Chapitre 5 : Discussion
5.7. Limites
Ce projet présente certaines limites tant concernant la revue de la recension des écrits que le devis pré-post. Premièrement, pour la revue systématique, il est possible que certains articles n’aient pas été identifiés en lien avec le choix de mots clés même si ce dernier était raisonné et confirmé par des experts. Aussi, même si les études évaluaient les mêmes construits, soit la mobilité et la participation, les items de chaque outil étaient différents. Il faut donc faire preuve de prudence dans l’interprétation des résultats. Toutefois, même si d’autres chercheurs avaient classifié certains items différemment, cela n’aurait pas mené à des changements majeurs dans les conclusions. En effet, toutes les études auraient tout de même été incluses et, conséquemment, les résultats incluent dans la synthèse les mêmes. Deuxièmement, concernant l’évaluation du programme Roulez
avec confiance, l’utilisation d’une collecte de données pré-post intervention sans groupe contrôle apporte des
risques de biais, liés notamment à l’effet du temps. Le temps pourrait à lui seul pourrait expliquer certains résultats obtenus. L’absence du groupe contrôle fait qu’il n’est pas possible de se prononcer sur l’efficacité du programme d’entrainement. Aussi, la taille de l’échantillon de participants ayant participé au programme est limitée. Toutefois, les analyses statistiques ont été sélectionnées en cohérence avec la taille d’échantillon et le type de données collectées, ce qui correspond aux attentes dans le domaine de la réadaptation. Finalement, les données de l’analyse qualitative ont été partiellement présentées en anglais pour des fins de publications dans un journal scientifique, bien que les entrevues étaient réalisées en français.
Conclusion
Le présent projet fournit des informations sur la pertinence des interventions impliquant des pairs dans le domaine de la réadaptation et les effets du programme Roulez avec confiance. Les interventions impliquant des pairs devraient être considérées dans le domaine de la réadaptation comme une stratégie d’intervention potentielle pour améliorer la mobilité et la participation d’adultes ayant des incapacités à la mobilité. Toutefois, davantage d’études sont nécessaires considérant la variabilité présente dans les outils de mesure utilisés dans les études, le contenu de chaque intervention et l’utilisation de devis pré-post. Roulez avec confiance est un programme d’entrainement à la conduite d’un fauteuil roulant manuel menée par un pair dans la communauté qui a eu une influence sur la participation sociale, l’auto-efficacité et les habiletés requises en fauteuil roulant manuel. Certaines améliorations devraient être apportées afin d’améliorer son intérêt pour les participants, notamment l’ajout de sorties dans des lieux sélectionnés par les participants. Aussi, la température extérieure doit être considérée dans l’administration de Roulez avec confiance puisqu’il s’agit d’une intervention se donnant dans la communauté et que la présence de neige et le froid peut limiter les activités réalisées dans lors des séances d’entrainement. Cette étude, et sa cohérence des résultats avec les écrits scientifiques montrent que
Roulez avec confiance est une intervention pertinente afin de dispenser un entrainement aux habiletés en
fauteuil roulant manuel mené par un pair dans la communauté. De futures études sont nécessaires afin d’évaluer l’efficacité de Roulez avec confiance, son implantation, son coût-efficacité ainsi que son impact sur le fardeau des professionnels de la réadaptation.
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