Wheelchair Skills Test in simulated versus community settings: a mixed-methods crossover study of experienced motorized mobility scooter users

PURPOSE

The Wheelchair Skills Test (WST) is commonly conducted in a simulated setting. Although the WST can be done in the community setting, its usefulness in this setting has not been systematically evaluated. The purpose of this study was to compare the WST in the simulated versus community settings, and to explore participants' perceptions of performing in each environment.

METHODS

For this mixed-methods study, we studied 20 motorized mobility scooter users who had used their devices for ≥ 3 months. Each participant completed the WST Version 4.3 twice in random order - once in a simulated setting and once in their community within a two-week period. Semi-structured interviews were conducted after completion of the WST in both environments. A self-report version of the WST (WST-Q) was also completed that measured perceived capacity, frequency of skill performance, and confidence.

RESULTS

The mean (SD) total WST score in the simulated setting was 88.9% (8.6) and 92.7% (7.8) in the community setting. The two WST scores were moderately correlated (r = 0.306, p = 0.190). Community-setting WST scores were moderately correlated with WST-Q confidence scores. Simulated-setting scores were moderately correlated with WST-Q frequency scores. Although most participants preferred performing the WST in their communities due to convenience and familiarity, they perceived the simulated setting to be reflective of their community settings.

CONCLUSION

Despite challenges, community-based testing may provide a better reflection of everyday performance for scooter users than testing in a simulated environment.

Powered mobility device use in residential aged care: a retrospective audit of incidents and injuries

BACKGROUND

Powered wheelchairs and motorised mobility scooters, collectively called powered mobility devices (PMD), are highly valued by older Australians, including those living in residential care, to facilitate personal and community mobility. The number of PMDs in residential aged care is expected to grow proportionally with that of the wider community, however, there is very little literature on supporting residents to use PMDs safely. Prior to developing such supports, it is important to understand the frequency and nature of any incidents experienced by residents whilst using a PMD. The aim of this study was to determine the number and characteristics of PMD use related incidents occurring in a group of residential aged care facilities in a single year in one state in Australia including incident type, severity, assessment, or training received and outcomes on follow-up for PMD users living in residential aged care.

METHODS

Analysis of secondary data, including documentation of PMD incidents and injuries for one aged care provider group over 12 months retrospectively. Follow-up data were gathered 9-12 months post incident to review and record the outcome for each PMD user.

RESULTS

No fatalities were recorded as a direct result of PMD use and 55 incidents, including collisions, tips, and falls, were attributed to 30 residents. Examination of demographics and incident characteristics found that 67% of residents who had incurred incidents were male, 67% were over 80 years of age, 97% had multiple diagnoses and 53% had not received training to use a PMD. Results from this study were extrapolated to project that 4,453 PMD use related incidents occur every year within Australian residential aged care facilities, with the potential for outcomes such as extended recovery, fatality, litigation, or loss of income.

CONCLUSION

This is the first time that detailed incident data on PMD use in residential aged care has been reviewed in an Australian context. Illuminating both the benefits and the potential risks of PMD use emphasizes the need to develop and improve support structures to promote safe PMD use in residential aged care.

Major trauma associated with mobility scooters: An analysis of the trauma audit research network

AIMS

To establish the incidence and nature of injuries seen in patients following mobility scooter incidents.

METHODS

The Trauma Audit and Research Network (TARN) database was used to collect data concerning injuries associated with mobility scooters. The data was taken from incidents that occurred between February 2014 and November 2020. The data analysed included: patient demographics, injury mechanism and patterns and associated mortality rates.

RESULTS

1,504 patients were identified of which 61.4% were male. The median age was 76.2 years (IQR 63.5-84.9). The median injury severity score (ISS) was 9 (IQR 9-17), with major trauma (ISS ≥16) being observed in 29.4% of patients. Injuries to the limb were most common, although injuries to the head were most severe. Vehicle collisions accounted for 65.4% of injuries and were most closely associated with the most severe incidents. The median length of stay in hospital was 12 days, excluding the patients who died. Overall, mortality following injury was 10.6%, but the mortality rate was 15.4% in those aged 75 years and over, and 24.2% in those sustaining severe trauma.

CONCLUSION

As the population ages, injury characteristics of those with both major and non-major trauma changes. Mobility scooter use is prevalent amongst older people, and we provided a detailed analysis of injuries sustained with their use across a national database. The length of stay and the inherent resource use, because of admission following mobility scooter trauma, is considerable. These injuries particularly affect the 'most elderly' and carry a considerable mortality burden.

Mechanism and severity of mobility scooter-related injuries

OBJECTIVE

As a result of an aging population, mobility scooter use is increasing in Western countries. Consequently, an increase in mobility scooter-related injuries (MSRIs) is observed. Yet there is a paucity of studies in the literature assessing MSRIs. The purpose of this study was to investigate mechanism, severity, and localization of injury of MSRIs in the emergency department (ED) of a Dutch level 2 trauma center over a 9-year period.

METHODS

This was a retrospective study of MSRIs in the ED of a teaching hospital in the Netherlands between January 2010 and December 2019. All patients with an MSRI were included, as long as they were the driver of the vehicle. Data were collected from electronic patient files. The primary outcomes were severity of injury, defined by the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), and mechanism and localization of injury.

RESULTS

A total of 382 patients were identified. Of these, 208 (54.3%) were female and the median age was 76 years (interquartile range [IQR] = 67.0-83.0). The median Charlson Comorbidity Index (CCI) was 5.0 (IQR = 4.0-6.0). Three (0.8%) patients had an ISS ≥ 16. The median ISS was 3.0 (IQR = 1.0-5.0). The lower extremity was the most commonly injured body region (46.5%), followed by head injury (36.3%), external injury (31.6%), and upper extremity injuries. Fractures were most commonly observed in the shoulder (10.2%), hip (8.9%), and ankle (6.3%). Most crashes were single-vehicle accidents (87.2%) and the most common mechanism of injury was rollover of mobility scooter (49.3%). Almost half of the patients (44.1%) had a fracture and the admission rate was 28.2% with a median length of stay (LOS) of 10 days. Fifty (13.1%) patients required surgery, of which 58% were hip repair surgery.

CONCLUSION

In this cohort of MSRIs, mobility scooter users had a median age of 76 years and severe comorbidity was common. Based on ISS, patients had a mild injury profile. However, the relatively high admission and surgery rates reflect the potential serious consequences of MSRIs and the obvious vulnerability of this population.

emergency departments: 2004-2025

Introduction

The proportion of mobility scooter users in the United States continues to rise. However, these devices impart a substantial yet underappreciated risk of serious injury - namely, fractures - on users.

Methods

The purpose of this cross-sectional, retrospective study was to use the National Electronic Injury Surveillance System (NEISS) to quantify the national burden of these device-associated fractures between 2004 and 2017, analyzing in two-year intervals. We also projected estimates to 2025, and described the demographic characteristics of those injured.

Results

We found that national estimates of device-associated fractures increased significantly between the 2004-2005 (N = 2583; C.I. 1851 - 3316) and 2016-2017 (N = 6553; C.I. 5026 - 8081) periods (p < 0.001). A linear regression model (R² = 0.89; P = 0.002) was applied to project 9824 such fractures (C.I. 8273-11,328) in the 2024-2025 period. Injured patients were commonly over age 65 (63.5%; C.I. 57.7%-69.4%) and white (61.4%; C.I. 50.7% - 72.1). Fractures often occurred at home (28.6%; C.I. 22.0%-35.3%) or in public (26.0%; C.I. 21.1%-30.9%).

Conclusion

Our study suggests that osteoarthritic patients relying on mobility scooters to manage pain during ambulation should be considered candidates for total joint replacement procedures. This may help minimize the growing economic and health burden of mobility scooter fractures.

Low vision and mobility scooters: the experiences of individuals with low vision who use mobility scooters

Purpose: Older adults with low vision are a growing population with rehabilitation needs including support with community mobility to enable community participation. Some older adults with low vision choose to use mobility scooters to mobilize within their community, but there is limited research about the use by people with low vision. This paper describes a pilot study and asks the question: what are the experiences of persons with low vision who use mobility scooters? Methods: This study gathered the experiences of four participants with low vision, aged 51 and over, who regularly use mobility scooters. Diverse methods were used including a go-along, a semi-structured interview and a new measure of functional vision for mobility called the vision-related outcomes in orientation and mobility (VROOM). Findings: Four themes were found to describe experiences: autonomy and well-being, accessibility, community interactions and self-regulation. Discussion and implications: This study was a pilot for a larger study examining self-regulation in scooter users. However, as roles emerge for health professionals and scooters, the findings also provide evidence to inform practice, because it demonstrates the complex meaning and influences on performance involved in low vision mobility scooter use. Implications for rehabilitation Scooter use supports autonomy and well-being and community connections for individuals with both mobility and visual impairments. Low vision scooter users demonstrate self-regulation of their scooter use to manage both their visual and environmental limitations. Issues of accessibility experienced by this sample affect a wider community of footpath users, emphasizing the need for councils to address inadequate infrastructure. Rehabilitators can support their low vision clients' scooter use by acknowledging issues of accessibility and promoting self-regulation strategies to manage risks and barriers.

Measurement properties of the Wheelchair Skills Test for scooters among experienced users

PURPOSE

To investigate the score distribution, reliability, and validity of the objective Wheelchair Skills Test (WST) for scooter users.

METHOD

A study using a test-retest design was conducted with 20 people who had mobility limitations that prevented them from ambulating more than one city block without a mobility aid, and who had owned a scooter for ≥3 months. Objective scooter skills, confidence, and physical accessibility were measured at both time points, while anxiety, depression, visual attention and task switching, functional independence, and visual acuity were measured only at baseline.

RESULTS

The mean total WST scores at Time 1 and Time 2 were 86.3% and 87.5%. The WST ICC was 0.889. The WST had a SEM of 2.50 and a Cronbach's alpha of 0.74. The total WST scores were significantly correlated with total subjective WST-Q scores (r = 0.547, p = 0.013), scooter confidence (r = 0.466, p = 0.038), and were affected by gender (p = 0.005).

CONCLUSION

The WST for scooters has good test-retest reliability and generally varies as anticipated with other measures. Although further study is needed, the WST for scooters appears to have promise for use in research and clinical practice. Implications for Rehabilitation It is important to understand the measurement properties of the tools we use in rehabilitation so the results can be interpreted correctly. As scooter use increases, better measurement of skills is required.