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Adapting the Wheelchair Skills Program for pediatric rehabilitation: recommendations from key stakeholders
Geneviève Daoust1,2, Paula W Rushton3,4, Marissa Racine1
1School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada.
Insights
The Wheelchair Skills Program (WSP) needs adaptations for pediatric use. Implementing these changes can help children improve their wheelchair mobility and independence.
Area of Science:
- Pediatric Rehabilitation
- Occupational Therapy
- Implementation Science
Background:
- The Wheelchair Skills Program (WSP) has 20 years of evidence supporting its effectiveness for adults.
- Limited evidence exists for the pediatric population, hindering WSP adoption in pediatric settings.
- Adapting evidence-based programs is crucial for successful implementation in diverse clinical contexts.
Purpose of the Study:
- To identify necessary adaptations of the WSP for pediatric settings.
- To understand barriers and facilitators to implementing the WSP in pediatric rehabilitation.
Main Methods:
- A qualitative descriptive study design was employed.
- Focus groups were conducted with Occupational Therapists (OTs) in pediatric settings.
- Data analysis was guided by the Knowledge to Action Framework and the Consolidated Framework for Implementation Research (CFIR).
Main Results:
- OTs identified benefits and challenges of the WSP, including unrealistic skills for children.
- Adaptations, such as a caregiver assistance score, were recommended.
- The study highlighted the need for new knowledge and knowledge translation (KT) tools.
Conclusions:
- Adaptations and KT tools are proposed to enhance WSP implementation in pediatric settings.
- These adaptations can improve wheelchair skills for pediatric manual wheelchair users.
- Successful implementation can enhance functional mobility and independence for children using wheelchairs.
Background:
Backed by over 20 years of research development, the Wheelchair Skills Program (WSP) has proven to be a safe and effective program to improving wheelchair skills for adult wheelchair users. However, evidence is lacking for the pediatric population, which may help to explain the limited use of the WSP in pediatric settings. While additional evidence specific to the pediatric population is needed, concurrent implementation of the WSP into pediatric clinical practice is equally prudent to allow those users to benefit from the years of accumulated WSP evidence. To facilitate implementation of evidence-based programs into practice, adaptation is also often required to improve the fit between the program and the local context. Therefore, the objective of this study was to understand what adaptations, if any, are required for the WSP to be implementable in a pediatric setting.
Methods:
A deductive qualitative descriptive study design was used, guided by the Knowledge to Action Framework and Consolidated Framework for Implementation Research (CFIR). Occupational Therapists (OTs) from a pediatric rehabilitation center and two specialized schools in Montreal, Canada were invited to participate in a 90-min focus group. The Framework Method was followed for the data analysis.
Results:
One focus group in each site (n = 3) was conducted with a total of 19 participants. From the OTs' perspectives, our analysis revealed benefits of WSP use and various issues (e.g. some skills seem unrealistic) affecting its uptake in relation to the constructs of the CFIR Intervention Characteristics domain. The results provided guidance for the recommendations of adaptations (e.g. addition of a caregiver assistance score) to enhance implementation of the WSP in pediatric rehabilitation settings and helped to identify the need for the production of new knowledge and knowledge translation (KT) tools.
Conclusions:
Implementation of the WSP with the adaptations and KT tools proposed could allow pediatric manual wheelchair users to improve their wheelchair skills.
