The effect of an outdoor powered wheelchair on activity and participation in users with stroke

Feasibility and clinical applicability of a novel power wheelchair training approach

PURPOSE

To evaluate the feasibility and the clinical applicability of administering the COMET (cognition, occupation, mobility, evaluation and training) intervention.

MATERIALS AND METHODS

A pilot research was conducted with adults who were being considered for power wheelchair (PWC) provision, or who were recently provided a PWC, and who had been identified to benefit from a PWC training. The COMET intervention applies a goal directed, client-centred and occupation-based approach. Feasibility and applicability indicators were collected for: process, resources, management and treatment. Indicators were evaluated as "successful/unsuccessful". Clinical outcomes included the Goal Attainment Scale (GAS), the Canadian Occupational Performance Measure (COPM), the Power mobility Indoor Driving Assessment (PIDA) and the Wheelchair Skills Test (WST).

RESULTS

Four females (62.5 ± 3.5 years) with cognitive impairment participated in the study. Among the 13 indicators, 10 were successfully achieved. Indicators that did not meet the criteria for success were adherence rate, safety and treatment for the PIDA. Two adverse events were reported, with one minor injury. Participants demonstrated better than expected results on the GAS, the COPM scores and the WST. However, only two reported an improvement beyond 4% of the PIDA.

CONCLUSIONS

With few modifications, the COMET intervention and the study protocol will be feasible and applicable in clinical practice. Individuals with complex cognitive and mobility impairment demonstrated abilities to learn PWC use. Further investigation of the COMET intervention is required to evaluate its efficacy.Implications for rehabilitationA novel power wheelchair (PWC) training approach adapted to individual with complex mobility and cognitive impairments was developed: the COMET (cognition, occupation, mobility, evaluation and training) intervention.The COMET intervention applies a goal directed, client-centred and occupation-based approach.With minor modifications, the COMET intervention may be feasible and clinically applicable to train individuals with complex motor and cognitive impairments how to use a PWC.Further evaluation of the COMET intervention and lager control trialsare suggested.

Factors that affect powered wheelchair use for an adult population: a systematic review

PURPOSE

The purpose of the review was to explore current factors affecting the use of a powered wheelchair for an adult person a with a disability.

MATERIALS AND METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Information about the characteristics of the studies (type, setting) and perceived barriers and facilitators to powered wheelchair use were extracted using a data extraction sheet. Data synthesis was achieved using narrative synthesis. The quality of the included studies was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (SQAC) and the CASP checklist (Critical Appraisal Skills Programme), Centre for Evidence-Based Medicine, SIGN (Scottish Intercollegiate Guidelines Network).

RESULTS

Fifteen studies qualified for inclusion in the review. The narrative synthesis produced a conceptual map of reported factors affecting the usability of a powered wheelchair.

CONCLUSIONS

This review demonstrates that powered wheelchair use is a multifaceted and multidisciplinary phenomenon that is dependent on numerous interconnected factors including individual adjustment, stakeholder cooperation, societal attitudes, functional performance, and environmental features. Based on the review findings, there are several applied learning outcomes and practical applications to the powered wheelchair prescription and provision.

Capturing multiple assistive technology use and its impact in later life: lessons learned from distinct measurement approaches

PURPOSE

Assistive technology (AT) use is prevalent in older adulthood and can accommodate activity difficulties to support well-being. However, within the context of multiple activity difficulties and multiple technology use, it is unclear how to best assess their combined effects on older adults' health outcomes. This study proposed four distinct approaches to quantify multiple AT use and examined their respective impact in later life.

MATERIAL AND METHODS

Using data from the 2015 round of the National Health and Aging Trends Study (n = 6,936), we compared four indices to summarize the state of multiple AT use among the U.S. older population: binary, item-specific, cumulative, and accommodative. Separate regression analyses tested the impact of each index on older adults' well-being and restricted participation in meaningful activities.

RESULTS

In 2015, 59.9% of the respondents were identified as AT users. Among these users, 53.8% reported using two or more technologies when performing daily self-care and mobility activities. The implications of multiple AT use for health outcomes varied across the four indices. Approaches that captured elements of person-technology fit provided the most nuanced and actionable insights on the benefits of using AT to support well-being.

CONCLUSIONS

ATs were commonly adopted by older adults in everyday activities. Overall, findings suggest that there are multiple approaches to conceptualize the independent, cumulative, or balanced effects of multiple AT use. Each measurement approach has unique implications for understanding the impacts of using ATs on older adults' health outcomes.

Blind spot sensor systems for power wheelchairs: obstacle detection accuracy, cognitive task load, and perceived usefulness among older adults

PURPOSE

Blind spot sensor systems can improve power wheelchair (PWC) safety. This research (1) compared accuracy of obstacle detection in the rear of a wheelchair with and without a sensor system, and (2) explored cognitive task load and perceived usability, safety, confidence and awareness in a laboratory setting, and (3) PWC users' perceptions in real-world settings.

MATERIALS AND METHODS

A mixed-method design was used. PWC users were provided with the sensor system. In laboratory accuracy of obstacle detection with and without a sensor system, cognitive task load and perceived usability, safety, confidence and awareness were evaluated. Participants then used the sensor system at home for two-months before completing semi-structured interviews. Statistical and thematic analyses were conducted.

RESULTS

Among 11 PWC users (age = 67.5 ± 7.5y), obstacles were detected more accurately with sensor system than without (p < 0.001). Using the sensor system required lower cognitive task loads (p = 0.005). The system was perceived by most users as easy to use (9/11) and its capabilities meeting their requirements (8/11). Most users did not perceive safety (9/11), confidence (9/11) or increased awareness (10/11) in the laboratory. Three themes emerged in the follow-ups: perceived usefulness, barriers to use, and recommendations. Four participants reported continued use after 2 months, reporting perceived increased awareness, convenience, and independence using the system. Those who discontinued use reported perceived lack of usefulness and technical issues. Recommendations included types of users who can benefit and sensor improvements.

CONCLUSIONS

Sensor systems may improve obstacle detection accuracy while reducing cognitive task load. However, larger scale implementation should consider recommendations for PWC service provision.IMPLICATIONS FOR REHABILITATIONBlind spot sensors systems increased speed and accuracy of obstacle detection when using a power wheelchair.Technical and hardware issues encountered by PWC users highlight the need for training and support services.Technical support was out of scope for the current research project and will be explored in future research given the critical role it might play in the usability and adoption of assistive technologies.PWC users perceived there to be practical uses for blind spot sensor systems.

Using a virtual reality power mobility device simulator to assess the driving skills of people with brain diseases

Introduction

No previous study has explored the effectiveness of current prescription standards for evaluating power mobility device (PMD) maneuverability. To verify the current prescription standards for PMDs using a virtual reality (VR)-based PMD simulator and to present the possibility of using a VR-based PMD simulator as an alternative to current evaluation standards.

Methods

A total of 52 patients with brain diseases were enrolled. All participants were over 18 years old and had gait disturbance or limited outdoor walking ability. Participants performed a driving ability test using a VR PMD simulator.

Results

The driving ability test using the VR PMD simulator indicated that cognitive impairment, measured by the K-MMSE (p = 0.017), and unilateral neglect, measured by line bisection (p = 0.031), led to reduced driving ability and safety. In addition, patients with cognitive impairment or neglect presented driving stability problems, which were observed in the driving trajectory. There was also no correlation between driving scores and MBI subitems.

Conclusion

In patients with brain lesions, a driving ability test using a VR PMD simulator can be a safe, objective method for comprehensively evaluating a driver's capacity, offering an alternative to the current prescription standards for PMDs.

Consensus for a power wheelchair training approach for people with cognitive impairments

PURPOSE

Power wheelchairs (PWCs) can enhance independent mobility. The World Health Organization recommends training PWC users. However, current PWC training approaches do not always meet the needs of PWC users with complex mobility and cognitive impairment. The aim was to co-develop an innovative approach to PWC training for individuals with complex mobility and cognitive impairments.

MATERIALS AND METHODS

A two-phase mixed method research, involving PWC users, clinicians and researchers throughout all aspects of the research, was realized. (1) Interviews and focus groups were used. (2) The Delphi method was followed to refine the PWC training approach.

RESULTS

Phase 1: Twenty-six stakeholders indicated that PWC training should consider the client as a partner, the learning environment, the proposed activities, interactions with the trainer and intervention format. Phase 2: two hundred and seven participants agreed that the PWC training should be goal directed, should be client-centred and occupation-based, should enhance client-therapist relationships and should be realized in a safe and adapted environment.

CONCLUSIONS

Stakeholders on PWC use came to agreement on key components that should be applied when training people with cognitive impairments.

"Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany

Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.

Factor Structure of an ICF-Based Measure of Activity and Participations for Adults in Taiwan's Disability Eligibility Determination System

To assess activity and participation for adults in Taiwan's Disability Eligibility Determination System (DEDS), we developed a measure, the Functioning Disability Evaluation Scale—Adult version (FUNDES-Adult), based on the 36-item interviewer-administered version of the WHO Disability Assessment Schedule 2.0. The purpose of this study was to examine the factor structures of performance and capability dimensions of the FUNDES-Adult. This study followed a methodology research design to investigate the construct validity of the two dimensions of the FUNDES-Adult. Two samples were randomly stratified from the databank of adults with disabilities to examine structural validity by the exploratory factor analysis (EFA) (n = 8,730, mean age of 52.9 ± 16.81) and the confirmatory factor analysis (CFA) (n = 500, mean age of 54.3 ± 16.81). The results demonstrated that the EFA yielded 5-factor structures for both performance dimension (73.5% variance explained) and capability dimension (75.9% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (GFI, NFI, CFI, and TLI ≥ 0.95, RMSEA < 0.09). The results of this study provide evidence that the FUNDES-Adult has acceptable structural validity for use in Taiwan's DEDS. Utility of the FUNDES-Adult in rehabilitation, employment, welfare, and long-term care services needs further study.

Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care – Study protocol for a multicenter cluster randomized trial

Introduction

Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants’ illness management skills and recovery.

Objective

To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual.

Method

This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory.

Ethics and dissemination

The study is approved by the Swedish Ethical Review Authority (Registration No. 2020–02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132).

Factors associated with injury severity among users of powered mobility devices

Objective

To examine the features of powered mobility device-related injuries and identify the predictors of injury severity in such settings.

Methods

Emergency Department-based Injury In-depth Surveillance data from 2011 to 2018 were used in this retrospective study. Participants were assigned to the mild/moderate and severe groups based on their excess mortality ratio–adjusted injury severity score and their general injury-related factors and injury outcome-related factors were compared.

Results

Of 407 patients, 298 (79.2%) were assigned to the mild/moderate group and 109 (26.8%) to the severe group. The severe group included a higher percentage of patients aged 70 years or older (43.0% vs. 59.6%, P=0.003), injuries incurred in the daytime (72.6% vs. 82.4%, P=0.044), injuries from traffic accidents and falls (P=0.042), head injuries (38.6% vs. 80.7%, P<0.001), torso injuries (16.8% vs. 32.1%, P=0.001), overall hospital admission (28.5% vs. 82.6%, P<0.001), intensive care unit admission (1.7% vs. 37.6%, P<0.001), death after admission (1.4% vs. 10.3%, P=0.034), and total mortality (0.7% vs. 9.2%, P<0.001). The odds ratios (ORs) for injury severity were as follows: age 70 years or older (OR, 2.124; 95% confidence interval [CI], 1.239–3.642), head injury (OR, 10.441; 95% CI, 5.465–19.950), and torso injury (OR, 4.858; 95% CI, 2.495–9.458).

Conclusion

The proportions of patients aged 70 years or older, head and torso injuries, injuries from traffic accidents and falls, and injuries in the daytime were higher in the severe group. Our results highlight the need for measures to address these factors to lower the incidence of severe injuries.

A Pilot Study of the Psychosocial Impact of Low-Cost Assistive Technology for Sexual Functioning in People with Acquired Brain Injury

People with acquired brain injury (ABI) face limitations when performing activities of daily living, including sexuality. Despite the common use among this group of assistive technology to compensate for or neutralize the limitations deriving from their condition, there is very little literature on outcome measures in assistive technology for sexual functioning. The aim of this study was to explore the psychosocial impact of the use of low-cost assistive technology in people with ABI. The sample was made up of 18 users: 15 men and 3 women diagnosed with ABI. The PLISSIT model was used, as well as the Psychosocial Impact of Assistive Device Scale-PIADS as an assessment tool. Three types of low-cost assistive technology were developed: seat cushions, bed equipment, and back supports. All three types of AT obtained positive scores on the PIADS total scale and its three subscales: competence, adaptability, and self-esteem. Although the results of this study are positive, more research into outcome measures for products to improve sexual functioning in people with ABI is required.

Technical quality of online resources for mobility device training

Purpose: Training is recommended to improve safe and effective use of mobility aids. The internet offers a large amount of information and it can be difficult to identify resources with good quality. This project aimed to create a catalogue of online educational resources for mobility device training. The objective of this study was to identify and assess the quality of existing online educational resources for mobility device training for individuals with physical disabilities and caregivers.Methods: A Google search was conducted in October 2016 and replicated in January 2018. Resources were included if they were educational, were available in English or French, provided instruction or training in mobility aid use, were free of charge, and were targeted towards mobility device users or their caregivers. Resources were assessed using a modified version of the Journal of the American Medical Association (JAMA) benchmarks for the evaluation of technical quality.Results: Two hundred and seventy-one resources were included in the final analysis. Two resources were added by the research team for a total of 273 resources. The average JAMA quality score per mobility device varied between 3 (for crutches) and 5 (for knee scooters) out of 6, and weighted average was 3.6. The two resources added by the research team obtained a JAMA quality score of 6. 58 resources were retained for the catalogue.Conclusions: The results suggest that the technical quality of online educational resources for mobility device training could be improved. A need for higher quality resources for device users and caregivers was identified.Implications for rehabilitationThe overall technical quality of online educational resources for mobility device training for users and caregivers is low.A Mobility Device Training Catalogue is freely available and summarizes the highest quality online resources found on mobility device training.The Mobility Device Training Catalogue is intended for use by users and caregivers, but it may also provide clinicians with a tool that may be shared with their clients.

Myoelectrically Controlled FES to Enhance Tenodesis Grip in People With Cervical Spinal Cord Lesion: A Usability Study

People with tetraplegia are often lacking grip strength, causing impairment in activities of daily living. For them, improving hand function is a priority because it is important for autonomy and participation in daily life. A tendon transfer surgery may be an option to improve the tenodesis grip, but it is an invasive procedure. Alternatively a similar effect can be produced, using a non-invasive method. We have previously described how myoelectrically controlled functional electrical stimulation (MeCFES) can be efficient for enhancing grip strength, using a one channel research prototype with wired connections to surface electrodes. In this paper we focus on the usability for activities of daily living and how it can fulfill an actual need. We recruited 27 participants with a cervical spinal cord lesion (C5-C7) for this trial. They tested the device in 12 sessions of 2 h each, in which the participants performed self selected activities involving the tenodesis grip. User centered outcomes were validated questionnaires: the Individually Prioritized Problem Assessment (IPPA) and the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST). Furthermore, they were asked if they found the device useful for continued use in daily life. The device facilitated prioritized activities for all participants. The IPPA change score was 4.6 on average (STD:3.5, effect size:1.3), meaning that the system greatly facilitated problematic tasks and the large effect size evinces that this was a meaningful improvement of hand function. It compares to the impact that a mobility device like a wheelchair has on daily living. Fourteen subjects found the system useful, expressing the need for such a neuroprosthesis. Examples of acquiring new abilities while using the device, indicate that the method could have a therapeutic use as well. Furthermore, results from the IPPA questionnaire are indicating what issues people with tetraplegia may hope to solve with a neuroprosthesis for the hand. The satisfaction of the device (QUEST) indicates that further effort in development should address wearability, eliminate wires, and improve the fitting procedure.

Influence of Cognitive Functioning on Powered Mobility Device Use: Protocol for a Systematic Review

Background

Power mobility devices (PMD) are critical to achieving independent mobility and social participation for many individuals who have trouble walking. Provision of PMDs is complex, with cognitive functioning expressed by clinicians as a major concern. Even if PMD use can be predicted by the level of cognitive functioning, outcome tools used to assess readiness do not consider how cognitive functioning may affect PMD use.

Objective

The specific aims of this review are to identify existing assessments used to assess cognitive functioning and PMD use, classify cognitive functions that are identified within existing assessments related to PMD use, and explore the relationships between cognitive functioning (ie, executive functions and attention) and PMD use.

Methods

A systematic review will be conducted using the electronic databases MEDLINE (Ovid), CINAHL, Embase, PsycINFO (Ovid), and Web of Science based on the concepts of PMD performance and capacity, and cognitive functioning. To be included, studies must have: a sample of PMD users (inclusive of age and diagnoses), an assessment of cognitive functioning, and an assessment of PMD capacity or performance. The International Classification of Functioning, Disability and Health will be used to classify cognitive functions. Study quality will be assessed using the Mixed Methods Appraisal Tool. Qualitative and quantitative studies will be analyzed in a complementary manner depending on their designs; a result-based convergent synthesis design will be applied.

Results

This proposed systematic review protocol has been registered in PROSPERO (CRD42019118957). It was funded by the Quebec Rehabilitation Research Network and approved on February 2019.

Conclusions

Results will inform the development of a PMD driving program that aims to enhance cognition. The results of this study will enhance understanding of the influence of cognitive functioning on PMD use and will support the clinical practice in choosing appropriate evaluative tools.

Trial Registration

PROSPERO CRD42019118957; https://www.crd.york.ac.uk/PROSPERO/display_record.php? RecordID=118957

International Registered Report Identifier (IRRID)

DERR1-10.2196/16534

Feasibility RCT protocol evaluating a powered-wheelchair training program for older adults

Background.

Powered-wheelchair use improves participation for people with mobility limitations; however, many individuals do not receive powered-wheelchair skills training that meets their learning needs.

Purpose.

The aim of this work is to evaluate the feasibility of a powered-wheelchair training program for older adults with cognitive impairment, using errorless learning strategies facilitated by shared control technology.

Method.

A feasibility 2 × 2 factorial randomized controlled trial will recruit 32 older adults in residential care with mild to moderate cognitive impairment who are new powered-wheelchair use. The intervention consists of six or 12 training sessions, facilitated by shared control technology, using errorless learning techniques. Control participants will receive six or 12 training sessions using trial-and-error methods. Feasibility and clinical outcomes data (primary outcome: powered-wheelchair skills) will be collected.

Implications.

Errorless learning facilitated by shared control technology may be an alternative to meet the powered-wheelchair learning needs of older adults with cognitive impairments.

The association between having assistive devices and activities of daily living ability and health-related quality of life: An exploratory cross-sectional study among people with advanced cancer

OBJECTIVE

To explore whether people with advanced cancer who had assistive devices had higher or lower ADL ability and/or HRQoL than people with advanced cancer who did not have assistive devices.

METHODS

A cross-sectional study of 164 participants with advanced cancer. Self-reported ADL ability and HRQoL were assessed using the ADL-Interview and the EORTC QLQ-C30. Data regarding assistive devices were collected using a study-specific questionnaire. Data were analysed using multiple linear regression. The regression coefficients (B) were presented in crude form and adjusted for potential confounding variables (age, gender, cohabiting, receiving help, physical functioning, fatigue and pain). p-Values (p) < 0.05 were considered statistically significant.

RESULTS

Having assistive devices was associated with lower ADL ability (B = -0.923, p = <0.0001), but this association was not significant after adjustment where it was found that physical functioning was a confounder positively associated with ADL ability (B = 0.030, p = <0.0001). No significant association was found between having assistive devices and HRQoL. Both fatigue (B = -0.336, p = <0.0001) and pain (B = -0.124, p = 0.010) were negatively associated with HRQoL.

CONCLUSION

The participants had the same ADL ability and HRQoL regardless of them having assistive devices. Interventions addressing physical functioning or fatigue and pain might contribute to enhancing ADL ability and HRQoL among people with advanced cancer.

A scoping review of powered wheelchair driving tasks and performance-based outcomes

Introduction: Wheelchairs and scooters promote participation and have positive effects on quality of life. However, powered wheelchairs (PW) use can be challenging and can pose safety concerns. Adequate PW assessment and training is important. There is a wide variety of tasks and PW driving assessment measures used for training and assessing PW driving ability in the literature and little consensus as to which tasks and outcomes are the most relevant. A scoping review of the literature was performed in order to characterize this extensive variety of tasks and performance-based outcomes used for training and assessing PW skills.Methods: A search of the literature was conducted in January 2017. Four databases were searched: CINAHL, Embase, PsycInfo and Medline. Articles were included if they contained at least one PW driving task.Results: 827 articles were screened and 48 articles were retained. PW driving tasks from each article were identified and categorized in terms of the environment in which they were performed: Driving in a controlled environment, ecological driving tasks, 2D virtual environment (VE) tasks, 3D VE tasks. The assessment measures formed a separate category. Subjective and objective performance-based outcomes related to PW driving were also identified and grouped into outcomes assessing speed and outcomes assessing accuracy.Conclusion: This scoping review provides an overview of tasks and performance outcomes used in the literature when training and assessing PW skills. The results of this review could guide future research when choosing appropriate tasks and performance outcomes for PW driving ability.Implications for rehabilitationThere is wide variety of tasks and performance-based outcomes for PW driving.Results showed that available assessment measures are not commonly used in research and that tasks used often lacked consistency across studies.New methods to measure the interaction of speed and accuracy are needed.The contents of this review could be used by researchers as a starting point when designing a PW task and selecting appropriate performance-based outcomes.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Equipment provision after stroke: A scoping review of the use of personal care and mobility aids in rehabilitation

Introduction

The aim of this scoping review was to examine and synthesise literature on adaptive equipment use for personal care and mobility after stroke.

Method

We searched databases including Medline, EMBASE, AMED, CINAHL and Scopus to February 2016. Two authors independently screened 789 titles, identifying 28 studies for inclusion in the review.

Results

Findings were grouped into four themes: (1) stroke-specific impairments and consequences for equipment use and training; (2) meaning of equipment for people with stroke; (3) cost of equipment after stroke; and (4) conflicts between equipment provision and models of stroke rehabilitation.

Conclusion

The wide range of impairments after stroke increases complexity of how people use equipment. Nonetheless, training needs and the relationship between social context, identity and equipment use are increasingly better understood,. The findings highlight a tension between practice that seeks to re-train function by ‘normal’ movement without equipment and restoration of function by using compensation strategies involving use of equipment. However, there is no evidence that compensation strategies impede recovery of physical abilities. High-quality evidence about costs of equipment after stroke, which could inform policy decisions, is urgently needed.

What environmental factors influence resumption of valued activities post stroke: a systematic review of qualitative and quantitative findings

OBJECTIVE

Identify the environmental factors that influence stroke-survivors' reengagement in personally valued activities and determine what specific environmental factors are related to specific valued activity types.

DATA SOURCES

PubMed, CINAHL and PsycINFO were searched until June 2016 using multiple search-terms for stroke, activities, disability, and home and community environments.

REVIEW METHODS

An integrated mixed-method systematic review of qualitative, quantitative and mixed-design studies was conducted. Two researchers independently identified relevant studies, assessed their methodological quality and extracted relevant findings. To validly compare and combine the various findings, all findings were classified and grouped by environmental category and level of evidence.

RESULTS

The search yielded 4024 records; 69 studies were included. Most findings came from low-evidence-level studies such as single qualitative studies. All findings were consistent in that the following factors facilitated reengagement post-stroke: personal adapted equipment; accessible environments; transport; services; education and information. Barriers were: others' negative attitudes and behaviour; long distances and inconvenient environmental conditions (such as bad weather). Each type of valued activity, such as mobility or work, had its own pattern of environmental influences, social support was a facilitator to all types of activities. Although in many qualitative studies others' attitudes, behaviour and stroke-related knowledge were seen as important for reengagement, these factors were hardly studied quantitatively.

CONCLUSION

A diversity of environmental factors was related to stroke-survivors' reengagement. Most findings came from low-evidence-level studies so that evidence on causal relationships was scarce. In future, more higher-level-evidence studies, for example on the attitudes of significant others, should be conducted.

Systematic Literature Review on ICF From 2001 to 2013 in the Nordic Countries Focusing on Clinical and Rehabilitation Context

We present a systematic review on International Classification of Functioning, Disability and Health (ICF) used in the Nordic countries from 2001 through 2013, describing and quantifying the development in utilization of ICF, and describe the extent to which the different components of the ICF have been used. A search was conducted in EMBASE, MEDLINE and PsycInfo. Papers from Nordic countries were included if ICF was mentioned in title or abstract. Papers were assigned to one of eight categories covering the wide rehabilitation area; furthermore, area of focus was assigned. Use of ICF components and intervention were coded in papers categorized as "clinical and/or rehabilitation contexts" or "non-clinical contexts". One hundred seventy papers were included, of these 99 papers were from the categories "clinical and/or rehabilitation contexts" or "non-clinical contexts". Forty-two percent of the 170 included papers were published in the period 2011 - 2013. There was an increase in ICF-relevant papers from 2001 to 2013, especially in the categories "clinical and/or rehabilitation contexts" and "non-clinical contexts". The most represented focus areas were neurology, musculoskeletal, and work-related areas. All five or at least four ICF components were mentioned in the results or discussions in most papers, and activity was most frequently mentioned.

Effectiveness of Powered Mobility Devices in Enabling Community Mobility-Related Participation: A Prospective Study Among People With Mobility Restrictions

OBJECTIVE

To investigate the effectiveness of powered mobility device (ie, powered wheelchair and scooter) interventions over a 1-year period in Nordic countries.

DESIGN

Prospective design.

SETTING

The study involved community-dwelling participants from Denmark, Finland, and Norway.

PARTICIPANTS

In all, 180 participants with different self-reported impairments participated in the study. The mean age was 68.7 years (95% confidence interval [CI] = 39.9-97.5 years), and 47.8% of the participants were men.

METHODS

Two face-to-face interviews about mobility and mobility-related participation were conducted with participants in their homes. The first interview took place shortly before the participants received their powered mobility device, and the second took place about 1 year later (mean, 386.9 days; standard deviation = 52.78).

MAIN OUTCOME MEASURES

Changes in frequency, ease/difficulty, and number of mobility-related aspects of participation in daily life were investigated in the total sample and in subgroups by means of the NOMO 1.0 instrument, applying a structured interview format.

RESULTS

In the total sample, the frequency of shopping for groceries (P < .001, effect size = 0.29, 95% CI = 0.08-0.50) and going for a walk/ride (P < .001, effect size = 0.62, 95% CI = 0.41-83) increased, whereas the number of aspects of participation performed (P < .001) increased only slightly. Going to a restaurant/café/pub, shopping for groceries, doing other shopping, posting letters, going to the bank or the chemist's, going for a walk/ride, and visiting family/friends became easier (P < .001 to P = .001); effect sizes varied between 0.50 (95% CI = 0.29-0.71) and 0.85 (95% CI = 0.63-1.07). Men, persons who used scooters, and persons with poor self-reported health seem to benefit the most from the intervention.

CONCLUSIONS

Powered mobility device interventions mainly contribute to mobility-related participation by making participation easier for people with mobility restrictions and by increasing the frequency of aspects of participation such as shopping for groceries and going for a walk/ride. The effects varied with regard to the subgroups. The present study further strengthens the current evidence that powered mobility devices increase mobility-related participation in daily life among certain subgroups of adults with mobility restrictions.

Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: an evidence-based review

This evidence-based review examined the evidence supporting the use of occupation-based interventions to improve areas of occupation and social participation poststroke. A total of 39 studies met the inclusion criteria and were critically evaluated. Most of the literature targeted activity of daily living (ADL)-based interventions and collectively provided strong evidence for the use of occupation-based interventions to improve ADL performance. The evidence related to instrumental ADLs was much more disparate, with limited evidence to support the use of virtual reality interventions and emerging evidence to support driver education programs to improve occupational performance poststroke. Only 6 studies addressed leisure, social participation, or rest and sleep, with sufficient evidence to support only leisure-based interventions. The implications of this review for research, education, and practice in occupational therapy are also discussed.

Power wheelchair driving challenges in the community: a users' perspective

PURPOSE

There is limited information on the difficulties individuals experience in manoeuvring their power wheelchairs during daily activities. The aim of this study was to describe the nature and context of power wheelchair driving challenges from the perspective of the user.

METHODS

A qualitative design using semi-structured interviews with power wheelchair users. Qualitative content analysis was used to identify themes.

RESULTS

Twelve experienced power wheelchair users were interviewed. Findings revealed that power wheelchair driving difficulties were related to the accomplishment of activities of daily living, and the influence of environmental context. Four key themes emerged: (1) difficulties accessing and using public buildings-facilities, (2) outdoor mobility, (3) problems in performing specific wheelchair mobility tasks/manoeuvres and (4) barriers and circumstances that are temporary, unforeseen or specific to a particular context.

CONCLUSION

This qualitative study furthers our understanding of the driving difficulties powered wheelchair (PW) users experience during daily activities. This knowledge will assist clinicians and researchers in two areas: in choosing assessment measures that are ecologically valid for power wheelchair users; and, in identifying and refining the content of training programs specific to the use of power wheelchairs.

IMPLICATIONS FOR REHABILITATION

A better understanding of the everyday challenges individuals experience in driving their power wheelchair will assist clinicians and researchers in: Choosing assessment measures and identifying training programs for this population. Refining the content of power wheelchair training programs.

Lower extremity ulceration caused by medical scooter injury: a case series

The motorized mobility scooter (MMS) provides considerable benefits to patients with mobility limitations. Nevertheless, safety concerns related to MMS use are an issue. With increased use because of increased life expectancy and chronic illness, there are a growing number of reports of MMS-related injuries, ranging from lacerations and contusions to fatalities. Comorbidities may also exacerbate wound care. Prevention of these injuries is greatly needed. The author presents 5 patients with lower-extremity ulceration caused by MMS injuries. To prevent these injuries, health care providers must carefully evaluate and monitor patients. Clinicians and MMS manufacturers also need to educate and train patients on the safe use of MMS devices, including the regular use of footwear.

Consumer perspectives on the usability and value of the iBOT(®) wheelchair: findings from a case series

PURPOSE

The iBOT(®) is an advanced power wheelchair introduced in 2003 for people with mobility impairments to enhance their independence and community access. Although this innovation soon gained popularity, the production of this wheelchair was recently stopped owing to the lower-than-expected sale figures. In this scenario, this study examines the impact of this wheelchair on current consumers by highlighting its usability in multiple contexts and verifying the value associated with its ownership.

METHOD

Seven active consumers of the iBOT(®) were interviewed using a mixed method approach. Participants discussed and rated the iBOT's usability in relation to their standard power wheelchair and shared their perceived value for it. A content analysis was used to elucidate the qualitative data, whereas the quantitative data was analyzed using descriptive and non-parametric comparisons to compute differences in consumer ratings for the two wheelchairs.

RESULT

Results, although statistically non-significant (α < 0.05), indicated the iBOT(®) to be a highly multi-functional wheelchair with relatively superior usability in workplace (p = 0.15), community (p = 0.18) and outdoors (p = 0.1). Participants greatly valued its capability to expand their mobility in otherwise inaccessible environments and to enhance their social participation through eye level communication.

CONCLUSION

The iBOT(®) serves as an exemplar to promote interest and funding for advanced AT devices for people with disabilities. [Box: see text].