WHEEL-LEARN: Evaluating the usability, feasibility, and proof of concept of an internet-based healthy lifestyle behavior change intervention for people with spinal cord injury

PM R. 2026 Oct 21. doi: 10.1002/pmrj.70220. Online ahead of print.

ABSTRACT

BACKGROUND: Individuals with spinal cord injury (SCI) are less physically active compared to the general population and face a higher risk of cardiometabolic diseases, some of which are modifiable through physical activity (PA). Personal and environmental barriers prevent people with SCI from meeting PA recommendations. WHEEL-LEARN, a 4-week virtual behavior change program, was developed to reduce PA barriers.

OBJECTIVE: To evaluate the usability, acceptability, feasibility, and proof of concept of WHEEL-LEARN in people with SCI.

METHODS: A pre-/postintervention study was conducted using mixed methods analysis. Each week for 4 weeks, text-based lessons were emailed to participants. Lessons included PA education and embedded Qualtrics surveys for homework and quizzes. The lessons were supplemented by 1-hour live video-conferencing sessions focused on PA education, group discussion, and guided exercise. Usability was evaluated with the System Usability Scale, an Acceptability Scale, and participant feedback. Pre- to post-intervention changes in leisure-time PA, quality of life, exercise self-efficacy, and social support were analyzed using Wilcoxon signed-rank tests. Participants provided recommendations for improving WHEEL-LEARN.

RESULTS: Participants from across the United States who used a manual wheelchair (N = 16, mean age 53.6 years, 62% female, 94% white) completed the study. Usability was rated excellent on the System Usability and Acceptability surveys, supported by participant feedback. Moderate-to-heavy leisure-time PA increased over 4 weeks from pre (87.8 ± 84.8) to post (146.3 ± 103.6) (p = .049), with an increase in number of participants meeting the PA guidelines from pre- (4/16 [ 25%]) to postintervention (15/16 [93.9%], p = .003) with 94% meeting PA guidelines. Pre-post quality of life (p = .003) and exercise self-efficacy (p = .038) improved, and social support remained stable (p = .453).

DISCUSSION: WHEEL-LEARN may have reduced PA barriers of limited professional and peer support by delivering physical therapist-led education and semistructured peer discussions that focused on developing short-term achievable PA goals.

CONCLUSION: WHEEL-LEARN, a short-term lifestyle behavior PA intervention for individuals with SCI, increased PA, quality of life, and exercise self-efficacy. Participant feedback will guide future refinements to enhance long-term support for PA behavior.

PMID:42904567 | DOI:10.1002/pmrj.70220