Power wheelchair prescription, utilization, satisfaction, and cost for patients with amyotrophic lateral sclerosis: preliminary data for evidence-based guidelines.

OBJECTIVES: To determine the features most frequently selected in a power wheelchair (PWC), level of satisfaction with the selections, and how often the PWC features are used by patients diagnosed with amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND). DESIGN: Internally generated questionnaire. SETTING: An ALS/Muscular Dystrophy Association center. PARTICIPANTS: Convenience sample of current patients (N=45) of our clinic with ALS/MND who are PWC users (men, n=27; women, n=18; age range, 27-85 y). INTERVENTION: Self-administered survey. MAIN OUTCOME MEASURE: Thirty-two patients completed a 31-question survey investigating patients' patterns of selection, satisfaction, and frequency of PWC use; technical and psychometric influences; and other aspects of decision-making processes that patients experience before, during, and after acquiring a PWC. RESULTS: Ninety percent of respondents received their evaluations at a multidisciplinary ALS clinic, 1 via the Department of Veterans Affairs, and 1 was unknown. Sixty-six percent of patients thought the chair evaluation was timed correctly, and 19% wished they had started sooner. Forty-five percent of people were able to walk a few steps, and 55% were able to stand when their chairs arrived. When they first received the chair, 79% were satisfied with the overall comfort of the chair, and 86% were satisfied with the ease of use; currently, 69% are satisfied with the overall comfort, and 72% are satisfied with ease of use. There was a statistically significant difference in how patients used their wheelchair features initially and currently in terms of seat elevate and attendant control, but not tilt, recline, and elevating leg rests. The average cost for the power chairs was $26,404 (range, $19,376-$34,311), and the average cost a month is $917. Overall, 88% of respondents said they would get the same type of chair with the same features again, and 81% felt that the chair was a good value for the cost. CONCLUSIONS: We obtained first-hand knowledge from 32 patients with ALS/MND who are current PWC users on their use and satisfaction with their PWCs from initial to current use. Based on this survey, patients with ALS/MND seen for their wheelchair evaluation with experienced clinicians exhibit high use and satisfaction with their PWCs.

Moving a hospital--a once in a lifetime experience.

It is a hugely complex task to move a 525-bed acute tertiary health facility to a new building whilst continuing to provide services to the public--a task that was undertaken at Brisbane's Princess Alexandra Hospital in March/April 2001. There were complex issues to manage, ranging from clinical unit interdependence across a split campus to the development of detailed plans for transferring telephone extensions/personal computers in a "live environment". The success of the Princess Alexandra exercise is shown by there having been no adverse effects on patients, the lack of negative media attention and the occurrence of only two staff injuries during the move. Meticulous planning and good communication with staff and stakeholders (other hospitals, general practitioners) supported this success. The decision to reduce clinical services where possible during the shift was helpful. Understanding the complexity and richness of the information technology, the work environment and the human elements on campus was also critical to success. One major error was the initial decision to schedule the move within weeks of receiving practical completion of the new building. It became all too clear in November 2000 that further time was required to commission the building. The Transition was therefore rescheduled from January to March 2001. This decision was critical to the success of the move.