Effectiveness of a Web-Based Direct-to-User Transfer Training Program: A Randomized Controlled Trial

Abstract

Objective: To determine the effectiveness of a web-based, direct-to-user transfer training program in improving transfer quality and maintaining improvements for up to 1 month after training as compared with a control group.

Design: Randomized controlled trial with participants randomized to an immediate intervention group (IIG) or waitlist control group (WLCG) that received the training after a 6-month delay.

Setting: Wherever the participants accessed the web-based training, likely the home environment.

Participants: Convenience sample of full-time wheelchair users (N=72; IIG, n=34; WLCG, n=38 for between-group analysis, n=48 for combined within-group analysis) with spinal cord injury or disorder who were able to independently perform a lateral scoot transfer.

Interventions: Self-paced, web-based transfer training module.

Main outcome measures: Transfer Assessment Instrument Questionnaire (TAI-Q) score at baseline, 1 month, and 6 months postbaseline (WLCG only), immediately posttraining, and 1 month posttraining. The TAI-Q is an 18-item self-assessment that covers several aspects of a quality transfer.

Results: The IIG significantly increased particpants' baseline TAI-Q score from 6.91±0.98 to 7.79±1.12 (P<.001) by 1 month posttraining. The WLCG also increased from baseline to the 1-month postbaseline assessment (from 6.52±1.13 to 7.00±1.09; P=.014), potentially from learning effects secondary to self-assessment with the TAI-Q. The extent of change over time did not differ significantly between the IIG and WLCG from baseline to 1 month (P=.169). However, significant improvements in TAI-Q scores were still evident after the training for the WLCG (P<.001). Those with a lower pretraining TAI-Q score and more shoulder pain were most likely to benefit from the training.

Conclusions: Repeated TAI-Q self-assessments likely contributed to improved transfer quality, with web-based training having an additive effect. Wheelchair users are likely to benefit from transfer training and self-assessment of transfer quality in their home environments. This has the potential to decrease injury risk while avoiding barriers to in-person training.

Trial registration: ClinicalTrials.gov NCT03164278.

Keywords: Internet-based intervention; Rehabilitation; Spinal cord diseases; Telerehabilitation; Wheelchairs.

Conflict of interest statement

Conflicts of interest

None to disclose.

Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1:

Study timeline for participants in the WLCG (top) and IIG (bottom). Pre-training timepoints are shown as grey ovals and post-training timepoints are shown as white rectangles. Timepoints used in the between-group comparison are represented by a dashed outline while times used in the within-group comparison are shown with a red outline. Median (IQR) days in between: * Baseline and 1-month assessments for between-group comparison: WLCG= 33 (31–36), IIG= 67 (44–118) † 1-month and 6-months post-baseline assessments: WLCG= 153.5 (150–160) ‡ Pre-training and immediately post-training assessments for within-group comparison: WLCG= 28 (8–119), IIG= 29 (7–83) § Immediately and 1-month post-training assessments for within-group comparison: WLCG= 32(28–35), IIG= 34 (31–42)

Figure 2:

CONSORT Flow Diagram showing participants who completed or missed each study timepoint. Pre-training timepoints are shown in grey and post-training timepoints are shown in white.

Figure 3:

Mean TAI-Q scores with standard deviation error bars for the WLCG and IIG a) between baseline and 1-month (WLCG=post-baseline, IIG=post-training) for the between-group comparison and b) pre-training (WLCG=6-months post-baseline, IIG=baseline), immediately post-training, and 1-month post-training for the within-group comparison. The circular markers indicate pre-training times, while the rectangular markers indicate post-training timepoints. * Significant difference over time for WLCG † Significant difference over time for IIG ‡ Significant difference between WLCG and IIG § Significant difference over time for combined WLCG and IIG