IntroductionThe perception of occupational therapists is essential to the improvement of universal accessibility projects. However, there is little evidence on the involvement of occupational therapists in this field.AimTo explore occupational therapists' perceptions of their professional experience and training in universal accessibility, and its integration into their practice.MethodologyThis study adopts a interpretative descriptive qualitative methodology. Semi-structured individual interviews were conducted with nine participants in Quebec, Canada. Thematic analysis was done.ResultsInterviews revealed three main themes: 1) knowledge of universal accessibility, 2) the accessibility project process, and 3) the occupational therapist's contribution to universal accessibility. Each theme also includes sub-themes: The main findings related to a lack of training in universal accessibility, the engagement and roles of occupational therapists in accessibility projects, and the added value of this professional's contribution to projects.ConclusionThese results can help occupational therapists and other professionals in the field of universal accessibility better understand the role of occupational therapists in this field and can guide occupational therapy programs in improving academic training in this area. This could help define the occupational therapist's role in this field and optimize their contribution.

OBJECTIVE:To describe the improvements of new power wheelchair (PWC) users' performance in virtual environments during home-based training. MATERIALS AND METHODS:This post hoc analysis used archival data from 24 new PWC users who participated in a two-week training program with the McGill immersive wheelchair (miWe) simulator (computer + joystick). The simulator offered six virtual environments (e.g., adapted transport, market) with three difficulty levels. Participants were instructed to practice each activity at least once, for 20 min every two days. Collisions, completion time and joystick movement fluidity were analysed across three training phases, at the beginning (T1: days 1-3), middle (T2: days 4-6) and end (T3: days 7-10) of training. RESULTS:Participants trained on average 9.7 times (4.9 h ± 3.1), completing 170 (±120) activities. The difficulty level chosen increased at the beginning and then remained stable. A significant effect of training phase was observed, with fewer collisions, faster completion times and smoother movements (all p < 0.001), most improvement occurring between T1 and T2. Activity-specific analyses revealed heterogeneous patterns: bathroom, market and elevator activities improved mainly from T1 to T2 and then stabilised, whereas street crossing performance remained stable, suggesting an early ceiling effect. CONCLUSIONS:The miWe simulator seemed well accepted and could support engagement of new PWC users in improving driving skills from home. Given activity-dependent plateaus and users' tendency not to select the highest difficulty, future research should explore optimal difficulty adjustments, integrate more complex scenarios and compare outcomes with experienced users to refine training strategies and maximise the learning potential of the simulator.

Background: Fear of falling may limit mobility in older adults, particularly during winter. Pragmatic, community-based interventions are needed to support safe, sustainable walking. Objective: To assess the feasibility and acceptability of a co-created intervention (MABIDA) promoting utilitarian and recreational walking among older adults. Method: Fifty-two older adults with fear of falling participated in a 12-week group intervention (summer/winter) consisting of one 60-minute supervised walking session/week, incorporating exercises. Walking group level was assessed using a subjective decisional tree. Results: Forty-one participants (73.3±5.7years) completed the study (dropout: winter only). Retention and adherence exceeded 75%. Intervention settings were considered appropriate (≥81%). The decisional tree correctly classified 72% of participants. Participants reported satisfaction (82%) and enjoyment (81%). No differences were observed between seasons or walking groups (p>0.05). Group walking was the main facilitator (59%), while weather was the main barrier (17%). Conclusion: MABIDA appears feasible, acceptable, and adapted across seasons and walking speed profiles.

Introduction: Motorized components on power wheelchairs (PWC) enable repositioning to pre-programmed positions (e.g., tilt, leg support, verticalization) to prevent prolonged static positions. Smart technologies can track positioning information and give feedback according to clinical recommendations and personal goals. This study aimed to explore users’ and clinicians’ perceptions of an intelligent dynamic seating (IDS) system prototype comprising a PWC with motorized multi-components connected to a web interface. Methods: A purposive sample of six PWC users and eight clinicians were recruited in this exploratory descriptive qualitative study. Semi-structured interviews included viewing a video of the IDS and images of the web interface. Interviews were transcribed, deductively coded, and thematically analyzed using a conceptual model for evaluating eHealth interventions. Results: Clinicians found the IDS system intuitive to use, customizable, relevant in terms of positioning and clinical recommendations, and timesaving. Powered wheelchair users perceived benefits that could motivate behavioural change, autonomy, health, and inclusion. Concerns related to familiarity with complex technology, funding, cognitive requirements, and technical and health risks were raised. Conclusion: The results inform improvements for the integration of the IDS in clinical practice to respond to the positioning needs of PWC users.

IntroductionThe Wheelchair Skills Training Program (WSTP) has demonstrated statistical and clinical effectiveness in improving manual wheelchair skills among pediatric manual wheelchair users (PMWUs). However, uptake of this program remains limited in pediatric rehabilitation settings, partly due to clinicians’ uncertainties about its suitability for playful and developmentally appropriate training. Despite children's and youths’ right to engage in discussions regarding their rehabilitation, PMWUs’ lived experiences receiving the WSTP have not yet been explored. The aim of this study was to explore PMWUs’ experiences with and preferences regarding the WSTP to inform the delivery of this program in pediatric rehabilitation.MethodsA descriptive qualitative study was conducted with a maximum variation sample of PMWUs recruited from a randomized controlled trial evaluating the WSTP in pediatrics. Online or in-person semi-structured interviews, informed by the Template for Intervention Description and Replication checklist for rehabilitation intervention reporting, explored experiences with and preferences regarding WSTP delivery. Interview procedures were individualized using a toolkit of strategies to support expression and engagement. The framework method guided deductive thematic analysis.ResultsThree overarching themes emerged from the 32 PMWUs’: 1) It's true that not many kids know how to use their wheelchair properly, so I think training is really a good thing, highlighted the perceived value of the WSTP for improving mobility, confidence, risk awareness, autonomy, and participation; 2) The trainer lets you practice everything that you want, reflected how trainers can facilitate mobility progress and engagement through collaborative goal-setting, the use of learning strategies, and the integration of skill practice into enjoyable and appropriately challenging activities; and 3) It depends on the person. Every child, every person with a disability or mobility aid is different. We're not all the same, emphasized the need to tailor training sessions to individual needs and preferences.ConclusionPMWUs’ positive experiences with the WSTP revealed that the program aligns with their training preferences and supports mobility progress, suggesting its suitability in pediatric rehabilitation settings.

Public transport is one of the most affordable forms of passive transport, supporting the life habits such as activities of daily living and social roles. Despite the potential benefits of public transit, adults with disabilities have restricted access to this mode of transportation due to factors such as limited knowledge of the transit system, travel skills and self-efficacy, for which travel training can be implemented. This systematic review examined the influence of travel training programs on knowledge, self-efficacy, travel skills and public transportation use among adults with disabilities and described their respective components. The search was carried out in Transport Database, MEDLINE, PsycINFO, Embase and Web of science from January 1990 to December 2023 (update performed 09/2024). Covidence software was used for article selection and data extraction, performed independently by two reviewers. The Template for Intervention Description and Replication (Tidier) and Mixed Methods Appraisal Tool (MMAT) were respectively used to extract intervention details and to assess methodological quality. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to report results. Of 5,104 citations retrieved, 12 were included in this review. Regardless the component used (combined didactic and practical, single hands-on approach, and assistive technologies with/without simulation), all included studies reported improvements in outcomes (e.g., knowledge, travel skills, self-efficacy, frequency of the public transport use) after travel training interventions. Although findings suggest travel training is promising, only one study demonstrated causal effect in randomized controlled trial. Therefore, findings should be interpreted with caution.

BACKGROUND:Manual wheelchairs (MWCs) are essential for individuals with mobility impairments, yet many users receive limited training, restricting mobility and participation. Innovative alternatives to therapist-led approaches, including eHealth and peer-led interventions, are emerging to address this gap. PURPOSE:This follow-up study examined long-term retention of participation and related outcomes 6 months after an eHealth wheelchair skills training program. Secondary aims explored associations between participant demographics, program engagement and post-intervention outcomes. METHODS:A repeated-measures cohort design was used with intervention participants from a multi-site randomised trial conducted across three Canadian urban centres. Nineteen adults using MWCs completed the 4-week TEAM Wheels program, comprising a tablet-based app with 200+ instructional videos and three peer-led teleconferences. Outcomes included participation, wheelchair skills capacity and performance, self-efficacy and health-related quality of life (HRQoL). FINDINGS:At 6 months, participants (n = 18) maintained or improved statistically significant gains in participation, skills and self-efficacy but not HRQoL. Improvements were comparable across demographic groups, whereas meeting recommended engagement guidelines was linked to larger gains in skills and confidence. CONCLUSION:TEAM Wheels benefits were largely retained at 6 months. eHealth and peer-led approaches offer promising, sustainable alternatives to traditional clinician-led MWC skills training. Clinical Trial Registration No. NCT04090177.

According to Article 23 of the United Nations Convention on the Rights of the Child, children with disabilities are entitled to education, including access to high-quality childcare services. Despite international and national commitments to inclusion, persistent obstacles continue to limit equitable access to childcare services for children with disabilities. This descriptive qualitative study examines barriers to the accessibility of childcare services for children with disabilities aged 0 to 5 years in Canada. Semi-structured interviews were conducted with 21 mothers and 21 childcare staff members. According to participants, key barriers include organisational limitations, lack of training among educators which leads to poor support, negative attitudes toward disability and inclusion, material shortages, and challenges related to the physical environment. Addressing these barriers is essential to fostering inclusive childcare systems that ensure equitable access and support the development and participation of all children.

People with special needs often face barriers to participating in adapted outdoor leisure physical activities. A participatory action research project involving a nonprofit organization, a citizen with motor disabilities, and researchers aimed to co-develop a digital platform connecting people with special needs interested in outdoor leisure physical activities with trained volunteers. The adopted co-design methodology followed four stages: (1) Exploration (identifying users’ needs and preferences), (2) Co-design (defining key information and platform features), (3) Validation (prioritizing features), and (4) Development (implementing and testing the platform). This article focuses on stages 2, 3, and 4. During stage 2, key information and features were identified to support matching people with special needs and volunteers and informing users about adapted outdoor leisure physical activities. In stage 3, these elements were prioritized using eight key considerations, including technological (e.g., ease of use), environmental (e.g., avoiding redundancy with existing initiatives), organizational (e.g., availability of human resources), and financial factors (e.g., grant planning). Stage 4 resulted in the launch of Tandem Actif, followed by user testing to document user experience and guide improvements. This article details the application of co-design within a participatory action research project aimed at promoting safe, ethical, and accessible participation in outdoor leisure physical activities for people with special needs.

Leisure time physical activity (LTPA) plays a vital role in preventing and managing chronic diseases in people with disabilities (PWD). Using virtual reality (VR) can help people feel more comfortable and confident about LTPA. The aim of this study is to identify research focusing on VR, LTPA, and people with motor disabilities. Methods: A scoping review was completed by searching MEDLINE, CINAHL, SportDiscuss, Academic Search Premier, and Web of Science in June 2024 (updated July 2025). Eighteen studies were included. Results: Most studies examined cycling (56%) and targeted post-stroke (28%) and spinal cord injury (22%) populations. VR interventions showed potential to improve various domains such as functional mobility, motor function, and psychosocial well-being. A total of 35 distinct outcome measures were identified, categorized into motor/balance, physiological, psychological, user experience, and performance themes. Conclusions: While most VR interventions used LTPA primarily as a therapeutic tool, some were designed to teach sport-specific skills to facilitate participation outside the clinical setting. Future research should examine how VR can aid rehabilitation and prepare PWD for sustained engagement in LTPA.

Diagonale des fous inclusive (DDFI) was an initiative to raise awareness towards disability inclusion, generate opportunities in inclusive outdoor leisure-time physical activity, and enhance quality of participation (QoP). QoP is defined as a broad subjective evaluation of satisfaction, enjoyment, and perception of personally valued outcomes that comprises of six experiential elements, including autonomy, belongingness, challenge, engagement, mastery, and meaning. For two years, the participants in this project took part in trail events across Quebec to prepare before culminating their journey on Réunion Island with a 105-km ultra-trail, one of the biggest ultra-trail events in the world. The aim of this study was to explore QoP and the conditions that shape it among team members preparing for and participating in the DDFI. This study used a qualitative ethnographic design (descriptive and interpretative). Twenty-three participants (aged 26–67 years old; 3 people with a disability, including one adapted all-terrain wheelchair-user) were recruited using purposive sampling. QoP was explored using semi-structured interviews (n = 19 before DDFI, n = 19 after DDFI). Participant observations were conducted during preparation activities and during the DDFI. Field notes were collected during participant observations to contextualize the data. Thematic analysis was instigated using a mixed approach (deductive and inductive). Four overarching themes were extracted from data: (1) A Human Experience illustrates the life of having a diverse and inclusive group; (2) Long Way to the Top represents the reality of long-term engagement; (3) Call of the Wild encompasses a spectrum of motivations and emotions related to adhesion; and (4) Paving the Way highlights the meaning of DDFI in relation to awareness. This study offers insight into the team's QoP through the experiential elements of autonomy, belongingness, challenge, engagement, mastery, and meaning. Some conditions to the six elements were highlighted, such as inclusion, experiencing a role, group environment, and spreading awareness towards disability inclusion. Further studies are needed using community-accessible trail opportunities that are inclusive to PWDs to expand on these outcomes.

PURPOSE:Wheelchair skills training is essential for optimising mobility and participation in meaningful activities. Peer-training is becoming a largely studied approach to meet the training needs of wheelchair users. The Training to Enhance Adaptation and Management for Wheelchair users (TEAM Wheels), a peer-led eHealth program, was evaluated in three Canadian cities. Peer-trainers in each city were recruited and trained to deliver TEAM Wheels. The aim of this study was to explore experiences and perceptions of peer-trainers after delivering the TEAM Wheels program. MATERIALS AND METHODS:A descriptive qualitative design employed semi-structured interviews with peer-trainers who delivered TEAM Wheels in a randomised controlled trial. All peer-trainers were contacted by study investigators and invited to participate. Open-ended questions explored wheelchair experiences of peer-trainers, previous peer mentorship, preparation for the peer-trainer role, and experiences with the TEAM Wheels study. Interview recordings were transcribed verbatim, content coded and inductively constructed into themes. RESULTS:All TEAM Wheels peer-trainers (n = 7) participated in this study. The first theme uncovered how merging lived experience and personal skills influenced their peer-trainer role, highlighting what peer-trainers perceived as important to accomplish their role. The second theme explored the building blocks of quality experiences for peer-trainers, suggesting flexibility and training as important aspects influencing their experience. CONCLUSION:When peer-trainers are adequately prepared, and there is a good mentor-mentee match, peer-trainers could play an important role in supporting the training to improve wheelchair mobility and general mentoring needs of wheelchair users.

Airport security checkpoints present many challenges for the inclusion of diverse passengers, including people with disabilities. Due to the complexity of this context, understanding the challenges and solutions for inclusion must be grounded in the real-life experiences of passengers. Therefore, this research aims to explore the experiences of passengers with disabilities, as well as neurodiverse individuals and seniors, when going through the security screening process at international airports. A qualitative multiple-case study was conducted at three international airports. In situ walk-along interviews were conducted with 70 participants. Data was analyzed using a deductive thematic approach grounded in the Canadian Model of Occupational Participation, to document interactions between participants and security checkpoint context. Findings reveal systemic barriers in the physical, social, institutional, and temporal contexts. Notably, challenges with space design, the ability to anticipate procedures, and the quality of interactions strongly influence the experience and create stress that extends beyond security checkpoints.This study helps to highlight the need to reframe the vision of services to promote inclusion for all. Rather than trying to accommodate an infinite number of possible scenarios, we propose adopting a flexible and adaptable approach focused on the needs of the individual, regardless of disability. Inclusion responsibility at security checkpoints must be a shared among all service providers affected by and affecting operations at security checkpoints. Collaborations between service providers and travellers affected by inclusion issues are essential to create solutions that align both with lived experience and operational realities.

This research aims to enhance the safety and autonomy of powered mobility device (PMD) users through the development of a serious game. Rooted in a co-design and Design Thinking approach, this study highlights the initial phase of the project, which aimed to foster empathy and gain deeper insights into the experiences of PMD users. The study included 42 participants, including users with varying levels of experience with mobility aids as well as professionals from the PMD users ecosystem. Key findings highlighted common errors made by PMD users, such as improper crossing at intersections, exceeding speed limits, using unauthorized accessories on PMD, and neglecting to check blind spots. These behaviors underscored significant gaps in knowledge and practice among users. Participants also perceived notable differences between users with prior driving experience and those without, suggesting that driving background influences behavior and learning needs. This study paves the way for the development of tailored interventions and training tools, such as the proposed serious game, to bridge the identified knowledge gaps and improve the overall safety and autonomy of PMD users.

PURPOSE:To explore the usability of a novel interactive video-based educational mobile application for teaching walking aid skills to users with various indications for and experiences with using walking aids. MATERIALS AND METHODS:This study employed a multi-method design. Participants used the app on two occasions, two weeks apart. Usability was explored through semi-structured interviews and the System Usability Scale (SUS) at the end of the intervention. Interviews were analysed thematically using the Braun and Clarke approach. A combination of inductive and deductive coding was used, leveraging constructs from the Technology Acceptance Model (TAM) and adding new themes as they emerged. RESULTS:Twelve walking aid users [mean (SD) age 54.2 (15.8) years; 6 males] participated. The mean (SD) SUS score was 88.3 (10.5). Four themes emerged: experiences of walking aid training, perceived ease of use, perceived usefulness, and motivations for app use. CONCLUSION:The SUS score obtained in this study was indicative of high usability (96th-100th percentile). Walking aid users found the interactive app to be easy-to-use and a useful platform for learning and maintaining walking aid skills. Participants also highlighted areas for improving the app, such as adding an audio component.

Airports present a uniquely complex environment for travelers with disabilities, where the promise of global mobility often collides with persistent physical, sensory, and procedural barriers. This scoping review synthesizes peer-reviewed and gray literature to examine the physical environment of airports and how it shapes access for persons with disabilities, including the interaction between spatial features and service-related components in real-world travel situations. Guided by Fougeyrollas’s five-dimensional framework of access availability, accessibility, acceptability, affordability, and usability the review examines how each dimension shapes real-world travel experiences from curb to gate. The results suggest that, in the reviewed studies, accessibility often appears fragmented across the airport journey, with infrastructures that may be present but not always usable, available, or meaningfully integrated into the travel experience. Access often relies on assistance-based models, and important gaps remain in addressing diverse user needs, particularly for individuals with invisible disabilities. At the same time, the literature highlights promising practices and ongoing improvements, including digital wayfinding tools, dedicated assistance services, and growing attention to inclusive design principles. Overall, this review emphasizes that accessibility cannot be reduced to regulatory compliance or the mere presence of infrastructure. Rather, it must be understood as a dynamic and continuous process shaped by the interaction between environments and diverse human needs throughout the airport journey.

OBJECTIVES:To assess the feasibility of a trial with a novel interactive video-based mobile application to teach safe walking aid use. To explore the preliminary effect of the novel application on balance confidence, balance, mobility, and endurance. DESIGN:Single-arm, pre-post feasibility study. SETTING:University research laboratory. PARTICIPANTS:Adult walking aid users (N=13). INTERVENTIONS:Participants used the novel application's fitting and gait training modules pertaining to their walking aid on 2 occasions (baseline, 2wks). MAIN OUTCOME MEASURES:Trial feasibility indicators were collected for process (recruitment rate, consent rate, and retention rate), resources (duration of each data collection session), management (participant processing time), and safety. At baseline and at 2 weeks, participants completed the Activities-specific Balance Confidence (ABC) Scale, the Berg Balance Scale (BBS), the timed Up and Go (TUG), and the 2-Minute Walk Test (2MWT). RESULTS:Thirteen walking aid users (7 men; mean ± SD age: 55±15y; mean ± SD duration of walking aid use: 2.7±4.0y) participated. Feasibility was attained on 3 of the 6 trial feasibility indicators. Participants achieved statistically significant improvements in balance confidence (ABC; small to medium effect; P<.001) and balance (BBS; small effect; P<.001). Participants did not experience significant changes in mobility (TUG; no effect) or endurance (2MWT; small effect; P=.25). CONCLUSIONS:Based on our criteria, a trial with the novel application may be feasible, with some modifications. Preliminary improvements in clinically relevant outcomes including balance confidence and balance were found. These findings will help inform a randomized controlled trial to evaluate the effect of the application on clinical outcomes.

BACKGROUND:Article 23 of the United Nations Convention on the Rights of the Child states that children with disabilities must have access to education. This includes ensuring access to high-quality, affordable and inclusive childcare services that are specifically tailored to meet the unique needs of young children with disabilities. However, little is known about the factors that enhance the accessibility of childcare services for these children. Therefore, the aim of this study is to identify solutions that promote this accessibility as well as the outcome variables collected among children following the implementation of these promising solutions. METHODS:To map available knowledge, a scoping review was conducted. A search strategy developed in collaboration with a research librarian was applied in seven databases: Medline, CINAHL, ERIC, Web of Science, PSYCInfo, Academic Search Premier and Education Source. Two reviewers independently screened the studies identified through the database search. Data were extracted by a single member of the research team and validated by another one. Promising solutions and documented outcome variables in the selected studies were categorised according to the International Classification of Functioning, Disability and Health for Children and Youth. RESULTS:Sixty-five studies were retained. The solutions most often documented in the scientific literature to improve the accessibility of childcare services for young children with disabilities involve various forms of support and relationships, mainly addressing the social and communication skills of children with autism. These promising solutions are generally child-centred. The literature makes little reference to changes in the physical environment. CONCLUSIONS:This study not only provides a list of solutions that have demonstrated substantial benefits for children with disabilities attending a childcare service but also highlights the need for documentation or development of new solutions. The findings will provide essential evidence that can inform the development of standards for high-quality and inclusive childcare services.

Background: Cities aim to enhance urban accessibility following the adoption of the United Nations' Convention on the Rights of Persons with Disabilities. However, implementation faces challenges due to complex municipal legislation, lack of awareness, and organizational obstacles. As shown in a Quebec City's partnership research process, engaging, engaging stakeholders and empowering municipal employees through knowledge mobilization is crucial. Aim: To report the implementation process, explore the employees' perceptions of the format and feasibility of the implementation strategy and examine the effects of knowledge mobilization tools on the implementation determinants of universal accessibility measures for municipal employees. Methods: The study used a multi-method design, involving interviews and a questionnaire with the project steering committee, comprising city employees and the research team. We conducted three 30-minute participatory workshops for culture, communications, and public consultation administrative units. Results: Participants appreciated the workshop format and video content, suggesting minor improvements for broader implementation. The tools effectively increased engagement in implementing universal accessibility measures, proving valuable for raising awareness. Discussion and conclusion: The study demonstrates the advantages of a collaborative approach in developing knowledge mobilization tools, enhancing municipal employees' capacity for universal accessibility measures, and highlighting the need for adaptable strategies.

IntroductionActimetry is increasingly used to measure physical activity (PA) for manual wheelchair (MWC) users. However, conversion of raw data into interpretable PA outcomes remains imprecise, and the differentiation between propulsion and non-propulsion is challenging. Using a previously developed algorithm, the objectives of this study were to: (1) measure the accuracy of total distance collected, and (2) validate the algorithm's accuracy in differentiating between self-propulsion and non-propulsion.MethodsExperimental study consisting of two data collection sessions. Actimetry data (Actigraph GT3X+) were collected indoors (controlled conditions) during 100 repetitions (n = 40 MWC propulsion, n = 60 pushing the MWC) over three distances (10, 50 and 100 m). Actimetry data were also collected outdoors (uncontrolled condition) during self-propulsion over 1000 m (10 repetitions). Descriptive statistics (mean and standard deviation) with confidence intervals and accuracy measures (percentage of true value) were conducted for each trial.ResultsThe algorithm measured total distance covered indoors with an excellent accuracy (98.9% to 99.8%). It differentiated between self-propulsion and non-propulsion with an accuracy between 96.2% and 99.2% under controlled condition, and between 91.3% and 100.0% under uncontrolled condition.ConclusionsThe algorithm tested allowed precise measurement of total distance covered, as well as an excellent discrimination between self-propulsion and non-propulsion.PreprintGagnon R, Best KL and Routhier F. Validation of an innovative two-part algorithm for detecting self-propulsion in manual wheelchair users. medRxiv 2024: 2024.2011.2014.24313548. DOI: 10.1101/2024.11.14.24313548.