2: Natural Hx & MeasurementExclusion Criteria: Unable to speak, read, & write in English or French Cohorts / ParticipantsProcedureP2: Natural Hx & MeasurementAll SitesVancouverOnly

What do we measure?The Consortium on Assistive Technology Outcomes Research (CATOR) Framework (Jutai et al, 2005)

Assistive Technology Device Outcome VantageEffectivenessSocial SignificanceSubjectiveWell-BeingICF FunctioningICF Contextual FactorsUser LongevityCaregivingCostResidential Care PlacementService UtilizationDevice UtilizationPsychological FunctioningQuality of LifeSatisfactionP2: Natural Hx & MeasurementEFFECTIVENESS: objectively examines the impact of the PWC at the individual wheelchair users level with a focus on functioning in activities and participation

SOCIAL SIGNIFICANCE: examines the impact of the PWC on society, from the caregiver perspective.

SUBJECTIVE WELL-BEING: examines the impact of the PWC on psychological functioning (e.g. confidence) and quality of life (e.g., perceived participation).

13Power Wheelchair Outcomes Tool Kit

Assistive Technology Device Outcome VantageEffectivenessSocial SignificanceSubjective Well-BeingWheelchair Skills Test (WST)

Wheelchair Skills Test Questionnaire (WST-Q)

Data Logger

Life Space Assessment (LSA)Caregiver Assistive Technology Outcome Measure (CATOM)Assistive Technology Outcomes Profile for Mobility (ATOP/M)

Wheelchair Use Confidence Scale (WheelCon)Plus qualitative interviews (baseline, 1, 4, & 25 mo)P2: Natural Hx & MeasurementRESULTS

P2: Natural Hx & MeasurementCurrent Quantitative Data Collection StatusT1T2T3T4T5T6T7Exp. PWU103959695893327New PWU252421201974Caregivers353033333300All SitesVancouverOnlyP2: Natural Hx & MeasurementWCU = 127CG = 35WD = 17

Quebec City: done Montreal: done Toronto: done Halifax: 4 data collection sessions left, all T5 (1 Cohort 1/2, 2 Cohort 3, and 1 Cohort 4) 1 yr data collection will be done by Jan 2014London: 8 data collection sessions left (2 at T4 [1 Cohort 1/2 and 1 Cohort 4) & 6 at T5 [4 Cohort 1/2 & 2 Cohort 4)). 1 yr data collection will be done by Jan. 31, 2014 at the latest.Vancouver: 9 data collection sessions left to complete T5 (all Cohort 1/2) many more for T6/T7 1 year data collection will be done by Oct. 18, 2013 at the latest. 2 Year Data Collection will be done by: Sept. 18, 201416Current Qualitative Data Collection StatusPWUsBaseline4 mo13 mo25 moVancouver13131212Montreal5444Quebec City3220P2: Natural Hx & Measurement4 times (baseline, 4 months, 13 months and 25 months) during the 2 year study Done Jan. 201417Objective 1: Reliability and Validity of the Tool Kit.P2: Natural Hx & MeasurementPower Wheelchair Outcomes Tool Kit

Assistive Technology Device Outcome VantageEffectivenessSocial SignificanceSubjective Well-BeingWheelchair Skills Test (WST)

Wheelchair Skills Test Questionnaire (WST-Q)

Data Logger

Life Space Assessment (LSA)Caregiver Assistive Technology Outcome Measure (CATOM)Assistive Technology Outcomes Profile for Mobility (ATOP/M)

Wheelchair Use Confidence Scale (WheelCon)Plus qualitative interviews (baseline, 1, 4, & 25 mo)P2: Natural Hx & MeasurementWST-P Internally consistentCronbachs alpha = 0.90

ReliableTest Retest ICC1,1 = 0.78

Validityr = 0.47 (p