# Efficacy of Manual Wheelchair Skills Training for Improving Skills and Confidence in People With Hereditary Degenerative Disorders: Protocol for a Sequential Multimethods Study

## TL;DR

This study will test if wheelchair skills training improves mobility and confidence in people with ARSACS and MD1, using a mixed-methods approach.

## Contribution

This is the first study to evaluate manual wheelchair skills training for people with ARSACS and MD1 using a randomized controlled trial and qualitative analysis.

## Key findings

- Manual wheelchair skills training may improve performance and self-efficacy in people with ARSACS and MD1.
- The study will explore how training influences mobility and skill retention over time.
- Qualitative insights will reveal participants' experiences and perceptions of wheelchair training.

## Abstract

Mobility impairment and participation restrictions are commonly experienced by individuals with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) and myotonic dystrophy type 1 (MD1), 2 disorders that are highly prevalent in the province of Quebec, Canada. People with ARSACS and MD1 experience a progressive decline in mobility, which commonly results in the provision of manual or power wheelchairs. While wheelchairs can facilitate mobility and social participation, their provision alone does not guarantee safe and effective use. Wheelchair skills training has been shown to be effective for improving manual skills and confidence among adult users with various diagnoses, which may enhance self-directed mobility and participation and reduce the risk of chronic and acute injuries. However, manual wheelchair skills training for people with ARSACS and MD1 remains understudied.

The primary aim of this study is to evaluate the efficacy of manual wheelchair skills training for safely improving wheelchair performance in people with ARSACS and MD1. The secondary outcomes include exploring the influence of manual wheelchair skills training on skill capacity, use self-efficacy, mobility, and the retention of outcomes 3 months later. We will also qualitatively explore the manual wheelchair training experiences of people with ARSACS and MD1.

This study will use a sequential multimethods design, combining a waitlist randomized controlled trial and qualitative interviews. The participants will include adults who have a diagnosis of ARSACS or MD1 who use a manual wheelchair for mobility. Participants will be randomly assigned to the intervention or control group using a 1:1 allocation ratio. The intervention group will receive 5 manual wheelchair skills training sessions (1-2 sessions/week), while the control group will receive no training. Data will be collected at baseline (T1), after the 4-week intervention (or waiting period for the control group; T2), and 3 months after T2 to assess retention (T3). The primary outcome will be manual wheelchair skills performance. Secondary outcomes will include manual wheelchair skills capacity, self-efficacy, and mobility. Semistructured individual interviews will be conducted to explore participants’ expectations regarding manual wheelchair use, past manual wheelchair experiences, and perceptions of manual wheelchair skills training. Quantitative data will be analyzed using analysis of covariance (ANCOVA), controlling for baseline scores, and qualitative data will be analyzed using reflexive thematic analysis.

This study received ethical approval (2025-3100) in July 2024. Recruitment started in January 2025. A graduate student, a research assistant, and a research coordinator have been recruited and trained.

The results of this randomized waitlist-controlled trial will confirm whether manual wheelchair skills training can improve self-directed mobility and related outcomes for people with ARSACS and MD1. The findings may help guide clinical practice toward manual wheelchair skills training for understanding potential influences on manual wheelchair mobility in people living with neuromuscular disorders.

ClinicalTrials.gov NCT06596850; https://clinicaltrials.gov/study/NCT06596850

PRR1-10.2196/66974