Preliminary examination of the relation between participation and confidence in older manual wheelchair users.

OBJECTIVE To examine the relation between frequency of participation and confidence with using a manual wheelchair among community-living, older wheelchair users, and the moderating effect of sex. DESIGN Cross-sectional. SETTING Community. PARTICIPANTS Participants (N=54) who were community-living manual wheelchair users (65% men), were ≥50 years of age (mean, 59y), used their wheelchair daily, and had ≥6 months experience using a wheelchair. INTERVENTIONS None. MAIN OUTCOME MEASURES The 16-item Late Life Disability Instrument and the 65-item Wheelchair Use Confidence Scale measured participation and confidence, respectively. Age, sex, and wheelchair skill measured using the performance-based Wheelchair Skills Test were included as covariates in the multiple regression models. RESULTS Significant and positive relations exist between participation and (1) confidence (β=.83, P=.002) and (2) interaction term (β=.33, P=.05). The R(2) change associated with confidence was 10% (P=.02), and 6% (P=.05) for the interaction term. Subsequent regression analyses revealed that the magnitude of the relation between higher confidence and greater participation is stronger for men (β=1.05, P=.002) than for women (β=.44, P=.05). CONCLUSIONS Confidence with using a manual wheelchair is a positive and significant determinant of frequency of participation of older wheelchair users, after controlling for important covariates. Because the relation is moderated by sex, treatments addressing low confidence may lead to increased frequency of participation, especially for wheelchair users who are men.