The Smartphone Peer Physical Activity Counseling (SPPAC) Program for Manual Wheelchair Users: Protocol of a Pilot Randomized Controlled Trial

Krista L Best, François Routhier, Shane N Sweet, Kelly P Arbour-Nicitopoulos, Jaimie F Borisoff, Luc Noreau, Kathleen A Martin Ginis, Krista L Best, François Routhier, Shane N Sweet, Kelly P Arbour-Nicitopoulos, Jaimie F Borisoff, Luc Noreau, Kathleen A Martin Ginis

Abstract

Background: Physical 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.

Objective: The 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).

Methods: A 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).

Results: 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. Pilot evaluation of intervention implementation is currently underway, with enrollment anticipated to begin early 2018.

Conclusions: There 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 registration: ClinicalTrials.gov NCT02826707; https://ichgcp.net/clinical-trials-registry/NCT02826707 (Archived by WebCite at http://www.webcitation.org/6pqIc14dU).

Keywords: Manual wheelchair; Peer training; Physical activity; Randomized controlled trial; Smartphone.

Conflict of interest statement

Conflicts of Interest: None declared.

©Krista L Best, François Routhier, Shane N Sweet, Kelly P Arbour-Nicitopoulos, Jaimie F Borisoff, Luc Noreau, Kathleen A Martin Ginis. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.04.2017.

Figures

Figure 1
Figure 1
Detailed description of the Smartphone Peer Physical Activity Counseling (SPPAC) trial design and outcome assessment. HADS: Hospital Anxiety and Depression Scale, ISEL: Interpersonal Support Evaluation List, BREQ-2: Behavioral Regulation in Exercise Questionnaire-2; LTPA BSE: Leisure-Time Physical Activity Barriers Self-Efficacy scale; LTPAQ: Leisure-Time Physical Activity Questionnaire; PNSES: Psychological Need Satisfaction in Exercise Scale; WheelCon: Wheelchair Use Confidence Scale; WhOM: Wheelchair Outcome Measure; WST: Wheelchair Skills Test.
Figure 2
Figure 2
The proposed study according to the five-step process described by the Medical Research Council framework for developing complex interventions [42].
Figure 3
Figure 3
Illustration of how the components of the SPPAC intervention map onto constructs of self-determination and social cognitive theories to influence motivation and behavior change. Figure adapted from Fortier et al [18].

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