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We propose to test an evidence-based wheelchair skills training program to optimize wheelchair safety and performance in veterans with SCI. The proposed training program incorporates emerging evidence on wheelchair biomechanics and motor-skills learning, and addresses recommendations in a new clinical practice guideline. Given the difficulty in translating wheelchair skills learned in a therapy clinic with "real world" problems in the home and community post-discharge, we are proposing to conduct the wheelchair skills training in and around the veteran's home. The immediate goal is to enhance ability, performance time, safety, community participation, and quality of life, while minimizing physical strain. The ultimate goal is to reduce morbidity/mortality associated with wheelchair use and promote successful aging with a disability.
The purpose of this 3-year randomized controlled clinical trial is to evaluate use of a community-based wheelchair skills training program (WSTP). Objectives include:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Wheelchair Skills Training Program | Other | Subjects are provided with five weeks of wheelchair skills training, tailored to meet their needs. The WSP is a set of assessment and training protocols related to wheelchair skills. The WSP includes the Wheelchair Skills Test (WST), the Wheelchair Skills Training Program (WSTP) and related materials. |
|
| Basic Health Education | Other | Basic health educational training sessions: Five sessions are held with subjects to provide them additional information regarding health related issues - such as nutrition, proper hand hygiene, sports, etc. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Wheelchair Skills Training | Behavioral | Subjects are provided with five weeks of wheelchair skills training, tailored to meet their needs. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Wheelchair Skills Test (WST) | The WST is a standardized evaluation method that permits a set of representative wheelchair skills to be objectively, simply and inexpensively documented. The WST is an instrument for the objective evaluation of wheelchair skills. The WST consists of a series of commonly used wheelchair skills spanning the spectrum from those as basic as applying brakes to those as difficult as climbing curbs and performing wheelies. The WSC encompasses 57 skills (in Version 4.1) which result in a total score. The WST provide a pass-fail score for each skill. Refusal to attempt a skill (e.g. because of fear) constitutes a failing grade. The numerator is the Total Raw Score (i.e., the number of individual skills awarded a passing score) and the denominator is the number of applicable skills (i.e., the total number of skills minus those awarded NP scores). 100% is the maximum possible percentage score. | long term (1 year) |
| Measure | Description | Time Frame |
|---|---|---|
| Craig Handicap Assessment and Reporting Technique (CHART): Physical Independence Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Physical Independence subscale measures the ability to sustain a customarily effective independent existence. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Shirley Groer, PhD MS | James A. Haley Veterans' Hospital, Tampa, FL | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| James A. Haley Veterans' Hospital, Tampa, FL | Tampa | Florida | 33612 | United States | ||
| VA Medical Center, Augusta |
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Recruitment intervals at each site were as follows: 4/08-8/10 at Tampa, 6/08-8/10 at Boston, and 11/08-10/09 at Augusta. Recruitment efforts included posters in VA elevators and in clinic waiting rooms, study brochures, and/or referral of subject by primary care physicians.
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| ID | Title | Description |
|---|---|---|
| FG000 | Wheelchair Skills Training Program | Subjects are provided with five weeks of wheelchair skills training, tailored to meet their needs. The WSP is a set of assessment and training protocols related to wheelchair skills. The WSP includes the Wheelchair Skills Test (WST), the Wheelchair Skills Training Program (WSTP) and related materials. |
| FG001 | Basic Health Education | Basic health educational training sessions: Five sessions are held with subjects to provide them additional information regarding health related issues - such as nutrition, proper hand hygiene, sports, etc |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
One hundred thirty-eight veterans were recruited and randomly selected for group assignments.
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| ID | Title | Description |
|---|---|---|
| BG000 | Wheelchair Skills Training Program | Subjects are provided with five weeks of wheelchair skills training, tailored to meet their needs. The WSP is a set of assessment and training protocols related to wheelchair skills. The WSP includes the Wheelchair Skills Test (WST), the Wheelchair Skills Training Program (WSTP) and related materials. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Wheelchair Skills Test (WST) | The WST is a standardized evaluation method that permits a set of representative wheelchair skills to be objectively, simply and inexpensively documented. The WST is an instrument for the objective evaluation of wheelchair skills. The WST consists of a series of commonly used wheelchair skills spanning the spectrum from those as basic as applying brakes to those as difficult as climbing curbs and performing wheelies. The WSC encompasses 57 skills (in Version 4.1) which result in a total score. The WST provide a pass-fail score for each skill. Refusal to attempt a skill (e.g. because of fear) constitutes a failing grade. The numerator is the Total Raw Score (i.e., the number of individual skills awarded a passing score) and the denominator is the number of applicable skills (i.e., the total number of skills minus those awarded NP scores). 100% is the maximum possible percentage score. | Posted | Mean | Standard Deviation | units on a scale | long term (1 year) |
|
Study duration, up to 1 year.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Wheelchair Skills Training | Wheelchair Skills Training: Subjects are provided with five weeks of wheelchair skills training, tailored to meet their needs. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hospitalization due to infected ankle wound | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Shirley Groer | VACO | 202-553-9899 | Shirley.Groer@va.gov |
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| ID | Term |
|---|---|
| D013119 | Spinal Cord Injuries |
| ID | Term |
|---|---|
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D020196 | Trauma, Nervous System |
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| Basic Health Education | Behavioral | Five sessions are held with subjects to provide them with educational information regarding health related issues - such as nutrition, proper hand hygiene, sports, etc. |
|
| long term (1 year) |
| Craig Handicap Assessment and Reporting Technique (CHART): Mobility Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Mobility Subscale measures the ability to move about effectively in his/her surroundings. | long term (1 year) |
| Craig Handicap Assessment and Reporting Technique (CHART): Occupation Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Occupation Subscale measures the ability to occupy time in the manner customary to that person's sex, age, and culture. | long term (1 year) |
| Craig Handicap Assessment and Reporting Technique (CHART): Social Integration Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Social Integration Subscale measures the ability to participate in and maintain customary social relationships. | long term (1 year) |
| Craig Handicap Assessment and Reporting Technique (CHART): Economic Self-Sufficiency Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Economic Self-Sufficiency subscale measures the ability to sustain customary socio-economic activity and independence. | long term (1 year) |
| Augusta |
| Georgia |
| 30904 |
| United States |
| VA Medical Center, Jamaica Plain Campus | Boston | Massachusetts | 02130 | United States |
| BG001 |
| Basic Health Education |
Basic health educational training sessions: Five sessions are held with subjects to provide them additional information regarding health related issues - such as nutrition, proper hand hygiene, sports, etc |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Age, Categorical | Count of Participants | Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
Subjects are provided with five weeks of wheelchair skills training, tailored to meet their needs. The WSP is a set of assessment and training protocols related to wheelchair skills. The WSP includes the Wheelchair Skills Test (WST), the Wheelchair Skills Training Program (WSTP) and related materials. |
| OG001 | Basic Health Education | Basic health educational training sessions: Five sessions are held with subjects to provide them additional information regarding health related issues - such as nutrition, proper hand hygiene, sports, etc |
|
|
|
| Secondary | Craig Handicap Assessment and Reporting Technique (CHART): Physical Independence Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Physical Independence subscale measures the ability to sustain a customarily effective independent existence. | Posted | Mean | Standard Deviation | units on a scale | long term (1 year) |
|
|
|
| Secondary | Craig Handicap Assessment and Reporting Technique (CHART): Mobility Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Mobility Subscale measures the ability to move about effectively in his/her surroundings. | Posted | Mean | Standard Deviation | units on a scale | long term (1 year) |
|
|
|
| Secondary | Craig Handicap Assessment and Reporting Technique (CHART): Occupation Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Occupation Subscale measures the ability to occupy time in the manner customary to that person's sex, age, and culture. | Posted | Mean | Standard Deviation | units on a scale | long term (1 year) |
|
|
|
| Secondary | Craig Handicap Assessment and Reporting Technique (CHART): Social Integration Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Social Integration Subscale measures the ability to participate in and maintain customary social relationships. | Posted | Mean | Standard Deviation | units on a scale | long term (1 year) |
|
|
|
| Secondary | Craig Handicap Assessment and Reporting Technique (CHART): Economic Self-Sufficiency Subscale | Use as a measure of handicap that captures the interaction of the person and the environment, and of community reintegration and participation. The CHART quantifies handicap by evaluating five domains: physical independence, mobility, occupation, social integration, and economic self-sufficiency. The CHART is made up of 27 questions with responses that are countable or in a yes/no format. Each of the five subscales has a maximum score of 100, and they may be summed to form a total score. High scores indicate lesser handicap. The CHART was developed as a specific instrument to measure handicap, is the only measure of that concept validated specifically for persons with SCI, and is currently the most widely used measure related to community reintegration in SCI. The Economic Self-Sufficiency subscale measures the ability to sustain customary socio-economic activity and independence. | Posted | Mean | Standard Deviation | units on a scale | long term (1 year) |
|
|
|
| 8 |
| 69 |
| 0 |
| 69 |
| EG001 | Basic Health Education | Basic health educational training sessions: Five sessions are held with subjects to provide them additional information regarding health related issues - such as nutrition, proper hand hygiene, sports, etc | 5 | 69 | 0 | 69 |
| Hospitalization due to depression and acute alcohol Intoxication | General disorders | Non-systematic Assessment |
|
| Hospitalization due to chronic heel/knee ulcers and heavy alcohol consumption | General disorders | Non-systematic Assessment |
|
| Hospitalization due to fever and possible infection | General disorders | Non-systematic Assessment |
|
| Hospitalization due to pneumonia | Infections and infestations | Non-systematic Assessment |
|
| Hospitalization for colonoscopy screening | Investigations | Non-systematic Assessment |
|
| Hospitalization due to fever and nausea | General disorders | Non-systematic Assessment |
|
| Hospitalization due to fever and infection | Infections and infestations | Non-systematic Assessment |
|
| Hospitalization due to bleeding colostomy and urinary tract infection | General disorders | Non-systematic Assessment |
|
| Hospitalization due to urinary tract infection | Renal and urinary disorders | Non-systematic Assessment |
|
| Hospitalization due to infected right foot pressure ulcer | Infections and infestations | Non-systematic Assessment |
|
| Hospitalization due to bladder stone | Surgical and medical procedures | Non-systematic Assessment |
|
| Hospitalization due to wound re-opening | Injury, poisoning and procedural complications | Non-systematic Assessment |
|
| Hospitalization due to surgical incision re-opening | Surgical and medical procedures | Non-systematic Assessment |
|
| Hospitalization due to bladder biopsy and cystoscopy | Investigations | Non-systematic Assessment |
|
| Hospitalization due to emesis and dehydration | General disorders | Non-systematic Assessment |
|
| Hospitalization due to stroke/mental status change | General disorders | Non-systematic Assessment |
|
| Hospitalization due to fever and urinary tract infection | General disorders | Non-systematic Assessment |
|
| Hospitalization due to pneumonia and altered mental status | General disorders | Non-systematic Assessment |
|
| Hospitalization due to mental status change and dehydration | General disorders | Non-systematic Assessment |
|
| Hospitalized for fever and confusion | General disorders | Non-systematic Assessment |
|
| Hospitalized for pneumonia, leukocytosis, fever and UTI. | General disorders | Non-systematic Assessment |
|
| Hospitalized for mental status changes, vomiting blood and dehydration. | General disorders | Non-systematic Assessment |
|
| Hospitalized for fever, chills, and nephrostomy tube placement for kidney stone/IV anti | General disorders | Non-systematic Assessment |
|
| Hospitalization due to change in mental status and declining health | General disorders | Non-systematic Assessment |
|
| Hospitalization due to hand surgery. | Surgical and medical procedures | Non-systematic Assessment |
|
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| D014947 | Wounds and Injuries |