Person factors and work environments of workers who use mobility devices.

BACKGROUND: Nearly 25% of people with mobility impairments and limitations who are of working age are employed, yet few studies have examined their perspectives on their jobs or work environments required to complete job tasks. OBJECTIVE: The purpose of this study was to describe the factors that contribute to successful employment for those who use mobility devices. PARTICIPANTS: A convenience sample of 132 workers who use power wheelchairs, manual wheelchairs, canes, crutches or walkers. METHOD: Participants completed an online version of the Mobility Device User Work Survey (MWS). A multivariate analysis and a two-step multiple linear regression analysis were used. RESULTS: Study participants had few secondary health conditions that influenced their work. Employee satisfactoriness to their employers was high. Accessibility of worksites was high. Assistive technologies were inexpensive, and personal assistance was used infrequently and usually was unpaid. Co-worker communications were very positive. Flexible work rules and supportive managers were highly valued. Job satisfaction positively correlated with accessibility, work tasks, co-worker communication and work support. CONCLUSION: The description of work environments of successfully employed mobility device users can provide some useful guidance to employers, vocational rehabilitation (VR) counselors and unemployed mobility device users to balance employee abilities and preferences with the needs of employers.

Work environments of people with mobility impairments and limitations: Mobility Device User Work Survey (MWS).

BACKGROUND: Few studies of employed people who use wheelchairs, canes, crutches or walkers have been reported in the literature. One reason for this paucity of research reports is that surveys are most often made of unemployed individuals with disabilities a defined broadly. Understanding the work site of successfully employed people who use mobility devices requires the development of as survey that can be used to examine the important features of worksite from employees who use mobility devices at their worksites. OBJECTIVE: This article describes the development and psychometrics of a survey on currently employed people with lower limb impairments and mobility limitations who use mobility devices. The items in the Mobility Device User Work Survey (MWS) were based on interviews and survey items pilot tested on employed mobility device users. PARTICIPANTS: A sample of 183 employed people who use mobility devices including wheelchairs, canes, crutches or walkers was recruited using internet postings on disability-related organizations. The average age of the sample was 46.3, most were college educated, 72% used wheelchairs and the average number of years of employment was 24. METHODS: The MWS was completed by 183 people who met the inclusion criteria. The survey was sent to these same people a second time and 132 of them returned the second survey. RESULTS: The MWS consists of 106 questions on demographic, work and worksite characteristics and 58 subjective evaluation items that were organized into five scales. The internal consistencies (Cronbach's alpha) of the five scales were moderate (0.72) to good (0.93). Stability values of the five scales were calculated using correlations between forms and ranged from 0.70 to 0.80. The evaluative scales were analyzed using exploratory factor analysis. CONCLUSIONS: The MWS provides a tool for studying the variables that influence employed people who use mobility devices. Future studies of unemployed people who use mobility devices may benefit from using the results of the MWS to plan interventions.

Development of a community mobility skills course for people who use mobility devices.

OBJECTIVE: We assessed mobility device skills in a lived-in environment on a community mobility skills course (CMSC) and related those skills to previously demonstrated skills in a controlled environment on an inside mobility skills course (IMSC). METHOD: Six mobility device users were selected from 91 adults who had previously completed the IMSC. Each of the following device groups was represented: power wheelchair, manual wheelchair, scooter, cane, crutch, and walker. CMSC tasks were modified from IMSC tasks and designed using materials in the community. RESULTS: All participants completed at least half of the CMSC tasks faster than they completed the corresponding IMSC tasks. The number of tasks on which participants improved and the amount of improvement varied by difficulty of task and mobility device used. CONCLUSION: Some mobility device skills used in controlled environments appear to transfer to community settings; others do not. Skills required for community participation may partially depend on mobility device used.

Cognitive, visual, auditory, and emotional factors that affect participation in older adults.

OBJECTIVE: To determine whether changes in hearing, cognition, depression, and vision affect daily life participation and whether screening tests that identify problems could be used in the home. METHOD: Interviewers assessed presence of medical conditions, social class, distance acuity, cognition, hearing, depression, and participation using valid screening tools. Participation scores were subgrouped according to negative or positive results. Multiple regression analysis determined association of screening tests with participation. RESULTS: Eighty-eight older adults, ages 62-90, participated. Positive screening tests were found in 43% of participants for distance acuity, 9% for cognitive problems, 8% for depression, and 15% for hearing loss. Relationships were found among age, cognition, depression, and vision and participation. CONCLUSION: Mild levels of decreased vision, depression, and decreased cognition are associated with lower participation. These conditions can be screened by occupational therapists and managed to help older adults remain active and maintain their health.

The influence of verbal training and visual feedback on manual wheelchair propulsion.

PURPOSE: To determine if verbal training with visual feedback improved manual wheelchair propulsion; to examine propulsion differences between an individual with paraplegia and an individual with tetraplegia. METHOD: Quasi-experimental study: Nine manual wheelchair-using adults participated in propulsion assessments and training. Baseline propulsion performance was measured on several tasks on different surfaces. Participants were trained on a wheelchair treadmill with verbal and visual feedback to increase push length, reduce push frequency and to modify propulsion pattern. Handrim biomechanics were measured with an instrumented wheel. Changes in propulsion were assessed. Differences in propulsion characteristics between a participant with paraplegia and a participant with tetraplegia were examined. RESULTS: Push length increased (p < 0.05), push frequency decreased (p < 0.01) and peak (p < 0.05) and average (p < 0.01) forces increased immediately after training. These changes were not sustained over time. Graphic representations showed differences in propulsion characteristics between a participant with paraplegia and a participant with tetraplegia. CONCLUSIONS: Verbal training may produce changes in push biomechanics of manual wheelchair users. Longer training periods may be needed to sustain propulsion changes. Findings from this study support other studies that have shown propulsion differences between people with tetraplegia and paraplegia. Propulsion training for populations with upper-extremity impairments warrants further study.

Influence of a Consumer-Directed Personal Assistance Services Program on the lives of persons with mobility impairments.

OBJECTIVE: To examine the effects of a consumer-directed personal assistance services (CDPAS) program on the lives of persons with disabilities. METHODS: Thirteen individuals receiving paid agency-directed PAS services before enrollment in a CDPAS program (Agency Group) and 40 individuals receiving only unpaid PAS before enrollment (Informal Group) participated in this prospective study. In-home interviews were conducted just prior to CDPAS enrollment and again 6 months after CDPAS enrollment. RESULTS: Overall choice and satisfaction with PAS improved significantly for both groups after CDPAS initiation (p < .05). Total PAS hours increased significantly for the Informal Group (p < .01) but not the Agency Group. The Informal Group used relatives to provide the majority of its CDPAS hours, while the Agency Group chose to use nonrelatives and nonfriends to provide the majority of its CDPAS hours. Few significant changes in health status were observed for either group after the CDPAS intervention, although most changes were in the positive direction. The CDPAS program did not appear to have a large effect on individuals' personal and community participation, but participants reported a relatively high quality of participation at both time points. CONCLUSION: This study supports other findings that consumers prefer CDPAS to agency-directed care and provides new evidence that this preference cannot be explained by an increase in PAS hours that often accompanies enrollment in a CPDAS program. Although CDPAS appear to have subtle positive effects on consumer health and participation, ways in which CDPAS can maximize health status and participation quality among consumers should be explored.

People with mobility impairments: Physical activity and quality of participation.

BACKGROUND: we sought to describe the characteristics of physical activity levels, health, community integration, and social participation of people with mobility impairments. METHODS: based on responses to a participation survey, respondents, located primarily in the Midwestern United States, were divided into 3 physical activity groups: high, low, and inactive. We chose a purposeful sample of 604 people with mobility limitations who had a diagnosis of spinal cord injury, multiple sclerosis, cerebral palsy, stroke, or poliomyelitis. The Participation Survey/Mobility (PARTS/M) was used to measure participation in 6 domains and 20 different activities, the Physical Activity and Health Status (SF-36) was used to measure health and quality of life, and the Reintegration to Normal Living Index (RNL) was used to measure integration into the community. RESULTS: people with mobility impairments who were identified as having a high level of physical activity reported greater participation, better health, and a higher level of reintegration to normal community living compared with participants who described their physical activity level as low or inactive. CONCLUSION: positive health status and superior community participation were found in a high physical activity group compared with low active or inactive groups of people with mobility impairments and limitations.

A subjective measure of environmental facilitators and barriers to participation for people with mobility limitations.

PURPOSE: The aim of this paper is to describe the development and psychometric properties of a self-report survey of environmental facilitators and barriers to participation by people with mobility impairments. METHOD: A measure called the Facilitators And Barriers Survey of environmental influences on participation among people with lower limb Mobility impairments and limitations (FABS/M) was developed using items based on focus groups to ensure content validity. Discriminant validity was assessed on 604 individuals who completed the FABS/M once. Internal consistency and test-retest reliabilities were based on 371 individuals who completed two surveys. RESULTS: The FABS/M includes 61 questions, 133 items and six domains including the type of primary mobility device; built features of homes; built and natural features in the community; community destination access; community facilities access; community support network. Environmental items are scored for the frequency of encounter and the magnitude of influence on their participation. The internal consistencies and the test-retest reliabilities of the domains of the FABS/M ranged from low to moderate. The discriminant validity of domains differed for device and diagnostic groups. CONCLUSION. The FABS/M joins the MQE and the CHIEF as another subjective measure for use in assessing environmental features important for understanding participation. The FABS can be used to assess the influence of environmental interventions at the individual and community levels of analysis. The type of primary mobility device that is used can be related to reported environmental barriers. Community-based improvements in built features, access to destinations, access to facilities and augmented support networks can be tracked through the reports of people with mobility impairments.

Development of a measure of receptivity of the physical environment.

PURPOSE: New models of disability identify the importance of measuring the influence of the environment (environmental barriers) on the performance of persons with disabilities. The objective of this paper is to present a new measure of the receptivity of the physical environment for persons with mobility impairments and to offer preliminary information about its psychometric properties. METHODS: The measure, The Community Health Environment Checklist (CHEC), was developed and validated in a community setting with a group of persons with mobility impairments. Sixty-three destinations (buildings, recreational areas or facilities) were assessed using the CHEC. RESULTS: Using Cronbach's alpha, the CHEC was found to have an internal consistency reliability of 0.95. The content validity of the CHEC was assured by the development procedure. CONCLUSION: The CHEC offers a brief, easily administered measure of receptivity of the physical environment for persons with mobility impairments that is psychometrically sound.

Participation survey/mobility: psychometric properties of a measure of participation for people with mobility impairments and limitations.

OBJECTIVE: To describe the development and psychometric properties of a self-report survey of participation by people with mobility limitations, the Participation Survey/Mobility (PARTS/M). DESIGN: The information obtained during interviews and focus groups was used to develop items for the PARTS/M. Demographics and measures of disability, health, and functioning were collected. The PARTS/M was administered twice. SETTING: Primarily in the midwestern United States. PARTICIPANTS: Purposeful sample of 604 people with mobility limitations having a diagnosis of spinal cord injury, multiple sclerosis, cerebral palsy, stroke, or postpoliomyelitis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: PARTS/M is composed of 20 major life activities that are placed in 6 domains used in the activity/participation component of the International Classification of Functioning, Disability and Health: self-care; mobility; domestic life; interpersonal interactions and relationships; major life areas; and community, social, and civic life. For each activity, questions were asked about components of participation including frequency, health-related limitations, importance, choice, satisfaction, use of assistive technology, and use of personal assistance. RESULTS: PARTS/M domains and components of participation had good internal consistency and stability. Composite participation scores were developed for participation components and domains. CONCLUSIONS: PARTS/M is a reliable measure of some aspects of participation in major life activities for people with mobility impairments and limitations living in community settings.