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

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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.