Feasibility and clinical applicability of a novel power wheelchair training approach

Abstract

Purpose

To evaluate the feasibility and the clinical applicability of administering the COMET (cognition, occupation, mobility, evaluation and training) intervention.

Materials and methods

A pilot research was conducted with adults who were being considered for power wheelchair (PWC) provision, or who were recently provided a PWC, and who had been identified to benefit from a PWC training. The COMET intervention applies a goal directed, client-centred and occupation-based approach. Feasibility and applicability indicators were collected for: process, resources, management and treatment. Indicators were evaluated as “successful/unsuccessful”. Clinical outcomes included the Goal Attainment Scale (GAS), the Canadian Occupational Performance Measure (COPM), the Power mobility Indoor Driving Assessment (PIDA) and the Wheelchair Skills Test (WST).

Results

Four females (62.5 ± 3.5 years) with cognitive impairment participated in the study. Among the 13 indicators, 10 were successfully achieved. Indicators that did not meet the criteria for success were adherence rate, safety and treatment for the PIDA. Two adverse events were reported, with one minor injury. Participants demonstrated better than expected results on the GAS, the COPM scores and the WST. However, only two reported an improvement beyond 4% of the PIDA.

Conclusions

With few modifications, the COMET intervention and the study protocol will be feasible and applicable in clinical practice. Individuals with complex cognitive and mobility impairment demonstrated abilities to learn PWC use. Further investigation of the COMET intervention is required to evaluate its efficacy.

Implications for rehabilitation

• A novel power wheelchair (PWC) training approach adapted to individual with complex mobility and cognitive impairments was developed: the COMET (cognition, occupation, mobility, evaluation and training) intervention.

• The COMET intervention applies a goal directed, client-centred and occupation-based approach.

• With minor modifications, the COMET intervention may be feasible and clinically applicable to train individuals with complex motor and cognitive impairments how to use a PWC.

• Further evaluation of the COMET intervention and lager control trialsare suggested.

Keywords:

• Client-centred
• cognitive impairment
• occupation-based intervention
• power wheelchair impairment

Disclosure statement

The authors of this article have no conflicts of interest.

Additional information

Funding

This work was supported by the Quebec Health Research Fund (FRQS) by a PhD scholarship, the Quebec Rehabilitation Research Network (REPAR) and the Research Québec Network on aging (RQRV). Drs. Best and Routhier have salary support from the Quebec Health Research Fund (FRQS).