Initial fidelity of a powered mobility intervention: a case report

ABSTRACT

Background

Powered mobility devices include any battery-operated and motorized device such as powered wheelchairs or modified ride-on cars. Off-the-shelf and battery-operated ride-on cars are modified through installation of a large and easy-to-press activation switch and custom seating support to facilitate greater accessibility for children with motor disabilities. Powered mobility devices are used in pediatric rehabilitation interventions and may be used during adapted physical education. However, reporting of powered mobility intervention fidelity is largely absent in the literature.

Conceptual approach

This case report uses a multi-dimensional construct for measuring intervention fidelity and includes four key areas (a) adherence, (b) dosage, (c) quality of intervention delivery, and (d) participant responsiveness.

Purpose

The purpose of this case report was to assess initial powered mobility intervention fidelity in a single caregiver–child dyad through adherence, dosage, inter-rater agreement of adherence and dosage, quality of intervention delivery, and participant responsiveness.

Method

This case report describes initial powered mobility intervention fidelity that included delivery of three, 2-h intervention sessions over a 3-week period to a caregiver and their child with motor disabilities. Intervention sessions were planned for at least 90 min and included three components: (1) Driving observation (at least 10 min); (2) Problem-solving discussion (at least 20 min); and (3) Education module (at least 60 min). Adherence and dosage and inter-rater agreement of adherence and dosage were assessed through a fidelity checklist. Quality of Intervention Delivery was assessed through a feedback survey that the caregiver completed following each intervention session. Participant Responsiveness was assessed through education module review questions.

Results

All fidelity domains were successful when scores and percentiles were averaged across the three intervention sessions: Adherence: 90%; Dosage 100%; Inter-Rater Agreement of Adherence (88%) and Dosage (100%); Quality of Intervention Delivery: 95%; Participant Responsiveness: 100%.

Conclusion

Powered mobility intervention fidelity is critical to advance the field across practice settings including clinical, research, and physical education. Powered mobility studies generally lack any measurement or discussion about intervention fidelity. This creates a significant challenge in replicating research studies or translating research to practice when delivery of intervention components is not documented. Powered mobility interventions in young children with motor disabilities provide a foundation of mobility skills for them to participate in physical education during their school-age years. Therefore, an important first step is to understand the fidelity of powered mobility interventions. There remains limited research in the physical education context of students who use powered mobility devices and offers future directions to impact physical educators’ pedagogical strategies for children with motor disabilities.

KEYWORDS:

• Disability
• pediatric rehabilitation
• fidelity
• adapted physical education

Acknowledgements

The authors thank the caregiver and child for participation in the intervention.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Good Samaritan Hospital Foundation/John C. Erkkila, M.D. Endowment for Health and Human Performance. Contents of this manuscript were developed under a grant from the U.S. Department of Education (grant #: H325H190001). However, the contents do not necessarily represent the policy of the U.S. Department of Education, and you should not assume endorsement by the Federal Government. Project Officers: Louise Tripoli and Richelle Davis. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant KL2TR002370. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.