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Oldfrey B, Holloway C, Walker J, McCormack S, Deere B, Kenney L, Ssekitoleko R, Ackers H, Miodownik M. Repair strategies for assistive technology in low resource settings. Disabil Rehabil Assist Technol 2024; 19:1945-1955. [PMID: 37466362 DOI: 10.1080/17483107.2023.2236142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To investigate the practices of repair that exist for users of mobility assistive products in low resource settings, as well as the psychosocial impact that the repair, or non-repair, of these devices has on users' lives. MATERIALS AND METHODS This article collates data on repair practices and the responses from participants on the topic of repair from studies conducted by the authors across four different low resource settings in Kenya, Uganda, Sierra Leone, and Indonesia. This data was then analyzed to identify the common themes found across geographies. RESULTS Three major models of repair practice emerged from the data: "Individual or Informal Repair in the Community"; "Local Initiatives"; and "Specialist AT Workshop Repair". Additionally, the wider impact on the participants' lives of "Problems & Concerns with Repair"; "Experiences of Breakages & Frequencies of Repair" and the "Impact of Broken Devices" are explored. CONCLUSIONS The results of this analysis demonstrate the paramount importance of community-based repair of devices, and how despite this importance, repair is often overlooked in the planning and design of assistive products and services. There is a need to further incorporate and support these informal contributions as part of the formal provision systems of assistive device.
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Affiliation(s)
- Ben Oldfrey
- Global Disability Innovation Hub (GDI Hub), London, UK
- Institute of Making, University College London, London, UK
- Interaction Centre (UCLIC), University College London, London, UK
| | - Cathy Holloway
- Global Disability Innovation Hub (GDI Hub), London, UK
- Interaction Centre (UCLIC), University College London, London, UK
| | - Julian Walker
- The Bartlett Development Planning Unit, University College, London, UK
| | - Steven McCormack
- Orthopaedic Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Bernadette Deere
- Division of Imaging Sciences and Biomedical Engineering, Department of Medical Engineering and Physics, King's College London, London, UK
| | - Laurence Kenney
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Robert Ssekitoleko
- Biomedical Engineering, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Helen Ackers
- School of Health and Society, University of Salford, Manchester, UK
| | - Mark Miodownik
- Institute of Making, University College London, London, UK
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McKenney CM, McKenney EE. Wheeled repair alliance: Rolling out wheelchair repair and maintenance in community bicycle shops. Assist Technol 2024:1-6. [PMID: 38771976 DOI: 10.1080/10400435.2024.2348163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/23/2024] Open
Abstract
The increasing population of wheelchair users in the United States highlights the importance of access to reliable and affordable wheelchair maintenance and repair. Having a well-maintained mobility device is essential to living a safe, healthy, and social life as a wheelchair user. Unfortunately, access to these services is limited. This study aims to address this need by developing and evaluating a workshop program designed to teach basic wheelchair maintenance skills to bike shop employees, allied health professionals, and wheelchair users themselves. The workshops covered key wheelchair maintenance tasks. Pre and post workshop surveys assessed participants' confidence in basic maintenance and repair skills and overall satisfaction with the workshop. Workshop participants reported increased confidence in all maintenance skills following the workshops and bike shop employees expressed increased confidence in their ability to work with and provide resources for wheelchair users. This study highlights that community-based workshops may help to enhance confidence in wheelchair maintenance skills, potentially aiding in bridging the gap in affordable and accessible repair services. The Wheeled Repair Alliance has the potential to empower wheelchair users and improve their quality of life. Further research should consider increasing the precision of measurements and assessing long-term outcomes related to wheelchair maintenance and repair.
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Affiliation(s)
- Caitlin M McKenney
- Institute on Disabilities, Temple University, Philadelphia, Pennsylvania, USA
| | - Erin E McKenney
- Psychology Department, Rowan University, Glassboro, New Jersey, USA
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3
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Mhatre A, Loew C, Yurtsever E, Mair C. Power wheelchair usage and repair are associated: a retrospective analysis. Disabil Rehabil Assist Technol 2024:1-8. [PMID: 38754034 DOI: 10.1080/17483107.2024.2353861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
Purpose: This study evaluates the effect of power wheelchair telemonitoring and battery charging training on user charging behavior and repair measures and assesses the relationship between wheelchair usage and repair measures to support technician-led servicing.Methods: This is a retrospective analysis of two matched cohorts with a total of n=237 users from the NHS service dataset. In the training cohort, a wheelchair usage telemonitoring device monitored the battery usage of n=119 power wheelchair users for 12 months. Users whose battery charging behavior was not optimal were instructed on appropriate charging practices. Wheelchair usage parameters of wheelchair drive and power time every month were used to predict repairs and associated costs.Results: Fifty-four out of 119 users in the training cohort did not charge batteries regularly and were instructed on appropriate charging. Twenty-six of them changed their behavior and charged their batteries every night. This cohort experienced reduced battery repairs by 18%, wheelchair repairs by 11%, and repair costs by £3,092 compared to a matched standard care cohort (n=118). User age and drive time were associated with repair measures. Drive time predicted time-to-failure for wheelchair parts and classified failure risk with the area under the receiver operating characteristic curve as 0.71 (95% CI 0.61 to 0.82; p<.001). Conclusions: By leveraging the significant relationships between wheelchair usage and repairs, wheelchair users at risk of part failures can be identified, and technician-led servicing tools for proactive interventions can be developed. Wheelchair battery health telemonitoring and instructing users on appropriate battery charging reduced repairs and associated costs.
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Affiliation(s)
- Anand Mhatre
- The Ohio State University, Division of Occupational Therapy, College of Medicine, Columbus, OH, USA
| | - Cassandra Loew
- The Ohio State University, Division of Occupational Therapy, College of Medicine, Columbus, OH, USA
| | - Ekim Yurtsever
- The Ohio State University College of Engineering, Columbus, OH, USA
| | - Colin Mair
- National Health Service West of Scotland Mobility and Rehabilitation Centre (WestMARC), Glasgow, UK
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Kirby RL, Parker K, Poon E, Smith C, Osmond D, Ladouceur M, Haworth VS, Theriault CJ, Sandila N. Effect of travel direction and wheelchair position on the ease of a caregiver getting an occupied wheelchair across a soft surface: a randomized crossover trial. Disabil Rehabil Assist Technol 2024; 19:1298-1306. [PMID: 36695416 DOI: 10.1080/17483107.2023.2170476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/09/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE To test the hypotheses that, in comparison with pushing an occupied upright manual wheelchair forward, pulling backward on the push-handles improves the objective and subjective ease with which a caregiver can get the wheelchair across a soft surface (e.g., grass, mud, sand, gravel); and the ease with which a caregiver can get the wheelchair across a soft surface improves if the wheelchair is tipped back into the wheelie position. METHODS We used a randomized crossover trial with within-participant comparisons to study 32 able-bodied pairs of simulated caregivers and wheelchair occupants. The caregiving participants moved an occupied manual wheelchair 5 m across a soft surface (7.5-cm-thick gym mats) under four conditions (upright-forward, upright-backward, wheelie-forward and wheelie-backward) in random order. The main outcome measure was time (to the nearest 0.1 s) and the main secondary measure was the ease of performance (5-point Likert scale). RESULTS The upright-backward condition was the fastest (p < 0.05) and had the highest ease-of-performance scores. In the forward direction, there was no statistically significant difference in the time required between the upright and wheelie positions, but the wheelie position was considered easier. CONCLUSIONS Although further study is needed, our findings suggest that caregivers should pull rather than push occupied wheelchairs across soft surfaces. In the forward direction, caregivers may find the wheelie position easier than the upright condition. These techniques have the potential to both improve the effectiveness of and reduce injuries to caregivers. Clinical Trial Registration Number: NCT04998539.
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Affiliation(s)
- R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kim Parker
- Assistive Technology Program, Nova Scotia Health, Halifax, NS, Canada
| | - Eric Poon
- Class of 2023, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Cher Smith
- Department of Occupational Therapy, Nova Scotia Health, Halifax, NS, Canada
| | - Dee Osmond
- Department of Occupational Therapy, Nova Scotia Health, Halifax, NS, Canada
| | - Michel Ladouceur
- Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | | | | | - Navjot Sandila
- Research Methods Unit, Nova Scotia Health, Halifax, NS, Canada
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Zorrilla M, Ao J, Terhorst L, Cohen SK, Goldberg M, Pearlman J. Using the lens of assistive technology to develop a technology translation readiness assessment tool (TTRAT)™ to evaluate market readiness. Disabil Rehabil Assist Technol 2024; 19:1145-1160. [PMID: 36538509 DOI: 10.1080/17483107.2022.2153936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/15/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Assistive Technologies encompass a wide array of products, services, healthcare standards, and the systems that support them. Product/market fit is necessary for a technology to be transferred successfully. Current tools lack variables that are key to technology transfer, and current trainings do not have a validated tool to assess the effectiveness of a training, increasing innovators' readiness for technology transfer. The goal was to develop a tool to evaluate the readiness of a technology by incorporating other models and focusing beyond just commercialization. MATERIALS AND METHODS The development involved five stages: 1. Review of current tools used in technology transfer in academic, government, and industry settings; 2. Development of the draft version of the tool with internal review; 3. Alpha version review and refinement, 4. Content validation of the tool's beta version; 5. Assessment of the readiness tool for reliability and preparedness for wide-use dissemination. RESULTS The tool was revised and validated to 6 subscales and 25 items. The assistive technology subscale was removed from the final version to eliminate repetitive questions and taking into consideration that the tool could be used across technologies. CONCLUSIONS We developed a flexible assessment tool that looked beyond just commercial success and considered the problem being solved, implications on or input from stakeholders, and sustainability of a technology. The resulting product, the Technology Translation Readiness Assessment Tool (TTRAT)TM, has the potential to be used to evaluate a broad range of technologies and assess the success of training programs.IMPLICATIONS FOR REHABILIATIONQuality of life can be substantially impacted when an assistive technology does not meet the needs of an end-user. Thus, effective Assistive Technology Tech Transfer (ATTT) is needed.The use of the TTRAT may help to inform NIDILRR and other funding agencies that invest in rehabilitation technology development on the overall readiness of a technology, but also the impact of the funding on technology readiness.The TTRAT may help to educate novice rehabilitation technology innovators on appropriate considerations for not only technology readiness, but also general translation best practices like assembling a diverse team with appropriate skillsets, understanding of the market and its size, and sustainability strategies.
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Affiliation(s)
- Michelle Zorrilla
- Department of Rehabilitation Science and Technology, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Jingning Ao
- Department of Business Administration, University of Pittsburgh, Katz Graduate School of Business, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Susan K Cohen
- Department of Business Administration, University of Pittsburgh, Katz Graduate School of Business, Pittsburgh, PA, USA
| | - Mary Goldberg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
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Higgins E, Zorrilla M, Murphy KM, Robertson M, Goldberg MR, Cohen SK, Augustine N, Pearlman JL. Barriers and facilitators to technology transfer of NIDILRR grantees. Disabil Rehabil Assist Technol 2024; 19:754-760. [PMID: 36136917 DOI: 10.1080/17483107.2022.2122604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/22/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The objectives of this mixed-methods study were to gather survey and interview data about the barriers and facilitators from grantees funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and to extract themes that could inform program changes that would increase technology translation (TT) success in assistive technology (AT). MATERIALS AND METHODS We developed a TT Barriers and Facilitators survey consisting of Likert scale and multiple-choice questions about barriers and facilitators to TT. With survey respondents who were willing, we conducting a semi-structured interview and asked pointed questions to expand upon survey response rankings and perceived barriers and facilitators. The questions were framed to explore the grantee's personal experience with ATTT and what helped and hindered their individualised processes. RESULTS Across survey and interview respondents, the three most common themes when exploring the barriers and facilitators of TT were funding, incentives, and collaboration. CONCLUSIONS Results indicate that there is a need for increased collaboration and access to additional resources such as funding for pilot grants, support to assess technology marketability, help to navigate regulatory and legal aspects, and assistance in establishing goals to help grantees successfully transfer assistive technologies to consumers. IMPLICATIONS FOR REHABILITATIONA large amount of research and development into assistive technology does not lead to tech transfer which means that these technologies are not getting to the people that need them.Educating tech transfer offices at universities about how to transfer AT would improve outcomes greatly.Creating a community of practice where grantees can find academic or industry partners would also increase the likelihood of tech transfer.Some tools to catalyse these improvements are: mentoring, access to consultants, podcasts, and online training.
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Affiliation(s)
- Erin Higgins
- Department of Rehabilitation Science and Technology, IMPACT Center, University of Pittsburgh, Pittsburgh, PA, USA
- University of Maryland, Baltimore, MD, USA
| | - Michelle Zorrilla
- Department of Rehabilitation Science and Technology, IMPACT Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Megan Robertson
- Department of Rehabilitation Science and Technology, IMPACT Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary R Goldberg
- Department of Rehabilitation Science and Technology, IMPACT Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan K Cohen
- College of Business Administration, Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy Augustine
- Department of Rehabilitation Science and Technology, IMPACT Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan L Pearlman
- Department of Rehabilitation Science and Technology, IMPACT Center, University of Pittsburgh, Pittsburgh, PA, USA
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7
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Ruffing JJ, Schmeler MR, Schein RM, Mhatre A. A cross-sectional descriptive analysis of complex rehabilitation technology (CRT) supplier opinions on the current state of wheelchair repair services. Disabil Rehabil Assist Technol 2024; 19:739-744. [PMID: 36094416 DOI: 10.1080/17483107.2022.2121007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/01/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE It is documented that wheelchair failures occur frequently, repair times are lengthy, and users often experience adverse consequences. This study aims to gather evidence on efficiency of current wheelchair repair processes from the perspective of complex rehabilitation technology (CRT) suppliers who perform repairs within the United States. MATERIALS AND METHODS A 20 statement survey was developed to identify barriers and facilitators related to wheelchair repairs across the domains of administrative and operational factors as well as to identify future opportunities for improvement. Key statements in these areas included time to perform a repair, documentation requirements, tracking repair progress, reimbursement, technician competency, emerging strategies and preventative maintenance. The online survey was broadly disseminated to a nationwide network of CRT suppliers for data collection. RESULTS A total of 127 responses were received. Results showed that administrative statements received the lowest scores while those statements dealing with future opportunities received the highest scores. Areas of the industry that suppliers were in most disagreement with included wait time for insurance approval, reimbursement for parts, reimbursement for technician travel time and lack of coverage for preventative maintenance. Telehealth system usage, preventative maintenance coverage, tracking repairs and repair scheduling were future opportunities that suppliers were in most agreement with. CONCLUSIONS Administrative issues exist in the CRT industry due to restrictive insurance policies associated with repairs and maintenance. Future opportunities to improve the process exist including payment models and the application of telehealth, device monitoring and service-based performance incentives to reduce adverse consequences to the user. Implications for rehabilitationHighlights the direct importance and barriers faced within the wheelchair repair industry by CRT suppliers.In a sample of CRT suppliers, there is agreement there exists many administrative and operational issues related to wheelchair repairs.There is agreement among survey respondents of opportunities to investigate further telehealth and remote strategies, preventative maintenance coverage and online tracking for wheelchair repairs.
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Affiliation(s)
- Jeffrey J Ruffing
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark R Schmeler
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard M Schein
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anand Mhatre
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
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Sundaram SA, Grindle G, Gebrosky B, Brown J, Kelleher A, Cooper R, Chung CS, Cooper RA. Classification of wheelchair pressure relief maneuvers using changes in center of pressure and weight on the seat. Disabil Rehabil Assist Technol 2023; 18:1026-1034. [PMID: 34411503 DOI: 10.1080/17483107.2021.1967472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pressure injuries from prolonged sitting are a significant problem for wheelchair users incurring high costs in healthcare expenditures and reducing quality-of-life. There is a need to improve pressure relief training and adherence in a variety of settings. OBJECTIVE To identify effective common wheelchair pressure relief (PR) manoeuvres based on changes to users' seated centre of pressure (CoP) and seated weight. PARTICIPANTS 20 individuals who use manual wheelchairs as their primary means of mobility. METHODS Participants performed 5 types of PR including seated push-ups, leftward, rightward, forward, and backward leans-while sitting in a wheelchair equipped with a custom instrumented seat pan support. Data were analysed using both clustering and decision tree approaches to identify types of PR. RESULTS Both clustering and decision tree approaches were able to identify and classify PR though neither could accurately distinguish between forward and backward PR. CONCLUSION Changes in the centre of pressure and the total weight on the wheelchair's seat can be used to automatically characterise type, amplitude and duration of pressure relief manoeuvres. Building such a classification and quality assessment scheme into an algorithm could enable a virtual coaching system to track users' pressure relief behaviour and make suggestions to improve adherence with clinical recommendations.IMPLICATIONS FOR REHABILITATIONMultiple bending beam load cells can be used to measure wheelchair users' seated centre of pressure independent of type of cushion used.Both cluster analysis and decision tree algorithms can classify commonly practiced pressure reliefs by measuring changes to the centre of pressure and total weight on the wheelchair's seat.The combination of force sensing for centre of pressure determination and either algorithm could serve as the basis for an application to coach wheelchair users to do effective pressure reliefs.
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Affiliation(s)
- S Andrea Sundaram
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Garrett Grindle
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Benjamin Gebrosky
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
| | - Josh Brown
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
| | - Annmarie Kelleher
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rosemarie Cooper
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cheng-Shiu Chung
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory A Cooper
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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9
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James AM, Pramana G, Schein RM, Mhatre A, Pearlman J, Macpherson M, Schmeler MR. A descriptive analysis of wheelchair repair registry data. Assist Technol 2023; 35:312-320. [PMID: 35200093 DOI: 10.1080/10400435.2022.2044407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 10/19/2022] Open
Abstract
Wheeled mobility and seating (WMS) devices allow users to achieve greater mobility independence. Previous studies determined that 53% of wheelchair users required one or more repairs over a 6-month period; however, there are a limited number of studies that have evaluated types of repairs. The purpose of this study was to describe the types of manual wheelchair, power wheelchair, and scooter repairs within the Wheelchair Repair Registry (WRR) and examine the association between WMS devices and the frequency of repairs. A dataset of 4,645 devices distributed in the United States was collected from equipment suppliers who performed and logged community-based wheelchair repair services. The results demonstrated common repairs found across devices were within the wheels/tires/forks and batteries/cables categories. Device type was the most significant predictor of variance in the number of repairs. Customizable manual wheelchairs, tilt-in-space, Groups 2 & 3 power wheelchairs, and scooters were associated with higher number of repairs compared to non-customizable manual wheelchairs, pediatric, heavy-duty manual wheelchairs, and Group 4 power wheelchairs. The higher failure rate found in specific devices may be associated with a population of more active users, environment/conditions where equipment is used, time spent in equipment, additional features on device, or lower durability.
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Affiliation(s)
- Alexandria M James
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gede Pramana
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard M Schein
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Mark R Schmeler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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10
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Schmeler MR, Dicianno BE. Viewpoints on the scoping review for the development of a novel coverage and service delivery policy for complex rehabilitation technology. Disabil Rehabil Assist Technol 2022; 17:872-874. [PMID: 36018331 DOI: 10.1080/17483107.2022.2113457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Mark R Schmeler
- Department of Rehabilitation Science & Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brad E Dicianno
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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11
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Masselink CE. Trends in wheelchair recommendations in a dedicated seating department. Assist Technol 2022; 34:264-272. [DOI: 10.1080/10400435.2020.1772899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Cara E. Masselink
- Occupational Therapy Department, Western Michigan University, Kalamazoo, USA
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12
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Mhatre A, Pearlman J, Schmeler M, Krider B, Fried J. Community-based wheelchair caster failures call for improvements in quality and increased frequency of preventative maintenance. Spinal Cord 2022; 60:58-62. [PMID: 34413486 PMCID: PMC8737191 DOI: 10.1038/s41393-021-00689-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN Secondary data analysis of wheelchair failures and service repair logs from a network of wheelchair suppliers. OBJECTIVE To determine the frequency of wheelchair caster failures and service repairs across wheelchair manufacturers and models and investigate the relationships between them. SETTING Wheelchair caster failures and service repairs occurred in the community. METHODS Reported caster failure types were classified based on the risk they pose for user injuries and wheelchair damage. Caster failures experienced by users of tilt-in-space and ultralightweight manual wheelchair models and Group 2, 3 and 4 power wheelchair models between January 2017 and October 2019 were analyzed using Chi-Square tests for independence. Correlational analysis of failures and service repairs was performed. RESULTS A total of 6470 failures and 151 service repairs reported across four manufacturers and five models were analyzed. Failure types were significantly associated with manufacturers and models, respectively. Users of tilt-in-space wheelchairs, who require greater seating support, experienced twice the proportion of high-risk caster failures than the ultralightweight manual wheelchair users. Similarly, Group 3 and 4 power wheelchair users, who have complex rehabilitation needs, experienced 15-36% more high-risk failures than Group 2 users. Service repairs negatively correlated with high-risk manual wheelchair caster failures. CONCLUSIONS Wheelchair users who have greater seating and complex rehabilitation needs are at a higher risk for sustaining injuries and secondary health complications due to frequent caster failures. The study findings call for significant reforms in product quality and preventative maintenance practices that can reduce wheelchair failures and user consequences.
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Affiliation(s)
- Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Schmeler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Benjamin Krider
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Fried
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Whitford M, Mitchell SJ, Marzloff GE, Zindle JK, Richmond MA, Bogie KM, Henzel MK. Wheelchair Mobility-Related Injuries Due to Inadvertent Lower Extremity Displacement on Footplates: Analysis of the FDA MAUDE Database From 2014 to 2018. J Patient Saf 2021; 17:e1785-e1792. [PMID: 32217931 DOI: 10.1097/pts.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to assess reports of wheelchair mobility-related injuries from inadvertent lower extremity displacement (ILED) on footplates, which were submitted to the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database during 2014-2018, characterize injury types, and evaluate MAUDE data quality. METHODS A systematic MAUDE database review was performed. Annual reports were searched using keywords: (a) "power wheelchair" and "injury" and (b) "mechanical (also known as manual) wheelchair" and "injury." Reports related to injuries from ILED on the footplate were reviewed. RESULTS Reports of 1075 wheelchair injuries were found across the review period. Twenty nine (3%) met our inclusion criteria. The most common source of reports was "manufacturer." The wheelchair was unavailable for evaluation in 55.17% of reports. Manufacturers' submission dates (number of days that passed after they were notified) ranged from 3 to 159. Reported injuries decreased by 60% from 2014 to 2018. The end user used a power wheelchair for all but one report. The most common injuries were single fractures, multiple fractures, wounds/cuts/infections, and amputations (in order of incidence). The most common mechanism was the foot slipping off the footplate during wheelchair mobility. CONCLUSIONS We observed inherent weaknesses in the MAUDE database reporting process and a concerning level of reporting bias. Although there were limited reports of injuries related to ILED on the footplate during wheelchair mobility, the injuries reported were significant. More standardized reporting of the mechanism and impact of these injuries is needed to better inform wheelchair design, prescription, and patient/family education.
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Developing a consensus on the core educational content to be acquired by people with spinal cord injuries during rehabilitation: findings from a Delphi study followed by a Consensus Conference. Spinal Cord 2021; 59:1187-1199. [PMID: 34108615 DOI: 10.1038/s41393-021-00652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Three-round Delphi study followed by a Consensus Conference with selected stakeholders. OBJECTIVES To identify a set of core educational content that people with spinal cord injury (SCI) need to acquire during rehabilitation. SETTING The Delphi study was performed electronically. The Consensus Conference was held at the Città della Salute e della Scienza University Hospital of Turin, Italy. METHODS A panel of 20 experts (healthcare professionals and SCI survivors) participated in a three-round Delphi study. In round 1, arguments for core educational content were solicited and reduced into items. In rounds 2 and 3, a five-point Likert scale was used to find consensus on and validate core educational content items (threshold for consensus and agreement: 60% and 80%, respectively). A Consensus Conference involving 32 stakeholders was held to discuss, modify (if appropriate) and approve the list of validated items. RESULTS The 171 arguments proposed in round 1 were reduced into 74 items; 67 were validated in round 3. The Consensus Conference approved a final list of 72 core educational content items, covering 16 categories, which were made into a checklist. CONCLUSIONS Consensus was achieved for a set of core educational content for people with SCI. The resultant checklist could serve as an assessment tool for both healthcare professionals and SCI survivors. It can also be used to support SCI survivors' education, streamline resource use and bridge the gap between information provided during rehabilitation and information SCI survivors need to function in the community.
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15
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Wilson-Jene H, Mhatre A, Ott J, Krider B, Smith C, Terhorst L, Pearlman J. Rolling resistance of casters increases significantly after two years of simulated use. J Rehabil Assist Technol Eng 2021; 8:20556683211025149. [PMID: 34408905 PMCID: PMC8365014 DOI: 10.1177/20556683211025149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Manual wheelchair propulsion is associated with upper limb pain and injury, and clinical guidelines recommend minimizing propulsive force to lower health risks. One of the strategies to reduce propulsive force is by minimizing rolling resistance (RR). Product testing studies suggest that RR of casters is affected by wear and tear which could have implications on the health risk of wheelchair users. The study will investigate the relationship between caster RR and environmental exposure using standard testing protocols. Methods RR of ten casters representing a range of diameters for different models of wheelchairs were measured before and after environmental exposure that includes corrosion, shock and abrasion simulating two years of community use. Results Four casters exhibited failures during durability testing, one catastrophically. Increases to RR after corrosion, shock and abrasion exposure were statistically significant using mixed-effects modeling, and four casters had increased RR greater than 20%. Conclusions Many of the casters evaluated exhibited increased RR forces and failure after environmental exposure. Improved caster design and use of corrosion resistant materials may reduce these failures. In addition, modification of the provision process could include replacement casters to reduce failures and avoid breakdowns that leave manual wheelchair users stranded or injured.
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Affiliation(s)
- Holly Wilson-Jene
- Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA.,International Society of Wheelchair Professionals, Pittsburgh, PA USA
| | - Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA.,International Society of Wheelchair Professionals, Pittsburgh, PA USA
| | - Joseph Ott
- Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA.,International Society of Wheelchair Professionals, Pittsburgh, PA USA
| | - Benjamin Krider
- Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA.,International Society of Wheelchair Professionals, Pittsburgh, PA USA
| | - Clair Smith
- Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA.,International Society of Wheelchair Professionals, Pittsburgh, PA USA
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16
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Effectiveness of Group Wheelchair Maintenance Training for People with Spinal Cord Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 103:790-797. [PMID: 34174224 DOI: 10.1016/j.apmr.2021.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of group wheelchair maintenance training and investigate participant characteristics associated with responsiveness to training. DESIGN Randomized controlled trial with an immediate group and a waitlist control group (WLCG) who received the intervention after a 6-month delay. SETTING Four Spinal Cord Injury Model Systems Centers. PARTICIPANTS Manual (MWC; n=80) and power wheelchair (PWC; n=67) users with spinal cord injury (N=147). INTERVENTIONS Two 90-minute structured wheelchair maintenance training program classes with 12-20 people per class and separate classes for MWC and PWC users. Each class included in-person hands-on demonstrations and practice of wheelchair maintenance. MAIN OUTCOME MEASURES Separate analysis was completed for MWC and PWC users using the Wheelchair Maintenance Training Questionnaire (WMT-Q) capacity (ability to complete), performance (frequency of completion) and knowledge at baseline, 1 month, 6 months, 6 months pretraining (WLCG only), and 1 year (immediate only). RESULTS After the intervention, participants in both the immediate and WLCG improved in maintenance capacity (MWC and PWC, P<.001) and performance (MWC and PWC, P<.001) with training. Only PWC users improved knowledge of wheelchair maintenance (P<.001). For both WLCGs (MWC and PWC), there was no difference between the 6-month pretraining time point and baseline. MWC users who responded to training had lower WMT-Q scores for all domains, whereas this was only the case for knowledge for PWC users. CONCLUSIONS Group wheelchair skills training is effective at improving capacity to complete maintenance and performance of maintenance activities for MWC and PWC users, even in a cohort of experienced wheelchair users. For MWC users, improvements were tied to lower WMT-Q scores at baseline, whereas PWC users improved in capacity and performance independent of baseline score. Delivering this training in a structured group format has a lower cost, which might improve adoption into clinical practice.
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Schein RM, Yang A, McKernan GP, Mesoros M, Pramana G, Schmeler MR, Dicianno BE. Effect of the Assistive Technology Professional on the Provision of Mobility Assistive Equipment. Arch Phys Med Rehabil 2021; 102:1895-1901. [PMID: 33891909 DOI: 10.1016/j.apmr.2021.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to examine factors associated with variability in satisfaction with functional mobility (as measured by the Functional Mobility Assessment [FMA]) in users of mobility devices. Our primary hypothesis was that device type and Assistive Technology Professional (ATP) involvement will be the most significant predictors of FMA score. Our secondary hypothesis was that ATP involvement is associated with use of more custom-fitted manual wheelchairs and group 3 and 4 power wheelchairs. DESIGN Retrospective cohort study. SETTING Data were collected from equipment suppliers who collaborate with clinicians to administer the FMA and associated Uniform Data Set within various settings (ie, rehabilitation clinic, school, supplier place of business). PARTICIPANTS A data set of 4743 cases was included in the analysis (N=4743). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FMA questionnaire collected at baseline, client age, gender, primary diagnosis, years since disability onset, device type, device age, living situation, ATP involvement, and geographic area. RESULTS Ordinal logistic regression modeling showed that geographic area, device type, ATP involvement, primary diagnosis, gender, age, device age, and years since onset of disability significantly predicted the variance in FMA scores at P<.05. Device type was the most significant predictor of variance in FMA score. Involvement of an ATP had a significant effect on the type of device that participants used (χ220=1739.18, P<.001; odds ratio, 0.589; 95% confidence interval, 0.49-0.708). If an ATP was involved, there were significantly higher proportions (all P<.05) of individuals using custom-fitted manual wheelchair and high-end groups 3 and 4 power wheelchairs prescribed compared with when no ATP was involved or when involvement was uncertain. CONCLUSIONS The relationship between ATP involvement and functional outcome supports the concept that ATP certification recognizes demonstrated competence in analyzing the needs of consumers with disabilities and selection of appropriate mobility assistive equipment with improved functional outcomes.
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Affiliation(s)
- Richard M Schein
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Anthony Yang
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Gina P McKernan
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Matthew Mesoros
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Gede Pramana
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Mark R Schmeler
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA.
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18
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Worobey LA, Heinemann AW, Anderson KD, Fyffe D, Dyson-Hudson TA, Berner T, Boninger ML. Factors Influencing Incidence of Wheelchair Repairs and Consequences Among Individuals with Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:779-789. [PMID: 33845000 DOI: 10.1016/j.apmr.2021.01.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the frequency and consequences of wheelchair repairs, looking at the relationship to usage, components, out-of-pocket costs, number of days affecting the user, and factors associated with the need for repairs or consequences. DESIGN Survey, cross-sectional. SETTING Nine spinal cord injury (SCI) Model Systems centers. PARTICIPANTS Wheelchair users with SCI (N=533). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Cost and incidence of wheelchair repairs and consequences and wheelchair usage within the past 6 months. RESULTS A total of 310 participants (56%) reported repairs, 127 (42%) of whom experienced at least 1 adverse consequence lasting a median of 5 days (interquartile range [IQR], 2-17.3 days). Repair rates were highest for the seating system, electronics, and tires. Participants were most often stranded at home or forced to use a backup chair. Median out-of-pocket costs were $150 (IQR, $50-$620). Active users, based on type of mobility and terrain, experienced more repairs and consequences than less active users. Repairs were more common among those who were Black (odds ratio [OR], 2.42) or power wheelchair (PWC) users (OR, 1.84), whereas consequences were more common among those who were Black (OR, 2.27), PWC (OR, 2.08) or power assist users (OR, 2.76), and those who had public insurance (OR, 1.70). CONCLUSIONS Wheelchair repairs continue to affect more than 50% of wheelchair users with significant financial and personal cost. High repair rates limited participation inside and outside of the home. Consequences lasted longer than 2 weeks for many and may be minimized by a working backup chair. Disparities exist based on participant and wheelchair factors; repairs and adverse consequences appear to hit those most vulnerable with the least financial resources. Costs may be a barrier to repair completion for some individuals. This ongoing problem of high repair rates and their associated effects requires action such as higher standards, access to quicker service, and better training of users on wheelchair maintenance and repair.
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Affiliation(s)
- Lynn A Worobey
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA.
| | | | | | | | | | - Theresa Berner
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA
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19
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Understanding the Global Challenges to Accessing Appropriate Wheelchairs: Position Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073338. [PMID: 33804868 PMCID: PMC8036353 DOI: 10.3390/ijerph18073338] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022]
Abstract
Introduction: Appropriate wheelchairs are often essential for the health and wellbeing of people with mobility impairments to enhance fundamental freedoms and equal opportunity. To date, provision has mainly focused on just delivering the wheelchair instead of following an evidence-based wheelchair service delivery process. In addition, many governments have not committed to a national wheelchair provision policy. Approach: To prepare this position paper, a systemic development model, founded on the sustainable human security paradigm, was employed to explore the global challenges to accessing appropriate wheelchairs. Positions: I: Consideration of key perspectives of wheelchair provision across the life course is essential to meet the needs to children, adults, older people and their families; II: Comprehensive wheelchair service delivery processes and a competent workforce are essential to ensure appropriate wheelchair service provision; III: Evaluations on wheelchair product quality development, performance and procurement standards are key as wheelchair product quality is generally poor; IV: Understanding the economic landscape when providing wheelchairs is critical. Wheelchair funding systems vary across jurisdictions; V: Establishing wheelchair provision policy is a key priority, as specific policy is limited globally. Conclusion: The vision is to take positive action to develop appropriate and sustainable wheelchair service provision systems globally, for me, for you, for us.
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20
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James AM, Pramana G, Mhatre A, Brienza D, Pearlman J, Karg P, Schmeler MR. Development of a Wheelchair Repair Registry. Arch Phys Med Rehabil 2021; 102:1416-1419. [PMID: 33731269 DOI: 10.1016/j.apmr.2021.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the development of a wheelchair repair registry from large datasets to attain an understanding of wheelchair failures and service repairs. DESIGN Guidelines for registry development were applied and anchored around Labor-Tracker, a web-based information management system for wheelchair suppliers to manage and track wheelchair repairs. The registry was designed using online analytical processing, allowing for rapid data queries from multiple dimensions that enable complex data analysis and discovery. SETTING The Wheelchair Repair Registry (WRR) was developed through an industry and academic collaboration whereby repair data were collected in the field, entered into the Labor-Tracker system, deidentified, and then transferred to the registry and made available for analyses. PARTICIPANTS Wheelchair supplier service technicians reported data from repair services provided to individuals who use power wheelchairs, manual wheelchairs, and scooters. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Wheelchair failure and repair data, including variables related to scheduling, equipment information (eg, manufacturer, model, serial number, purchase date), labor, parts, and reasons for repairs. RESULTS The WRR was developed to analyze wheelchair repairs and failures from the Labor-Tracker system. Currently, the registry has more than 60,000 repairs conducted on more than 5000 wheelchair devices from 25 manufacturers. The devices include 60% power wheelchairs, 35% manual wheelchairs, and 5% scooters. CONCLUSIONS The WWR creates opportunities to apply large-data analytical methodologies that will serve to inform quality standards, practice, equipment selection, preventative maintenance routines, product design, and policy.
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Affiliation(s)
- Alexandria M James
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Gede Pramana
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - David Brienza
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Patricia Karg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Mark R Schmeler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
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21
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Henderson GV, Boninger ML, Dicianno BE, Worobey LA. Type and frequency of wheelchair repairs and resulting adverse consequences among veteran wheelchair users. Disabil Rehabil Assist Technol 2020; 17:331-337. [DOI: 10.1080/17483107.2020.1785559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Geoffrey V. Henderson
- Department of Bioengineering, Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael L. Boninger
- Department of Bioengineering, Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, Department of Veterans Affairs, Pittsburgh, PA, USA
| | - Brad E. Dicianno
- Department of Bioengineering, Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, Department of Veterans Affairs, Pittsburgh, PA, USA
| | - Lynn A. Worobey
- Department of Bioengineering, Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, Department of Veterans Affairs, Pittsburgh, PA, USA
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22
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Gebrosky B, Bridge A, O'Donnell S, Grindle GG, Cooper R, Cooper RA. Comparing the performance of ultralight folding manual wheelchairs using standardized tests. Disabil Rehabil Assist Technol 2020; 17:40-49. [PMID: 32338550 DOI: 10.1080/17483107.2020.1754928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To evaluate ultralight folding manual wheelchairs (UFMWs) in order to produce comparative data on their strength, durability, stability and cost-benefit, and to determine progress of wheelchairs by comparing these results to results of past studies.Design: Engineering testing using American National Standards Institute (ANSI) and Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) standards.Setting: Laboratory testing of UFMW stability, and static, impact and fatigue strength performance with three devices using ANSI/RESNA standardized tests.Participants: The three wheelchair models were the TiLite Aero X (Permobil, Lebanon, TN), Sunrise Medical Quickie 2 (Fresno, CA) and Ki Mobility Catalyst 5 (Stevens Point, WI).Interventions: ANSI/RESNA standardized tests.Main outcome measures: Mass and critical measurements, static stability, static strength, impact strength, fatigue strength and cost analysis.Results: The ultralight folding wheelchairs continued to outperform their lightweight and rigid framed counterparts. According to these data, the quality of ultralight wheelchairs has not declined over the past 10 years. The Ki Catalyst did not pass strength and durability testing, while the TiLite Aero X and Sunrise Medical Quickie 2 surpassed these tests.Conclusions: This result exemplifies the need for ongoing research to identify whether wheelchairs satisfy ANSI/RESNA testing requirements and highlights the importance of creating a resource data set. This is particularly important when numerous other wheelchairs fail to meet minimum ANSI/RESNA requirements.Implications for RehabilitationFolding frame wheelchairs offer benefits such as transportability and convenience that may benefit certain wheelchair users, assuming their durability is sufficient and they provide similar benefits vs. other wheelchair construction.Previous studies have shown that folding wheelchairs perform meet the minimum requirements of standardized testing, and it is important to see if durability has increased, decreased or remained the same over the years. Other wheelchair types have remained stagnant with respect to durability and are less likely to meet the minimum durability requirements.Durable devices will improve a wheelchair user's quality of life by reducing downtime while waiting for repairs, and also reduce the likelihood of injury due to component failure.
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Affiliation(s)
- Benjamin Gebrosky
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ann Bridge
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn O'Donnell
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Garrettt G Grindle
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rosemarie Cooper
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Assistive Technology, UPMC Health System, Pittsburgh, PA, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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23
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Eshraghi M, Sawatzky B, Mortenson WB. Feasibility of a peer-led, manual wheelchair maintenance skills training programme to improve wheelchair efficiency, and knowledge and confidence about wheelchair maintenance: a pre-post study. Disabil Rehabil Assist Technol 2020; 16:918-926. [PMID: 32275453 DOI: 10.1080/17483107.2020.1749897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Wheelchair users typically receive little training about wheelchair maintenance. Therefore, we developed a peer-led, manual wheelchair skills maintenance training programme, with the intention of evaluating its efficacy in a future experimental study. PURPOSE The purpose of this feasibility study was to examine how well we were able to implement the training programme and to evaluate the feasibility of conducting a larger scale clinical trial. SETTING Spinal cord injury research centre. PARTICIPANTS Five mentors and fifteen mentees were recruited to complete this feasibility study. METHOD We collected information about recruitment capability and sample characteristics, data collection procedure, acceptability of the training programme, resources required, and participants' responses to the intervention. Participants completed all the items and we had little missing data. Participants did not face any difficulty answering the questionnaires or performing the tests. Therefore, we could conclude data collection was feasible moving forward to perform larger efficacy trials. The acceptability of the wheelchair maintenance programme was more than 90%. There was a statistically significant improvement in wheelchair maintenance knowledge test and total rolling resistance. Confidence of mentees increased significantly after the training. Improvements in the 3-cone test and the 6-min push test results were not significant. CONCLUSIONS If recruitment and scheduling challenges can be overcome, our data suggested that it is feasible to conduct a larger experimental study to test the efficacy of the programme.Implications for RehabilitationWheelchair maintenance skills are important to help wheelchair users keep their wheelchairs working safely and efficiently.The findings from this study suggest that a peer-led wheelchair maintenance training programme may improve participants' wheelchair maintenance knowledge and maintenance self-confidence.The study also suggests that a peer-led wheelchair maintenance training programme may decrease the rolling resistance of participants' wheelchairs.A larger clinical trial is needed to demonstrate the efficacy of this intervention authoritatively.
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Affiliation(s)
- Mehdi Eshraghi
- International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - Bonita Sawatzky
- International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - W Ben Mortenson
- International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
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Mhatre A, Reese N, Pearlman J. Design and evaluation of a laboratory-based wheelchair castor testing protocol using community data. PLoS One 2020; 15:e0226621. [PMID: 31923276 PMCID: PMC6953824 DOI: 10.1371/journal.pone.0226621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/29/2019] [Indexed: 11/19/2022] Open
Abstract
Wheelchair castors fail frequently causing physical, social and economic consequences for wheelchair users. These failures occur in spite of established wheelchair test methods and regulations, suggesting that the existing tests may not be sufficient to screen poorly designed castors. An expert stakeholder group, convened by the International Society of Wheelchair Professionals (ISWP), noted castor failures as a high priority and recommended that a new castor testing system should be developed. In a previous study, the effect of shock exposure on castor durability was studied. The current paper extends the previous work and focuses on the development of a castor testing protocol based on shock, corrosion and abrasion exposure data collected in the community. The testing protocol was applied to 8 different castor models tested under four conditions: shock, corrosion + shock, abrasion + shock and abrasion + corrosion + shock. For each model, a total of n = 8 samples were evaluated across the four conditions. Results demonstrate that corrosion and abrasion reduced castor durability between 13% to 100% depending on the model. Importantly, the inclusion of corrosion and abrasion resulted in changes in the failure modes for 75% of the tested models and two-thirds of the altered failure modes are associated with increased risk of injury for wheelchair users. These results suggest that corrosion and abrasion present in the community reduce castor durability, thus supporting their inclusion in the castor testing protocol and potentially other wheelchair standards.
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Affiliation(s)
- Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
| | - Norman Reese
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- Engineering & Engineering Technology, LeTourneau University, Longview, Texas, United States of America
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
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25
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Dicianno BE, Joseph J, Eckstein S, Zigler CK, Quinby E, Schmeler MR, Schein RM, Pearlman J, Cooper RA. The Voice of the Consumer: A Survey of Veterans and Other Users of Assistive Technology. Mil Med 2019; 183:e518-e525. [PMID: 29635318 DOI: 10.1093/milmed/usy033] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The need for advancements in mobility-assistive technologies is continually growing due to advances in medicine and rehabilitation that preserve and prolong the lives of people with disabilities, increases in the senior population, and increases in the number of veterans and civilians involved in conflict situations. The purpose of this study is to survey a large sample of veterans and other consumers with disabilities who use mobility-assistive technologies to identify priorities for future research and development. Materials and Methods This survey asked participants to provide opinions on the importance of developing various mobility-assistive technologies and to rank the importance of certain technologies. Participants were also asked to provide open-ended comments and suggestions. Results A total of 1,022 individuals, including 500 veterans, from 49 states within the USA and Puerto Rico completed the survey. The average age of respondents was 54.3 yr, and they represented both new and experienced users of mobility-assistive technologies. The largest diagnostic group was spinal cord injury (SCI) (N = 491, 48.0%). Several themes on critical areas of research emerged from the open-ended questions, which generated a total of 1,199 comments. Conclusion This survey revealed several themes for future research and development. Advanced wheelchair design, smart device applications, human-machine interfaces, and assistive robotics and intelligent systems emerged as priorities. Survey results also demonstrated the importance for researchers to understand the effects of policy and cost on translational research and to be involved in educating both consumers and providers.
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Affiliation(s)
- Brad E Dicianno
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - James Joseph
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Stacy Eckstein
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Christina K Zigler
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Eleanor Quinby
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mark R Schmeler
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Richard M Schein
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Jon Pearlman
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Rory A Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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26
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Múnera S, Pearlman J, Toro M, Worobey L, Boninger M, Cooper RA. Development and efficacy of an online wheelchair maintenance training program for wheelchair personnel. Assist Technol 2019; 33:49-55. [PMID: 31169455 DOI: 10.1080/10400435.2019.1619632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To develop an online version of the wheelchair maintenance training program (WMTP) and compare learning outcomes from the in-person and online programs using the wheelchair maintenance training questionnaire (WMT-Q), administered before and after the intervention. DESIGN Iterative development of an online version of the WMTP and implementation. SETTING Online. PARTICIPANTS 26 graduate and undergraduate students. INTERVENTION Web-based training. These results are compared with those from another study of the in-person WMTP with 10 participants. MAIN OUTCOME MEASURES Feedback survey and WMT-Q. RESULTS The training program was well-received and valued by all 26 participants. A significant increase in all scores after the online training program was found, based on pre-/post-intervention scores. In manual wheelchair open-ended questions, knowledge increased from 16% to 21%, p < .05; in power wheelchair open-ended questions, from 9% to 31%, p < .05; in multiple-choice questions related to knowledge, from 27% to 59%, p < .05; confidence increased from 8% to 80%, p < .05; and capacity from 12% to 88%, p < .05. There was no statistical difference in WMT-Q scores between individuals who participated in the in-person and online programs. CONCLUSION This study indicates that there was a similar-increased knowledge for participants, indicating that web-based training may be a viable approach for delivering maintenance training.
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Affiliation(s)
- Sara Múnera
- El Comité de Rehabilitación , Medellín, Colombia
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Maria Toro
- School of Physical Therapy, Universidad CES , Medellín, Colombia
| | - Lynn Worobey
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Michael Boninger
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System , Pittsburgh, Pennsylvania, USA
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27
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Gebrosky B, Grindle G, Cooper R, Cooper R. Comparison of carbon fibre and aluminium materials in the construction of ultralight wheelchairs. Disabil Rehabil Assist Technol 2019; 15:432-441. [PMID: 30907192 DOI: 10.1080/17483107.2019.1587018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Carbon fibre-reinforced polymers have been used in the sporting goods industry for decades, and wheelchairs have incorporated the material since the late 1980s. There is no independently collected data available on carbon fibre-reinforced polymer wheelchairs' performance on the ANSI/RESNA testing standards, however. This study evaluated three full carbon fibre wheelchair specimens to determine their performance versus similar wheelchairs. Testing determined that while the frames survived more testing cycles than any other wheelchair, the casters and rear tires failed similarly to other devices. Overall, due to the purchase cost, the cost benefit of the tested wheelchair model was similar to aluminium wheelchairs.Implications for rehabilitationCarbon fibre wheelchair construction is a viable alternative to aluminium, titanium, or steel construction, and decreasing costs will continue to improve the benefits of carbon fibre over these modelsCarbon fibre wheelchair found to be more durable than aluminium models, but are also much more expensive. The additional cost may be justified for some users that need the increased durability, howeverIncreased durability will reduce the number of repairs and warranty claims, potentially reducing the burden on a wheelchair user, and also improving their ability to travel and participate in their communityThe low weight of carbon fibre wheelchairs may increase the mobility of some users by allowing them to transfer more easily into and out of vehicles and manoeuvre throughout the environment.
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Affiliation(s)
- Benjamin Gebrosky
- VA Pittsburgh Healthcare System, Human Engineering Research Laboratories, Pittsburgh, PA, USA
| | - Garrett Grindle
- VA Pittsburgh Healthcare System, Human Engineering Research Laboratories, Pittsburgh, PA, USA.,Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rosemarie Cooper
- Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rory Cooper
- VA Pittsburgh Healthcare System, Human Engineering Research Laboratories, Pittsburgh, PA, USA.,Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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28
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Mhatre AA, Lachell S, Pearlman JL. Development, reliability, and piloting of a wheelchair caster failure inspection tool (C-FIT). Disabil Rehabil Assist Technol 2019; 15:195-204. [PMID: 30729825 DOI: 10.1080/17483107.2018.1554714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Wheelchair casters fail frequently in the field causing multiple user consequences and wheelchair breakdowns. To inform caster design improvement, there exists no validated tools that can collect caster failures. This need motivated the development of a user-reported, caster failure inspection tool (C-FIT).Methods: To develop C-FIT, a multistep design and testing approach was used which included face validity testing, test-retest reliability testing and expert review. Reliability testing was conducted with two independent cohorts of wheelchair professionals who inspected caster failures physically and online through pictures. The tool was revised based on testing outcomes and expert feedback. For preliminary data collection and evaluating usability, C-FIT was piloted at wheelchair service centers in Scotland, Indonesia and Mexico.Results: Caster failure items reported in the literature were screened to develop the initial list of C-FIT items. Face validity testing conducted through surveys with wheelchair experts (n = 6) provided 14 items for C-FIT inclusion. The test-retest reliability was found to be high for 10 items with physical failure inspections (n = 12). For each of these items, 75% or more participants had substantial to almost perfect agreement scores (κ = 0.6-1.0). Lower reliability scores were found with online failure inspections (n = 11). C-FIT received positive usability feedback from study participants and data collectors in the field. Pilot field data (n = 31) included comprehensive details about failures useful for manufacturers, designers and researchers to improve caster designs.Conclusions: The C-FIT tool developed in this study has substantial reliability and can be used for documenting caster failures at wheelchair service centers.Implications for rehabilitationCollecting data on caster failures is an important first step to inform design improvements and caster quality testing methods.The caster failure inspection tool is a reliable tool that can be used during wheelchair repair and servicing to collect caster failures in a standardized way.The failure data can be used by wheelchair manufacturers, designers, technicians and researchers to develop reliable caster designs. Wheelchair providers can select caster designs based on context of use.
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Affiliation(s)
- Anand A Mhatre
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephanie Lachell
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan L Pearlman
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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29
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Hogaboom NS, Worobey LA, Houlihan BV, Heinemann AW, Boninger ML. Wheelchair Breakdowns Are Associated With Pain, Pressure Injuries, Rehospitalization, and Self-Perceived Health in Full-Time Wheelchair Users With Spinal Cord Injury. Arch Phys Med Rehabil 2018; 99:1949-1956. [PMID: 29698640 DOI: 10.1016/j.apmr.2018.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/28/2018] [Accepted: 04/07/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the relation between wheelchair breakdowns, their immediate consequences, and secondary health complications after spinal cord injury. "Immediate consequences" occur when part of a wheelchair breaks and leaves an individual stranded or injured, or causes him or her to miss medical appointments, work, or school. DESIGN Survey, cross-sectional. SETTING Spinal Cord Injury Model Systems Centers. PARTICIPANTS Full-time wheelchair users (N=771) with SCI from 9 Spinal Cord Injury Model Systems Centers, with data collected between 2011 and 2016. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Incidence of self-reported wheelchair breakdowns within the past 6 months that did or did not result in immediate consequences (ie, injury, being stranded, missing a medical appointment, or an inability to attend school/work); self-perceived health status scale; pain severity numerical rating scale; rehospitalizations; and self-reported pressure injury development within the past 12 months. RESULTS A total of 610 participants with complete data sets were included in the analyses. When compared to those who reported no breakdowns, participants who reported 1 or more immediate consequences had worse secondary complications: higher self-perceived health status and pain scores (partial -η2=.009-.012, P<.05), and higher odds of rehospitalization (odds ratio: 1.86, P<.05) and pressure injury development (odds ratio: 1.73, P<.05). Secondary health complications were not different in those who reported no immediate consequences compared to those who reported no breakdown. CONCLUSIONS Wheelchair breakdowns that resulted in injury, being stranded, missing medical appointments, and/or an inability to attend work/school appear to have far-reaching impacts on health and secondary injury. Preventing wheelchair breakdowns, through either better maintenance or manufacturing, may be a means of decreasing secondary disability.
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Affiliation(s)
- Nathan S Hogaboom
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lynn A Worobey
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Bethlyn V Houlihan
- Spaulding New England Regional SCI Center, Boston, Massachusetts; The Health and Disability Research Institute, Department of Health Policy and Management School of Public Health, Boston University, Boston, Massachusetts
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
| | - Michael L Boninger
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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30
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Dicianno BE, Joseph J, Eckstein S, Zigler CK, Quinby EJ, Schmeler MR, Schein RM, Pearlman J, Cooper RA. The future of the provision process for mobility assistive technology: a survey of providers. Disabil Rehabil Assist Technol 2018; 14:338-345. [PMID: 29557196 DOI: 10.1080/17483107.2018.1448470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the opinions of providers of mobility assistive technologies to help inform a research agenda and set priorities. MATERIALS AND METHODS This survey study was anonymous and gathered opinions of individuals who participate in the process to provide wheelchairs and other assistive technologies to clients. Participants were asked to rank the importance of developing various technologies and rank items against each other in terms of order of importance. Participants were also asked to respond to several open-ended questions or statements. RESULTS A total of 161 providers from 35 states within the USA consented to participation and completed the survey. CONCLUSIONS This survey revealed themes of advanced wheelchair design, assistive robotics and intelligent systems, human machine interfaces and smart device applications. It also outlined priorities for researchers to provide continuing education to clients and providers. These themes will be used to develop research and development priorities. Implications for Rehabilitation • Research in advanced wheelchair design is needed to facilitate travel and environmental access with wheelchairs and to develop alternative power sources for wheelchairs.• New assistive robotics and intelligent systems are needed to help wheelchairs overcome obstacles or self-adjust, assist wheelchair navigation in the community, assist caregivers and transfers, and aid ambulation.• Innovations in human machine interfaces may help advance the control of mobility devices and robots with the brain, eye movements, facial gesture recognition or other systems.• Development of new smart devices is needed for better control of the environment, monitoring activity and promoting healthy behaviours.
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Affiliation(s)
- Brad E Dicianno
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,b Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,c Department of Rehabilitation Science and Technology , University of Pittsburgh School of Health and Rehabilitation Sciences , Pittsburgh , PA , USA
| | - James Joseph
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA
| | - Stacy Eckstein
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA
| | - Christina K Zigler
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,b Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Eleanor J Quinby
- b Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Mark R Schmeler
- c Department of Rehabilitation Science and Technology , University of Pittsburgh School of Health and Rehabilitation Sciences , Pittsburgh , PA , USA
| | - Richard M Schein
- c Department of Rehabilitation Science and Technology , University of Pittsburgh School of Health and Rehabilitation Sciences , Pittsburgh , PA , USA
| | - Jon Pearlman
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,c Department of Rehabilitation Science and Technology , University of Pittsburgh School of Health and Rehabilitation Sciences , Pittsburgh , PA , USA
| | - Rory A Cooper
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,b Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,c Department of Rehabilitation Science and Technology , University of Pittsburgh School of Health and Rehabilitation Sciences , Pittsburgh , PA , USA
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31
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Gebrosky B, Pearlman J, Cooper R. Comparison of High-Strength Aluminum Ultralight Wheelchairs Using ANSI/RESNA Testing Standards. Top Spinal Cord Inj Rehabil 2017; 24:63-77. [PMID: 29434462 DOI: 10.1310/sci16-00057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: The use of ultralight manual wheelchairs has been shown to benefit wheelchair users when compared to other types. New aluminum alloy frame materials coming to the market have not been independently evaluated for durability and cost benefit. Methods: Three 70XX aluminum ultralight wheelchair models were tested and compared based on dimensions, stability, and durability using the ANSI/RESNA standards. The results were also compared to previous manual wheelchair studies. Results: This study found that there were no significant cost benefit or durability differences between the wheelchairs tested and previous aluminum or titanium ultralight rigid models. Additionally, 5 of the 9 wheelchairs tested failed to meet the minimum ANSI/RESNA requirements for durability. Conclusion: These results are similar to results from previous rigid ultralight wheelchair studies and indicate that the quality of wheelchairs of this type has not improved and better requirements are necessary for wheelchairs marketed in the United States.
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Affiliation(s)
- Benjamin Gebrosky
- Human Engineering Research Laboratories, Department of Veterans Affairs, Rehabilitation Research and Development Service, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Jonathan Pearlman
- Human Engineering Research Laboratories, Department of Veterans Affairs, Rehabilitation Research and Development Service, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rory Cooper
- Human Engineering Research Laboratories, Department of Veterans Affairs, Rehabilitation Research and Development Service, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
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32
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Bazant ES, Himelfarb Hurwitz EJ, Onguti BN, Williams EK, Noon JH, Xavier CA, Garcia FDS, Gichangi A, Gabbow M, Musakhi P, Lee Kirby R. Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines. Afr J Disabil 2017; 6:318. [PMID: 29134178 PMCID: PMC5675920 DOI: 10.4102/ajod.v6i0.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/03/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The World Health Organisation recommends that services accompany wheelchair distribution. This study examined the relationship of wheelchair service provision in Kenya and the Philippines and wheelchair-use-related outcomes. METHOD We surveyed 852 adult basic manual wheelchair users. Participants who had received services and those who had not were sought in equal numbers from wheelchair-distribution entities. Outcomes assessed were daily wheelchair use, falls, unassisted outdoor use and performance of activities of daily living (ADL). Descriptive, bivariate and multivariable regression model results are presented. RESULTS Conditions that led to the need for a basic wheelchair were mainly spinal cord injury, polio/post-polio, and congenital conditions. Most Kenyans reported high daily wheelchair use (60%) and ADL performance (80%), while these practices were less frequent in the Philippine sample (42% and 74%, respectively). Having the wheelchair fit assessed while the user propelled the wheelchair was associated with greater odds of high ADL performance in Kenya (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1) and the Philippines (OR 2.8, 95% CI 1.8, 4.5). Wheelchair-related training was associated with high ADL performance in Kenya (OR 3.2, 95% CI 1.3, 8.4). In the Philippines, training was associated with greater odds of high versus no daily wheelchair use but also odds of serious versus no falls (OR 2.5, 95% CI 1.4, 4.5). CONCLUSION Select services that were associated with some better wheelchair use outcomes and should be emphasised in service delivery. Service providers should be aware that increased mobility may lead to serious falls.
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Affiliation(s)
| | | | | | | | | | | | - Ferdiliza D S Garcia
- College of Allied Medical Professions, University of the Philippines, Manila, Philippines
| | | | - Mohammed Gabbow
- National Council for Persons With Disabilities, Government of Kenya, Kenya
| | - Peter Musakhi
- Ministry of East African Community (EAC), Labour and Social Protection, Government of Kenya, Kenya
| | - R Lee Kirby
- Division of Physical Medicine & Rehabilitation, Dalhousie University, Canada
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Magasi S, Wong A, Miskovic A, Tulsky D, Heinemann AW. Mobility Device Quality Affects Participation Outcomes for People With Disabilities: A Structural Equation Modeling Analysis. Arch Phys Med Rehabil 2017; 99:1-8. [PMID: 28784356 DOI: 10.1016/j.apmr.2017.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/16/2017] [Accepted: 06/30/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To test the effect that indicators of mobility device quality have on participation outcomes in community-dwelling adults with spinal cord injury, traumatic brain injury, and stroke by using structural equation modeling. DESIGN Survey, cross-sectional study, and model testing. SETTING Clinical research space at 2 academic medical centers and 1 free-standing rehabilitation hospital. PARTICIPANTS Community-dwelling adults (N=250; mean age, 48±14.3y) with spinal cord injury, traumatic brain injury, and stroke. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES The Mobility Device Impact Scale, Patient-Reported Outcomes Measurement Information System Social Function (version 2.0) scale, including Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities, and the 2 Community Participation Indicators' enfranchisement scales. Details about device quality (reparability, reliability, ease of maintenance) and device type were also collected. RESULTS Respondents used ambulation aids (30%), manual (34%), and power wheelchairs (30%). Indicators of device quality had a moderating effect on participation outcomes, with 3 device quality variables (repairability, ease of maintenance, device reliability) accounting for 20% of the variance in participation. Wheelchair users reported lower participation enfranchisement than did ambulation aid users. CONCLUSIONS Mobility device quality plays an important role in participation outcomes. It is critical that people have access to mobility devices and that these devices be reliable.
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Affiliation(s)
- Susan Magasi
- Departments of Occupational Therapist and Disability Studies, University of Illinois at Chicago, Chicago, IL.
| | - Alex Wong
- Departments of Occupational Therapy and Neurology, School of Medicine, Washington University, St. Louis, MO
| | | | - David Tulsky
- Departments of Physical Therapy and Psychological and Brain Sciences, Center on Assessment Research and Translation, University of Delaware, Newark, DE
| | - Allen W Heinemann
- Shirley Ryan Ability Lab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Shirley Ryan Ability Lab, Center for Rehabilitation Outcomes Research, Northwestern University, Chicago, IL
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Rispin K, Riseling K, Wee J. A longitudinal study assessing the maintenance condition of cadres of four types of wheelchairs provided in low-resource areas. Disabil Rehabil Assist Technol 2017; 13:146-156. [PMID: 28326868 DOI: 10.1080/17483107.2017.1299805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Wheelchair breakdowns increase the risk of injury and limit the mobility of wheelchair users. In the endeavour to meet the enormous global need for wheelchairs, manufacturers of wheelchairs for low-resource settings face a cost-benefit tension between affordability and durability. Field studies are needed to provide feedback on durability. Four manufacturers provided cadres of wheelchairs to the organization providing rehabilitation to students at a boarding school for children with disabilities in a low-resource area. The Wheelchair Components Questionnaire for Condition was used to evaluate wheelchair maintenance condition at several time intervals after fitting. Because the maintenance regime was not identical for the four wheelchair types, wheelchair types were not compared. Analysis of variance indicated differences in condition across time and between wheelchair components. Tukey's simultaneous comparison of means indicated that across the entire group, brakes, seats, casters and foot rests received lower ratings than frame. Preliminary data after each iteration of this study were provided to manufactures and resulted in responsive design changes. Implications for Rehabilitation Longitudinal studies with the Wheelchair Components Questionnaire for Condition (WCQc) have enabled manufacturers to make responsive design improvements. Additional studies could be done with other wheelchair types to result in responsive positive design changes for those wheelchairs as well. The WCQc can be used in studies on wheelchair condition even when records of repair history are not reliably available, a situation which is not uncommon in low-resource areas. Data sets collected at an individual clinic uses the WCQc could focus attention on wheelchair components needing regular repair. With that data in mind, the maintenance regime could be modified to respond and in so doing improve wheelchair condition and reduce loss of mobility or risk of injury. Organizations involved in funding wheelchairs for a particular location could use data from longitudinal studies done with the WCQc at that location to inform purchasing decisions.
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Affiliation(s)
- Karen Rispin
- a Department of Biology and Kinesiology , LeTourneau University , Longview , TX , USA
| | - Kristofer Riseling
- b School of Rehabilitation Therapy, Queens University , Kingston , ON , Canada
| | - Joy Wee
- b School of Rehabilitation Therapy, Queens University , Kingston , ON , Canada
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35
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Friesen EL, Theodoros D, Russell TG. Usability of mobile shower commodes for adults with spinal cord injury. Br J Occup Ther 2017. [DOI: 10.1177/0308022616676817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction This paper describes the usability of mobile shower commodes for adults with spinal cord injury, as measured by the new electronic Mobile Shower Commode Assessment Tool Version 1.0 (eMAST 1.0). Method A retrospective analysis of data collected for a cross-sectional validation study with adults aged 18 years or older, living with spinal cord injury, who use mobile shower commodes for toileting and/or showering ( n = 32), was conducted. Usability was measured using the eMAST 1.0. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results Overall usability on both the features and performance subscales was rated as high to very high. Ratings of very low to low usability were reported for portability/foldability/packability (41%, n = 13), mobile shower commode stability (25%, n = 8), positioning and repositioning (25%, n = 8), seat cushioning (25%, n = 8), and lower leg supports (22%, n = 7). Items receiving the highest number of qualitative comments included lower leg supports, seating, propelling and manoeuvring, cleaning and maintenance, and stability. Conclusion Results across the eMAST 1.0’s subscales showed high to very high usability. However, analysis of individual items and qualitative comments showed specific areas of reduced usability for individual users. Item-level responses and qualitative comments suggest research is urgently needed in the areas of stability, portability, durability, and seating. Studies exploring use of the eMAST 1.0 during initial provision, and after short- and long-term mobile shower commode use, are also needed.
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Affiliation(s)
- Emma L Friesen
- PhD Candidate, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Deborah Theodoros
- Professor of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Trevor G Russell
- Professor of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
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Toro ML, Bird E, Oyster M, Worobey L, Lain M, Bucior S, Cooper RA, Pearlman J. Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users. Disabil Rehabil Assist Technol 2017; 12:843-851. [PMID: 28129705 DOI: 10.1080/17483107.2016.1277792] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose of state: The aims of this study were to develop a Wheelchair Maintenance Training Programme (WMTP) as a tool for clinicians to teach wheelchair users (and caregivers when applicable) in a group setting to perform basic maintenance at home in the USA and to develop a Wheelchair Maintenance Training Questionnaire (WMT-Q) to evaluate wheelchair maintenance knowledge in clinicians, manual and power wheelchair users. METHODS The WMTP and WMT-Q were developed through an iterative process. RESULTS A convenience sample of clinicians (n = 17), manual wheelchair (n ∞ 5), power wheelchair users (n = 4) and caregivers (n = 4) provided feedback on the training programme. A convenience sample of clinicians (n = 38), manual wheelchair (n = 25), and power wheelchair users (n = 30) answered the WMT-Q throughout different phases of development. The subscores of the WMT-Q achieved a reliability that ranged between ICC(3,1) = 0.48 to ICC(3,1) = 0.89. The WMTP and WMT-Q were implemented with 15 clinicians who received in-person training in the USA using the materials developed and showed a significant increase in all except one of the WMT-Q subscores after the WMTP (p < 0.007). CONCLUSION The WMTP will continue to be revised as it is further implemented. The WMT-Q is an acceptable instrument to measure pre- and post-training maintenance knowledge. Implications for Rehabilitation The Wheelchair Maintenance Training Program can be used to educate rehabilitation clinicians and technicians to improve wheelchair service and delivery to end users. This training complements the World Health Organization basic wheelchair service curriculum, which only includes training of the clinicians, but does not include detailed information to train wheelchair users and caregivers. This training program offers a time efficient method for providing education to end users in a group setting that may mitigate adverse consequences resulting from wheelchair breakdown. This training program has significant potential for impact among wheelchair users in areas where access to repair services is limited.
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Affiliation(s)
- Maria Luisa Toro
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,b Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Emily Bird
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,c Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA
| | - Michelle Oyster
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,c Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA
| | - Lynn Worobey
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,c Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA
| | - Michael Lain
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,c Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA
| | - Samuel Bucior
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA
| | - Rory A Cooper
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,b Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Jonathan Pearlman
- a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.,b Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA
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Rispin K, Dittmer M, McLean J, Wee J. Preliminary reliability and internal consistency of the Wheelchair Components Questionnaire for Condition. Disabil Rehabil Assist Technol 2017; 12:852-856. [PMID: 28100094 DOI: 10.1080/17483107.2016.1277793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Wheelchair durability and maintenance condition are key factors of wheelchair function. Durability studies done with double drum and drop testers, although valuable, do not perfectly imitate conditions of use. Durability may be harvested from clinical records; however, these may be inconsistent because protocols for recording information differ from place to place. Wheelchair professionals with several years of experience often develop a good eye for wheelchair maintenance condition. The Wheelchair Components Questionnaire for Condition (WCQc) was developed as a professional report questionnaire to provide data specifically on the maintenance condition of a wheelchair. The goal of this study was to obtain preliminary test-retest reliability and internal consistency for the WCQc. Participants were a convenience sample of wheelchair professionals who self-reported more than two years' of wheelchair experience, and completed the WCQc on the same wheelchair twice. Results indicated preliminary reliability and internal consistency for domain related questions and the entire questionnaire. Implications for rehabilitation The WCQc, if administered routinely at regular intervals, can be used to monitor wheelchair condition and alert users and health professionals about the need for repair or replacement. The WCQc is not difficult to use, making early monitoring for wear or damage more feasible. The earlier a tool can detect need for maintenance, the higher likelihood that appropriate measures may be employed in a timely fashion to maximize the overall durability of wheelchairs and minimize clinical complications. Keeping wheelchairs appropriately maintained allows users to minimize effort expended when using them, and maximize their function. It also lowers the risk of injury due to component failure. When assessing groups of similar wheelchairs, organizations involved in funding wheelchairs can use data from the WCQc to make purchase decisions based on durability, and manufacturers can use WCQc data for responsive design change.
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Affiliation(s)
- Karen Rispin
- a Department of Biology and Kinesiology , LeTourneau University , Longview , TX , USA
| | - Melanie Dittmer
- a Department of Biology and Kinesiology , LeTourneau University , Longview , TX , USA
| | - Jessica McLean
- a Department of Biology and Kinesiology , LeTourneau University , Longview , TX , USA
| | - Joy Wee
- b Department of Rehabilitation and Therapy , Queens University , Kingston , ON , Canada
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Kirby RL, Mitchell D, Sabharwal S, McCranie M, Nelson AL. Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial. PLoS One 2016; 11:e0168330. [PMID: 28002472 PMCID: PMC5176312 DOI: 10.1371/journal.pone.0168330] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group. METHODS We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30-45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores. RESULTS Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021). CONCLUSIONS Individualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.
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Affiliation(s)
- R. Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
| | - Doug Mitchell
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, United States of America
| | - Sunil Sabharwal
- Veterans Administration Boston Health Care System and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark McCranie
- Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Audrey L. Nelson
- Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, College of Public Health, University of South Florida, Tampa, Florida, United States of America
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Interrater Reliability of the Power Mobility Road Test in the Virtual Reality–Based Simulator-2. Arch Phys Med Rehabil 2016; 97:1078-84. [DOI: 10.1016/j.apmr.2016.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 11/24/2022]
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Kamaraj DC, Dicianno BE, Mahajan HP, Buhari AM, Cooper RA. Stability and Workload of the Virtual Reality–Based Simulator-2. Arch Phys Med Rehabil 2016; 97:1085-1092.e1. [DOI: 10.1016/j.apmr.2016.01.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/04/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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Type and Frequency of Reported Wheelchair Repairs and Related Adverse Consequences Among People With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97:1753-60. [PMID: 27153763 DOI: 10.1016/j.apmr.2016.03.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/20/2016] [Accepted: 03/25/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the frequency and types of wheelchair repairs and associated adverse consequences. DESIGN Convenience cross-sectional sample survey. SETTING Nine Spinal Cord Injury Model Systems Centers. PARTICIPANTS People with spinal cord injury who use a wheelchair >40h/wk (N=591). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Number of repairs needed and resulting adverse consequences, number and types of repairs completed, and location where main repair was completed in the previous 6 months. RESULTS There were 591 participants responded to the survey, 63.8% (377/591) of them needed ≥1 repair; of these, 27.6% (104/377) experienced ≥1 adverse consequence, including 18.2% (69/377) individuals who were stranded. Of those who needed repairs, 6.9% did not have them completed (26/377). Repairs completed on the wheels and casters were the most frequent repair to manual wheelchairs, whereas repairs to the electrical and power and control systems were the most frequent type of repair on power wheelchairs. Forty percent (79/201) of manual wheelchair users reported completing repairs at home themselves compared with 14% (21/150) of power wheelchair users. Twelve percent of the variance in the odds of facing an adverse consequence because of a wheelchair breakdown can be described as a function of occupation, funding source, and type of wheelchair. CONCLUSIONS Wheelchair repairs are highly prevalent. There are differences in types of repairs and who completes the repairs based on the type of wheelchair. Wheelchair breakdowns result in adverse consequences for users, and there is a deficit between repairs needed and those completed, highlighting the need for interventions that address these problems.
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Toro ML, Eke C, Pearlman J. The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia. BMC Health Serv Res 2016; 16:26. [PMID: 26801984 PMCID: PMC4722611 DOI: 10.1186/s12913-016-1268-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/12/2016] [Indexed: 11/28/2022] Open
Abstract
Background For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization’s service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls. Methods This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only. Results 167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list (p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a “wheelie”. The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist (p = 0.019). Conclusions Wheelchair provision according to World Health Organization’s 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages.
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Affiliation(s)
- Maria L Toro
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Programa de Ingenieria Biomedica, Escuela de Ingeniería de Antioquia y Universidad CES, Envigado, Antioquia, Colombia
| | - Chika Eke
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jonathan Pearlman
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. .,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.
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Kirby RL, Miller WC, Routhier F, Demers L, Mihailidis A, Polgar JM, Rushton PW, Titus L, Smith C, McAllister M, Theriault C, Thompson K, Sawatzky B. Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial. Arch Phys Med Rehabil 2015; 96:2017-26.e3. [PMID: 26232684 PMCID: PMC4674291 DOI: 10.1016/j.apmr.2015.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation. DESIGN Randomized controlled trial. SETTING Rehabilitation centers and communities. PARTICIPANTS Powered wheelchair users (N=116). INTERVENTION Five 30-minute WSTP training sessions. MAIN OUTCOME MEASURES Assessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA). RESULTS There was no significant t2-t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3. CONCLUSIONS Powered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.
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Affiliation(s)
- R Lee Kirby
- Department of Medicine, Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia; Vancouver, British Columbia, Canada
| | - Francois Routhier
- Department of Rehabilitation, Laval University, Québec City, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City Rehabilitation Institute, Québec City, Quebec, Canada
| | - Louise Demers
- School of Rehabilitation, University of Montreal, Montréal, Quebec, Canada; Research Center, University of Montreal Institute of Geriatrics, Montréal, Quebec, Canada
| | - Alex Mihailidis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jan Miller Polgar
- School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Paula W Rushton
- School of Rehabilitation, University of Montreal, Montréal, Quebec, Canada; University Hospital Centre Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Laura Titus
- School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Cher Smith
- Department of Occupational Therapy, Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - Mike McAllister
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Theriault
- Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kara Thompson
- Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bonita Sawatzky
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Proportion of Wheelchair Users Who Receive Wheelchair Skills Training During an Admission to a Canadian Rehabilitation Center. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Akhigbe T, Chin AS, Svircev JN, Hoenig H, Burns SP, Weaver FM, Bailey L, Carbone L. A retrospective review of lower extremity fracture care in patients with spinal cord injury. J Spinal Cord Med 2015; 38:2-9. [PMID: 24621029 PMCID: PMC4293530 DOI: 10.1179/2045772313y.0000000156] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE To identify circumstances surrounding incident lower extremity fractures (ILEFs) in patients with spinal cord injury (SCI) and to describe the impact of these fractures on service needs and provision of pharmacological therapies for osteoporosis. DESIGN Retrospective medical record review. SETTING Four Veterans Affairs Medical Centers in the USA. PARTICIPANTS One hundred and forty patients with traumatic SCI who sustained an ILEF from 2002 to 2007. OUTCOME MEASURES Fracture circumstances and use of assistive devices were described using percentages, means, and standard deviations. Fisher's exact test was used to determine the relationship between fracture site, and patient age and duration of SCI. Differences in pharmacological provision of therapies for osteoporosis pre- and post-fracture were examined using exact McNemar's test. RESULTS One hundred and fifty-five ILEFs were identified in 140 patients. Tibia/fibula and femur fractures were the most common fractures. Fracture site was not related to patient's age or duration of SCI. Almost one-third of all fractures occurred during transfers to and from wheelchairs. Post-fracture, the provision of new or modified assistive devices, primarily wheelchairs, was frequent, occurring in 83% of patients in the year post-fracture. Few patients transferred residence to a nursing home following the fracture. There was a significant difference in the use of pharmacological therapies for osteoporosis in the first year post-fracture compared with the year prior to the fracture (P < 0.01), with significant differences in the volume of prescriptions for calcium supplements (P < 0.01) and bisphosphonates (P = 0.02). Overall, the amount of prescriptions for osteoporosis increased the year post-fracture (56%) from the year pre-fracture (39%); this increase was secondary to increases in prescriptions for calcium supplements (pre = 13%; post = 30%) and bisphosphonates (pre = 2%; post = 7%). CONCLUSIONS We have identified that wheelchair and other transfer activities are a key area that could be a focus of fracture prevention in SCI. The need for new or modified assistive devices and/or wheelchair skills retraining post-fracture should be anticipated. Examination of whether treatments for osteoporosis following a fracture can prevent future osteoporotic fractures is warranted.
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Affiliation(s)
| | - Amy S. Chin
- Edward J. Hines, Jr. Veterans Affairs Hospital, Hines, IL, USA
| | | | - Helen Hoenig
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Stephen P. Burns
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | - Lauren Bailey
- Edward J. Hines, Jr. Veterans Affairs Hospital, Hines, IL, USA
| | - Laura Carbone
- Correspondence to: Laura Carbone, Department of Medicine, Division of Rheumatology, University of TN Health Science Center, 956 Court Ave, Room G326, Memphis, TN 38163-0001, USA
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Reis JP, Ballerini K, O'Farrell S, Jasch C, Boninger M, Duerden M, Kirschner KL. Is an appropriate wheelchair becoming out of reach? - Part 2. PM R 2014; 6:934-44. [PMID: 25441718 DOI: 10.1016/j.pmrj.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Judy Panko Reis
- Health Policy Team at Access Living of Chicago, Chicago, IL(∗)†
| | | | - Sean O'Farrell
- Kellstadt Graduate School of Business, DePaul University, Chicago, IL‡
| | - Christine Jasch
- Technology Center for the Environment, Computers and Communication at Rehabilitation Institute of Chicago, Chicago, IL§
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine; University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA‖
| | - Marc Duerden
- Durable Medical Equipment Medicare Administrative Contractors, Jurisdiction B (National Government Services) for Center for Medicare and Medicaid Services; Indiana University School of Medicine¶
| | - Kristi L Kirschner
- Departments of Medical Humanities and Bioethics, and Physical Medicine and Rehabilitation, Northwestern University Feinberg, School of Medicine, Chicago, IL#.
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Pineau J, Moghaddam AK, Yuen HK, Archambault PS, Routhier F, Michaud F, Boissy P. Automatic Detection and Classification of Unsafe Events During Power Wheelchair Use. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2014; 2:2100509. [PMID: 27170879 PMCID: PMC4848073 DOI: 10.1109/jtehm.2014.2365773] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 08/15/2013] [Accepted: 10/07/2014] [Indexed: 11/10/2022]
Abstract
Using a powered wheelchair (PW) is a complex task requiring advanced perceptual and motor control skills. Unfortunately, PW incidents and accidents are not uncommon and their consequences can be serious. The objective of this paper is to develop technological tools that can be used to characterize a wheelchair user’s driving behavior under various settings. In the experiments conducted, PWs are outfitted with a datalogging platform that records, in real-time, the 3-D acceleration of the PW. Data collection was conducted over 35 different activities, designed to capture a spectrum of PW driving events performed at different speeds (collisions with fixed or moving objects, rolling on incline plane, and rolling across multiple types obstacles). The data was processed using time-series analysis and data mining techniques, to automatically detect and identify the different events. We compared the classification accuracy using four different types of time-series features: 1) time-delay embeddings; 2) time-domain characterization; 3) frequency-domain features; and 4) wavelet transforms. In the analysis, we compared the classification accuracy obtained when distinguishing between safe and unsafe events during each of the 35 different activities. For the purposes of this study, unsafe events were defined as activities containing collisions against objects at different speed, and the remainder were defined as safe events. We were able to accurately detect 98% of unsafe events, with a low (12%) false positive rate, using only five examples of each activity. This proof-of-concept study shows that the proposed approach has the potential of capturing, based on limited input from embedded sensors, contextual information on PW use, and of automatically characterizing a user’s PW driving behavior.
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Kamaraj DC, Dicianno BE, Cooper RA. A participatory approach to develop the Power Mobility Screening Tool and the Power Mobility Clinical Driving Assessment tool. BIOMED RESEARCH INTERNATIONAL 2014; 2014:541614. [PMID: 25276796 PMCID: PMC4172927 DOI: 10.1155/2014/541614] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/28/2014] [Accepted: 08/05/2014] [Indexed: 11/18/2022]
Abstract
The electric powered wheelchair (EPW) is an indispensable assistive device that increases participation among individuals with disabilities. However, due to lack of standardized assessment tools, developing evidence based training protocols for EPW users to improve driving skills has been a challenge. In this study, we adopt the principles of participatory research and employ qualitative methods to develop the Power Mobility Screening Tool (PMST) and Power Mobility Clinical Driving Assessment (PMCDA). Qualitative data from professional experts and expert EPW users who participated in a focus group and a discussion forum were used to establish content validity of the PMCDA and the PMST. These tools collectively could assess a user's current level of bodily function and their current EPW driving capacity. Further multicenter studies are necessary to evaluate the psychometric properties of these tests and develop EPW driving training protocols based on these assessment tools.
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Affiliation(s)
- Deepan C. Kamaraj
- VA Center of Excellence in Wheelchairs and Related Technology, VA Pittsburgh Healthcare System and Human Engineering Research Laboratories, Pittsburgh, PA 15206, USA
- Human Engineering Research Laboratories,
6425 Penn Avenue, Bakery Square, Suite 400, Pittsburgh, PA 15206, USA
| | - Brad E. Dicianno
- VA Center of Excellence in Wheelchairs and Related Technology, VA Pittsburgh Healthcare System and Human Engineering Research Laboratories, Pittsburgh, PA 15206, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory A. Cooper
- VA Center of Excellence in Wheelchairs and Related Technology, VA Pittsburgh Healthcare System and Human Engineering Research Laboratories, Pittsburgh, PA 15206, USA
- Human Engineering Research Laboratories,
6425 Penn Avenue, Bakery Square, Suite 400, Pittsburgh, PA 15206, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Gebrosky B, Pearlman J, Cooper RA, Cooper R, Kelleher A. Evaluation of lightweight wheelchairs using ANSI/RESNA testing standards. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 50:1373-89. [PMID: 24699973 DOI: 10.1682/jrrd.2012.08.0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 06/13/2013] [Indexed: 11/05/2022]
Abstract
Lightweight wheelchairs are characterized by their low cost and limited range of adjustment. Our study evaluated three different folding lightweight wheelchair models using the American National Standards Institute/Rehabilitation Engineering Society of North America (ANSI/RESNA) standards to see whether quality had improved since the previous data were reported. On the basis of reports of increasing breakdown rates in the community, we hypothesized that the quality of these wheelchairs had declined. Seven of the nine wheelchairs tested failed to pass the multidrum test durability requirements. An average of 194,502 +/- 172,668 equivalent cycles was completed, which is similar to the previous test results and far below the 400,000 minimum required to pass the ANSI/RESNA requirements. This was also significantly worse than the test results for aluminum ultralight folding wheelchairs. Overall, our results uncovered some disturbing issues with these wheelchairs and suggest that manufacturers should put more effort into this category to improve quality. To improve the durability of lightweight wheelchairs, we suggested that stronger regulations be developed that require wheelchairs to be tested by independent and certified test laboratories. We also proposed a wheelchair rating system based on the National Highway Transportation Safety Administration vehicle crash ratings to assist clinicians and end users when comparing the durability of different wheelchairs.
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Affiliation(s)
- Benjamin Gebrosky
- Human Engineering Research Laboratories, Department of Veterans Affairs (VA), Rehabilitation Research and Development Service, VA Pittsburgh Healthcare System, Pittsburgh, PA
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Differences between manufacturers in reported power wheelchair repairs and adverse consequences among people with spinal cord injury. Arch Phys Med Rehabil 2013; 95:597-603. [PMID: 24361786 DOI: 10.1016/j.apmr.2013.11.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/19/2013] [Accepted: 11/28/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the frequency of power wheelchair (PWC) repairs and consequences experienced over a 6-month period by individuals with spinal cord injury (SCI) who use a PWC ≥40h/wk, based on manufacturer, seating functions, Healthcare Common Procedure Coding System (HCPCS) group, and model, and over time. DESIGN Convenience observational sample survey. SETTING Spinal Cord Injury Model System centers. PARTICIPANTS Individuals with SCI (N=945) who use a PWC ≥40h/wk. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Number of required wheelchair repairs and resulting consequences (ie, being stranded, missing work/school, or missing a medical appointment). RESULTS Rates of required repairs (47.6%-63.3%) and consequences (26.7%-40.7%) were high across manufacturers. Differences between manufacturers were found among PWCs without seating functions (P<.001-.008) and among group 2 wheelchairs (P=.007). Across the 10 most prescribed wheelchairs in this study, 54.5% to 73.9% of users required 1 or more repairs over a 6-month period. Increases in the number of repairs were also found for several PWC manufacturers with time. Differences were found in participant age, working status, years since injury, and presence of seating functions between manufacturers. CONCLUSIONS The differences found in the number of repairs reported by survey respondents based on PWC manufacturer and the increases in repairs over time require further evaluation.
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