Service delivery for complex rehabilitation technology: a scoping review

Falls in people with mobility limitations: a cross-sectional analysis of a US registry of assistive device users

Purpose of the Article: To (1) summarise the personal and clinical characteristics of persons with disabilities (PwDs) in the US who were evaluated for mobility assistive equipment (MAE) in the functional mobility assessment and uniform dataset (FMA/UDS) and (2) stratify subpopulations of PwD who reported falling versus those who do not report a fall.

Materials and Methods: This study was a retrospective, descriptive cohort analysis of adults with disabilities using the FMA/UDS. Data are collected during a user's initial evaluation for a new mobility device. The sample is intentionally general to be inclusive of all mobility device users. The primary variable of interest was a patient-reported fall within the 3 months leading up to their evaluation for a new mobility device. Subpopulation characteristics were stratified by this binary fall variable.

Results and Conclusions: This study provides descriptions of PwDs being evaluated for a new mobility device. There were 11,084 PwDs with 31 different primary diagnoses. During their new mobility device evaluation, 52.2% of PwDs reported at least one fall in the last 3 months. For those who reported a fall, 46.6% of PwDs were using a walking aid or no device at all before the new mobility device evaluation. Additionally, persons with progressively acquired disabilities (i.e., Parkinson's disease, osteoarthritis and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida). These findings will influence future studies comparing different types of devices and their influence on falls and user satisfaction.

Investigation of stakeholder perceptions of the wheelchair service delivery process

Introduction: The wheelchair service delivery process (SDP) is a large complex system and therefore has many potential points of failure; determining priorities for improvement is challenging. The complexities introduce several barriers to accessing and maintaining wheelchairs for individuals with mobility impairments. Given the breadth and depth of the barriers, it is important to know in which areas to focus future policy reform efforts.

Purpose:The purpose is to explore the perceptions of stakeholders regarding the performance of the wheelchair SDP in the United States and guide future policy reforms.

Methods: A cross-sectional, observational, online questionnaire was deployed. Questions were positive statements regarding the wheelchair SDP and participants rated their agreement with the statements on a standard six-point Likert scale. A snowball sampling strategy was used and consisted of emailing 42 organisations representing 5 stakeholder groups: (1) consumers/caregivers; (2) clinicians; (3) manufacturers; (4) payers; and (5) suppliers.

Results: 1,052 responses were collected: 41% clinicians, 30% suppliers, 24% consumers/caregivers, 3% manufacturers, 2% payers. Stakeholders view the wheelchair SDP as not performing well. Less than 18% of all responses indicate a positive perception. Funding and procurement was viewed in the least positive light, with 5% positive responses. Follow-up, maintenance, and repair was the second least positive component with 9% positive responses. Fitting, training, and delivery was viewed most positively with over 42% positive responses.

Conclusion: The wheelchair SDP is not viewed as performing well by its stakeholders. Funding, procurement, maintenance, and repairs are viewed particularly negatively, representing opportunities for focused system reform efforts.

Wheelchair user's perceived access to maintenance and repair services: a qualitative study

PURPOSE

Wheelchairs and associated seating and positioning systems require maintenance and repair services to sustain essential functions for wheelchair users. This study aims to amplify wheelchair users' opinions and experiences related to their perceived access to crucial wheelchair maintenance and repair services.

METHODS

We conducted semi-structured interviews with four full-time wheelchair users using five semi-structured interview questions. The collected data was analyzed using a reflexive thematic analysis approach. Six interconnected themes were inductively, reflexively, and collaboratively constructed through critical discussions and mind-mapping techniques.

RESULTS

These themes are as follows: "improving accessibility and efficiency: service delivery," "access challenges: diversifying repair options and locations," "systemic challenges: the role of policy," "design, durability, and dependability: meeting the user's needs," "empowering accessibility: bridging the knowledge gap," and "The system Itself: a call for change."

CONCLUSIONS

Our findings suggest that wheelchair users prioritize not only the revision of existing barriers to access but also the implementation of preventative measures to minimize repair needs. Stakeholders are encouraged to collaborate to critically analyze existing wheelchair service delivery processes and associated policies. Practical implications include adjusting current policies, establishing best practice guidelines, and enacting preventative measures to facilitate improved user access to maintenance and repair services and optimize related outcomes.

Rehabilitation clinicians' use of mainstream wireless technologies in practice: a scoping review

PURPOSE

This scoping review was conducted to understand the barriers, facilitators, and education and training needs of rehabilitation clinicians in their use of mainstream wireless technologies (MWT) to support people with disabilities and older adults. It was also conducted to understand the functional skills of clients that were targeted with MWT use.

MATERIALS AND METHODS

This scoping review was reported using PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) and the Population (or Participants)/Concept/Context) framework. We searched PubMed; ProQuest to access APA PsycINFO; Web of Science Core Collection; and EBSCOhost to access Cumulated Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE ALL, and Education Resources Information Center (ERIC). Articles published between 2015-2022 were retrieved.

RESULTS

A total of 90 articles were included. Most interventions were apps, smartphones, and tablets; were geared toward adults; and targeted motor, cognitive and speech skills. An infographic on barriers and facilitators was generated as a decision support tool for clinicians when implementing MWT. The topic, format, timing, and source of information clinicians need are also delineated.

CONCLUSION

MWT such as apps, smartphones and tablets are being used by rehabilitation clinicians to address motor, cognitive, and speech skills, most commonly in adults. Clinicians voice a need for more education and training. Barriers and facilitators exist at the clinician-, technology-, client-, institution-, and policy levels.

Provision and use of assistive products in patients after stroke and spinal cord injury in Germany: a qualitative interview study

PURPOSE

Mobility impairments are a common consequence of stroke and spinal cord injury (SCI). Assistive products (APs) such as wheelchairs are often needed for activities and participation. The aim of the study was to explore the provision and use of APs in Germany and to identify associated factors underlying this practice.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 19 professionals from outpatient neurorehabilitation services (three general practitioners, five physical therapists, five occupational therapists, one speech therapist, one neuropsychologist, two outpatient nurses, one rehab technician and one social worker), two patient advocates (long-term survivors, each stroke and SCI) and 20 patients (10 each after stroke and SCI with mobility impairment, and first-ever affected). Analysis was performed by qualitative content analysis.

RESULTS

Reported experiences were mixed, varying from high satisfaction to unusable APs and unmet needs. Identified factors associated with these experiences were related to care pathways, care coordination, inter-professional collaboration, professionals' knowledge and patient information, cost coverage, and approval procedures.

CONCLUSION

Overall, patients seem satisfied with the APs they receive, but patients with more severe mobility impairments in particular experience deficits in the provision and use of APs. Further research is needed to develop and test strategies for the provision and use of APs.