Preliminary Examination of the Relation Between Participation and Confidence in Older Manual Wheelchair Users

Abstract

Objective-To examine the relationship between frequency of participation and confidence with using a manual wheelchair among community-living, older wheelchair users, and the moderating effect of sex. Design-Cross-sectional Setting-CommunityParticipants-54 participants who were community-living manual wheelchair users (65% male), were ≥50 years of age (mean = 59 years), used their wheelchair daily, and had ≥6 months experience with using a wheelchair. Intervention-NoneMain Outcome Measures-The 16-item Late Life Disability Instrument, and the 65-item Wheelchair Use Confidence Scale measured participation and confidence respectively. Age, sex, and wheelchair skill measured using the performance-based Wheelchair Skills Test, were included as covariates in the multiple regression models.Results-Significant and positive relationships exist between participation and: 1) confidence (standardized coefficient (β)=0.83, p=0.002), and; 2) the interaction term (β=0.33, p=0.05). The We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated AND, we certify that all financial and material support for this research (eg, NIH or NHS grants) and work are clearly identified in the title page of the manuscript. Conclusions-Confidence with using a manual wheelchair is a positive and significant determinant of frequency of participation of older wheelchair users, after controlling for important covariates. Because the relationship is moderated by sex, treatments addressing low confidence may lead to increased frequency of participation especially for male wheelchair users. Keywordswheelchairs; mobility; social participation; self efficacy; agingParticipation is an individual's involvement in life situations. 1 It is characterized by a complex relationship between an individual's health condition, and the context in which the person conducts his/her life. 1 Because a high level of participation is important for better quality of life, 2 enabling participation in desired roles is an important rehabilitation focus.Individuals with mobility disabilities are often faced with less than optimal participation, and consequently have an increased risk of health issues, including depression. 3 Fortunately, manual wheelchairs are often prescribed to facilitate mobility and promote independent participation in various roles. However, older wheelchair users are more likely to report a lack of independence with using their wheelchair 4 and they experience less than desirable participation levels due to increased participation restrictions associated with aging. 3 Thus, an issue in the study of this population is that despite knowledge of an increase in the prevalence of older wheelchair users related to aging, an insufficient amount of research has focused only on a limited number of determinants of participation, accounting for modest amounts of variance. 5,6 Confidence with using a manual wheelchair is an em...

Wheelchair Skills Training to Improve Confidence With Using a Manual Wheelchair Among Older Adults: A Pilot Study

“…The WheelCon-M has predictive validity in older, community-living, manual wheelchair users. 21 Support for the reliability and validity of the WheelCon-M have also been reported in other studies with samples partially comprised of older adults. 19,23 Because of the potential for confounding, information on depression and anxiety symptoms, risk taking behaviour, and wheelchair skills were collected.…”

“…21 This finding is significant because it was observed after controlling for ability to use a wheelchair, thereby suggesting that low confidence may be a barrier to participation among older wheelchair users regardless of their ability to use their wheelchair. The authors concluded that because the confidence-participation relationship was moderated by sex, treatment strategies to address low confidence may be especially important for older male wheelchair users when attempting to increase their frequency of participation in social and personal roles.…”

“…For example, a recent study has established that confidence with using a manual wheelchair, as measured by the Wheelchair Use Confidence Scale (WheelCon-M), 19 is a positive and significant determinant of frequency of participation, as measured by the Late Life Disability Instrument, 20 of older wheelchair users. 21 This finding is significant because it was observed after controlling for ability to use a wheelchair, thereby suggesting that low confidence may be a barrier to participation among older wheelchair users regardless of their ability to use their wheelchair. The authors concluded that because the confidence-participation relationship was moderated by sex, treatment strategies to address low confidence may be especially important for older male wheelchair users when attempting to increase their frequency of participation in social and personal roles.…”

“…The authors concluded that because the confidence-participation relationship was moderated by sex, treatment strategies to address low confidence may be especially important for older male wheelchair users when attempting to increase their frequency of participation in social and personal roles. 21 Therefore, efforts to foster realistic perceptions of ability may help prevent the negative consequences of low confidence. One of the most influential strategies believed to have an effect on confidence is performance accomplishment.…”

Rasch Analyses of the Wheelchair Use Confidence Scale

“…Evidence using Classical Test Theory methods indicates that the WheelCon measurements are both reliable and valid in manual wheelchair-users. 2 Furthermore, research using the WheelCon has shown that lower self-efficacy is associated with lower levels of participation frequency 3,4 and life-space mobility 5 in wheelchair-users aged 50 and older.…”