Ed Giesbrecht*, University of Manitoba, Winnipeg, Canada William Miller*, University of British Columbia, Vancouver, Canada Janice Eng, University of British Columbia, Vancouver, Canada Track: Research Presentation Topic: Mobile & Tablet Health Applications Presentation Type: Oral presentation Submission Type: Single Presentation Building: Sheraton Maui Resort Room: A - Wailuku Date: 2014-11-13 11:50 AM – 12:35 PM Last modified: 2014-09-04

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Background. Alternative and innovative strategies, such as mHealth and e-learning, are becoming a necessity for delivery of rehabilitation services. For example, older adults who require a wheelchair receive little, if any, training for proficiency with mobility skills. This substantive service gap is due to restricted availability and time for clinicians to provide 1:1 therapy; limited content expertise; and challenges for consumers to attend appointments, particularly in rural or remote locations. Using a Participatory Action Design approach clinicians, consumers and care providers engaged with occupational therapists and computer engineers to develop a tablet-based application called Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels), which enables in-chair home training, asynchronous on-line expert trainer monitoring, and trainee-trainer communication via secure voice messaging.
Objective. Prior to undertaking a randomized controlled trial (RCT), a pilot study was conducted with two divergent participants: a novice older adult manual wheelchair (MWC) user (representing the target population) and a proficient, long-term older adult MWC user (offering an experienced evaluation).
Method. The program included two 1:1 training sessions with an occupational therapist (day 1 and 15) and four weeks of independent home training. The EPIC Wheels application included video instruction and demonstration, self-paced training activities, and interactive training games. Participants were provided a 10” Android tablet with mounting apparatus (for in-chair training) and wireless hotspot device for Internet connectivity. Frequency and duration of all tablet interactions were monitored and uploaded daily to an on-line trainer interface. Participants completed a structured evaluation survey and provided written and verbal feedback post-study. The occupational therapist also provided feedback on the training protocol and trainer interface.
Results. Both participants perceived the training program to be comprehensive, useful, and easily navigated. The expert trainer indicated usage data was comprehensive and informative for monitoring participant progress, compliance, and adapting the training regime. The application performed equally well on multiple tablet devices tested. Some initial issues with login requests were resolved via tablet-specific settings. Inconsistent Internet connectivity, resulting in delayed data upload and voice messaging, were specific to individual hotspot devices and resolved by standardizing configuration. Several upgrades were also made subsequent to the pilot feedback. The tablet software and content download is more robust and the interface incorporates additional features such as check marks for completed content, a more consumer-friendly aesthetic, and achievement “awards”. The trainer interface monitors multiple trainee accounts simultaneously, updating individual usage daily on a secure server, and provides both numerical and visual summary of participant data.
Conclusions. The EPIC Wheels pilot study provided useful feedback on the feasibility of a tablet-based home program for wheelchair skills training among older adults. The revised trainee and trainer applications are currently being evaluated in an RCT. The program offers considerable potential for expansion and use with various populations and delivery of other rehabilitation training programs, particularly for those living in rural/remote locations having limited access to rehabilitation services, including those in developing nations. Future development will consider integration of built-in tablet sensors to provide performance feedback and enable interactive training activities.