Mobility of wheelchair users: a proposed performance assessment framework (original) (raw)
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Factors Associated with Change in Functional Performance among Wheelchair Users
Factors Associated with Change in Functional Performance among Wheelchair Users, 2019
Objective: The main objective of this study was to explore demographics, wheelchair characteristics, and functional status indicators associated with changes in perceptions and functional performance of wheelchair users. Method: Nineteen wheelchair users were selected for this exploratory study. Utilizing Exhaustive Chi-Squared Automatic Interaction Detector (CHAID) analysis, seven models were generated to examine specific demographics, wheelchair characteristics, and functional status indicators associated with pretest to posttest change scores in perceptions and performance of everyday tasks over time of three target variables. Validation of the models generated by Exhaustive CHAID analyses was conducted through the n-fold cross-validation procedure. The Functioning Everyday with a Wheelchair (FEW), the FEW-Capacity (FEW-C), and the FEW-Performance (FEW-P) were the measures used in this study. Results: The means for the change score were larger for the FEW (1.08 ± 0.59) followed by the FEW-C (0.69 ± 0.63), and then the FEW-P (0.33 ± 0.45). Most of the factors identified in each model were derived from the pretest. Our study explored factors that were significantly associated with change scores of the FEW tools. Independence, number of physical assists, safety, and tasks related to Outdoor Mobility at pretest were the functional status indicators found to be of greatest importance and significantly associated with changes in perceptions and performance of everyday tasks over time in our models. For all analyses, the values of the Risk Estimate for the Risk Statistics and Cross-validation were close with relatively small differences, suggesting strong and reasonable confidence in the validity of the seven models. Conclusion: This study may suggest specific focus areas for assessment and intervention and may highlight the importance of some factors that influence changes in functional performance among clients who have been referred for, and prescribed, a wheeled mobility device.
Role of Wheelchairs and Wheelchairs Assessments: A review
Role of Wheelchairs and Wheelchairs Assessments: A review, 2018
Wheelchairs are enablers of community participation and are used to enhance function, to improve independence, and to enable a person to successfully live at home and in the community. It is estimated that 70 million people require wheelchairs worldwide (World Health Organization [WHO], 2017) [1]. The most current available data on persons who use wheelchairs comes from the 2008 National Survey of Income and Program Participation, which indicated that there were about 56.7 million people with disabilities (number increased by 2.2 million since 2005) and 3.6 million wheelchair/scooter users in the United States (USA) in 2010 [2]. Despite the vital role of wheelchairs, the substantial number of wheelchair users and the increasing demand on providers to meet their needs, there is currently a lack of comprehensive outcome measures that focus on everyday functioning with a wheelchair. Therefore, appropriate outcome measurements are needed.
Technology and Disability
The Obstacle Course Assessment of Wheelchair User Performance (OCAWUP) is a new tool designed to assess and document manual and motorized wheelchair user mobility performance in controlled environmental situations which are standardized and potentially difficult. The instrument is designed to cover environmental obstacles that are related to daily wheelchair use. In this paper, we present the methodology and results of the content validity process regarding the choice of items (obstacles) and development of the scoring system. The methodology comprises three steps: 1) determining obstacle categories through a literature review, 2) determining obstacles through a focus group and individual interviews, and 3) developing the scoring system through a focus group and individual interviews. The content validation triangulates three data sources: literature, opinions of experts (wheelchair users, occupational therapists and researchers) and Canadian norms for home adaptation. Consensuses were reached on the choice of categories and items, and the scoring system. According to various experts, the obstacles are representative of those encountered in daily activities and social roles. It is expected that the OCAWUP could help clinicians in their interventions with wheelchair users to improve their social participation. Other studies should be conducted to obtain more information about its validity and reliability properties.
Assessing mobility characteristics and activity levels of manual wheelchair users
The Journal of Rehabilitation Research and Development, 2007
Although engaging in an active lifestyle is beneficial for maintaining quality of life, a majority of wheelchair users are inactive. This study investigated the mobility characteristics and activity levels of manual wheelchair users in the residential setting and at the National Veterans Wheelchair Games (NVWG). Demographic factors that may have influenced activity in the home environment were also identified. Fifty-two manual wheelchair users completed a brief survey, and their activity was monitored with a custom data logger over a period of 13 or 20 days. We found that they traveled a mean +/-standard deviation of 2,457.0 +/-1,195.7 m/d at a speed of 0.79 +/-0.19 m/s for 8.3 +/-3.3 h/d while using their primary wheelchair in the home environment. No significant differences in mobility characteristics or activity levels were found for level of spinal cord injury or disability. We also found that subjects traveled significantly farther and faster and were active for more hours during an average day at the NVWG than in the home environment (p < 0.001). We found that manual wheelchair users who were employed covered more distance, accumulated more minutes, and traveled a greater average maximum distance between consecutive stops than those who were unemployed. Results from this study provide a better understanding of the activity levels achieved by manual wheelchair users and insight into factors that may influence this activity.
Evaluation of manual wheelchair performance in everyday life
Topics in Spinal Cord Injury Rehabilitation, 2009
Evaluation of wheelchair performance (capacity and skills) is crucial in the investigation of wheeled mobility in people with a spinal cord injury (SCI). Manual wheelchair use is a complex combination of skills, which together determine overall functioning, daily activities, participation, and quality of life. The evaluation of wheelchair performance requires a systematic biophysical approach that appreciates the importance of the individual elements of the wheelchair-user combination: the wheelchair, the wheelchair-user interface, and the user, as well as the environment. Measurement technologies and outcomes of experimental and observational studies will highlight the importance of a well-balanced individual wheelchair performance.
Archives of Physical Medicine and Rehabilitation, 2011
Objective: To quantify wheelchair mobility of persons with a spinal cord injury (SCI), and to assess the relationship between wheelchair mobility and demographics, type of manual wheelchair, and participation. Design: Cross-sectional study. Setting: Six Model Spinal Cord Injury Systems. Participants: People (Nϭ132) with SCI who use a manual wheelchair as their primary means of mobility. Interventions: Not applicable. Main Outcome Measures: Wheelchair-related mobility characteristics measured by a data-logging device, and community participation measured by the short form of the Craig Handicap Assessment Recording Technique (CHART). Results: Age was found to be significantly (rϭ-.225, PϽ.01) related to average speed traveled per day. Whites were found to travel significantly further (PϽ.01) and accumulate more minutes per day (PϽ.01) compared with minorities. Participants who were employed traveled significantly further (PϽ.01), faster (PϽ.01), and for more minutes per day (PϽ.01) compared with those who were not employed. A moderate relationship (rϭ.245-.390) was found between wheelchair mobility data and CHART total score. Conclusions: Results suggest a need for future investigation of the factors that influence wheelchair mobility and community participation of persons with SCI. Findings indicate the efficacy of a quantitative method to track wheelchair mobility in community settings, which could serve as a way of identifying community participation for persons with SCI and possibly uncovering additional aspects of participation.
Spinal Cord, 2012
Study design: Cross-sectional. Objectives: To describe the manual wheelchair (MWC) skill profiles of experienced MWC users with spinal cord injury and their wheeled mobility (distance and speed) while considering their level of injury and age. Setting: Rehabilitation centers, participant's home and the community. Methods: MWC skills were evaluated using the wheelchair skills test (WST) and wheeled mobility data were collected in the participants' own environment over a 7-day period, using a Cateye cycle computer (VELO 8). A total of 54 participants took part in the study. Results: The mean total performance score of the sample on the WST was 80.7 ± 11.8%, with a significant difference between participants with tetraplegia (C4-C8) and those with low-level paraplegia (T7-L2) (Po0.01). The average daily distance covered was 2.5±2.1 km at 1.7±0.9 km h À1 , with no significant difference between participants with paraplegia and those with tetraplegia (wheeled distance: P¼0.70; speed: P¼0.65). Significant relationships were found between MWC skills and daily wheeled distance (r¼À0.32, Po0.05), but the correlation between these variables did not remain significant when controlling for age (partial r¼0.26, P¼0.07). Conclusion: These results suggest that the level of injury is related to MWC skills but not wheeled mobility. MWC skills are related to greater wheeled distance, but to a lesser extent when controlling for age.
Functional Assessment of Wheeled Mobility and Seating Interventions: Relationship of Self-Report and Performance-Based Assessments, 2019
The main objective of this study was to investigate associations, concordance and differences among self-report and performance-based measures, and reveal new factors associated with changes in wheelchair function. The Functioning Every day with a Wheelchair (FEW); a self-report measure, the FEW-Capacity (FEW-C); a performance-based measure for the clinic, and the FEW-Performance (FEW-P) that measures clients’ skills in the home were the measures used in this study. Relevant literature yielded few studies that examined the associations and concordance between subjective and objective methods of assessment with wheelchair users. We conducted secondary analyses of data collected by Mills et al. (2002) and Schmeler (2005), in which participants were assessed with their current wheelchairs at pretest, and later at posttest after they received their new wheelchairs. The strength of the associations varied by time, item, and environment, and there was a stronger association between the three tools at the pretest when compared with the posttest, perhaps due to the familiarity of their current wheeled mobility device and their desire for a new wheelchair. Exhaustive CHAID analysis revealed new factors that were significantly associated with pretest to posttest changes in wheelchair function and should therefore be assessed at pretest and targeted for intervention, namely, independence, number of physical assists, safety, and tasks related to Outdoor Mobility at pretest. Furthermore, for total scores, at pretest, there was no significant difference between the FEW-C and the FEW-P, whereas, at posttest, the Clinic total safety and quality scores were significantly better than the Home scores. We also found that the FEW-C was more concordant with the FEW-P compared to the FEW; therefore, clinicians may get a more accurate estimation of performance in the home from a clinic assessment compared to self-report. Clinically, the FEW tools provide complementary data which can contribute to clinical and research assessments of clients’ everyday functioning with their wheelchairs.
Association of Self-Report and Performance-Based Instruments to Measure Functional Performance among Wheelchair Users, 2019
Objective: The main objective of this study was to investigate associations of self-report and performance-based measures of functional performance for wheelchair users. Method: The Functioning Everyday with a Wheelchair (FEW); a self-report measure, the FEW-Capacity (FEW-C); a performance-based measure for the clinic, and the FEW-Performance (FEW-P); a performance-based measure that measures clients’ skills in the home were the measures used in this study. The current study examines the associations among the different methods used with the FEW, FEW-C and FEW-P at pretest when participants used their customary wheel chairs and post test when participants used their new wheelchairs. Results: Our hypothesis that there would be a stronger association between the FEW, FEW-C, and FEW-P at the pretest than the posttest due to the familiarity with the wheeled mobility device was partially confirmed. Overall, the relationships among the self-report (FEW) and the performance-based (FEW-C, FEW-P) total independence scores were significantly associated at both pretest and posttest as were the relationships between the two performance-based tools. However, these significant relationships were stronger at the pretest compared to the posttest. Conclusion: Our hypothesis that there would be a stronger association between the FEW, FEW-C and FEW-P at the pretest when compared with the posttest was accepted for the total scores but was only partially confirmed for the individual items of these tools. Our findings indicate that both methods (self-report and performance-based) can yield useful information, may have potential roles in clinical and research settings, and may have complementary relationships.