Sol M1,2, Bloemen M1, Verschuren O2, Rushton P3, Visser-Meily JMA2, De Groot J1
1HU University of Apllied Sciences Utrecht, Lifestyle and Health, Utrecht, Netherlands, 2University Medical Center Utrecht, Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands, 3Université de Montréal, École de Réadaptation, Montreal, Canada

Background: Confidence plays a key role in engaging in physical activity behavior in youth according to the “physical activity in people with a disability” model. When looking at physical activity behavior, studies have shown that youth using a wheelchair are less active than able-bodied peers.. Recent studies have described the importance of wheelchair mobility (WM) skills and confidence in facilitating participation in physical activity in youth. Therefore, when aiming to improve physical activity, not only the evaluation of WM skills, but also the evaluation of confidence in WM needs to be considered. There is currently no questionnaire available to assess confidence in WM in youth. There is, however, the Wheelchair Use Confidence Scale (WheelCon-M) for assessing confidence in wheelchair use in adults. Evidence has shown that the WheelCon-M is a valid and reliable questionnaire to measure confidence in wheelchair use in adults. Until now, no modifications or validity assessments have been made to the WheelCon-M to measure confidence in WM in youth.

Purpose: The objectives of this study were to (1) cross-cultural validate WheelCon-M for Dutch Youth (WheelCon-M-D-Y) and (2) evaluate the internal consistency and construct validity of the WheelCon-M-D-Y.

Methods: The first phase was aimed at the cross-cultural validation of the WheelCon-M. Firstly, a translation process was used to translate the original WheelCon-M from English into Dutch. Secondly, item adaptation was evaluated through focus groups with youth, parents and healthcare professionals. In the second phase, participants completed the WheelCon-M-D-Y, Utrecht Pediatric Wheelchair Mobility Skills Test 2.0 and the Self-Perception Profile for Children. Internal consistency of the WheelCon-M-D-Y was assessed using Cronbach's alpha. Construct validity was assessed by evaluating hypothesized relationships of the WheelCon-M-D-Y with the UP-WMST 2.0 and the SPPC.

Results: Cross-cultural validation in phase one led to general adaptations in instructions, sentence structure and outcome parameters. On item level, 41 items were deemed not relevant, 6 items did not need adaptation, 19 items needed modification and 7 new items were F as relevant for assessing confidence in WM in Dutch Youth. In phase two, 62 participants were included for completing the WheelCon-M-D-Y, UP-WMST 2.0 and SPPC. The WheelCon-M-D-Y had an excellent Cronbach's alpha of 0.924, a significant correlation (r = 0.44) with the UP-WMST 2.0 and no significant correlation with the SPPC.

Conclusion(s): This study resulted in the adaptation of the WheelCon-M into the WheelCon-M-D-Y for Dutch youth using a manual wheelchair. Furthermore, this study shows positive evidence towards internal consistency and construct validity of the WheelCon-M-D-Y. Future studies should lead to further refinement of the WheelCon-M-D-Y, assess test-retest agreement and measurement error.

Implications: Wheelchair mobility skills training to improve participation has the potential to become an important aspect in the rehabilitation program for youth using a manual wheelchair. When evaluating the effects of a training not only WM skills, but also confidence in WM needs to be considered. To the best of our knowledge this is the first questionnaire validated for youth to assess confidence in WM.

Keywords: Wheelchair mobility, Confidence, youth

Funding acknowledgements: Funded by an unconditional grant (PRO-4-03) of the SIA-RAAK and the Dutch non-profit organization for children with a disability (NSGK)

Topic: Paediatrics; Outcome measurement; Disability & rehabilitation

Ethics approval required: No
Institution: University Medical Center Utrecht
Ethics committee: UMCU Utrecht ethical committee
Reason not required: The committee concluded this study is not a medical scientific research, as the outcome measurements used are part of usual care.

All authors, affiliations and abstracts have been published as submitted.

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