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

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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.

Section snippets

Study design

This study was a randomized controlled trial using an immediate intervention group (IIG) and a waitlist control group (WLCG) who received the intervention after a 6-month delay. Figure 1 shows the timing of the assessments for both groups.

Recruitment, eligibility, and group allocation

Eligibility included aged 18-75 years, wheelchair use as the primary mode of mobility (>40h/wk), ability to transfer independently, and diagnosis of a SCI or disorder (ie, multiple sclerosis, spina bifida). Exclusion criteria were pain prohibiting transfers,

Participants

For the between-group analysis, 72 participants were included who completed the baseline and 1-month postbaseline (WLCG, n=38) or 1-month posttraining (IIG, n=34) assessments (fig 2). For the within-group analysis, 48 participants were included who completed the pretraining, immediate posttraining, and 1-month posttraining times. Because of technical difficulties, follow-up was inconsistent at times, resulting in 1 missed 6-month postbaseline and 7 missed 1-month posttraining assessments for

Discussion

Although the IIG had significantly higher TAI-Q scores at 1 month posttraining, this improvement in transfer quality was not enough to reach statistical significance when compared with the change in WLCG TAI-Q scores. However, compared with pretraining, participants improved their transfer quality and maintained that improvement through 1 month after completing the direct-to-user, web-based transfer training. Sixty-eight percent of the sample was ≥10 years since injury, indicating that gains in

Conclusions

Direct-to-user web-based training and repeated transfer self-assessments are effective at increasing transfer quality for at least 1 month posttraining. This training may be useful in sustaining high-quality transfers long-term, which may decrease the risk of injury and improve quality of life. With increasing interest to deliver health care and other needs remotely, there is a great need for transfer training on a web-based platform, with caution taken to assure that everyone who needs

Suppliers

  • a.

    Facebook; Facebook, Inc.

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    CourseSites; Blackboard Inc.

  • c.

    SPSS Statistics, version 26.0; IBM Corp.

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    • Presented in a platform presentation to the Academy of Spinal Cord Injury Professionals, September 6-9, 2020, virtual.

    Supported by the Paralyzed Veterans of America Research Foundation, National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant nos. 90SI5014, 90DP0078) and the National Institute of Child Health and Human Development (NICHD) (grant no. K23HD096134).

    Disclosures: none.

    Clinical Trial Registration No.: NCT03164278.

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