The value of powered mobility scooters from the perspective of elderly spouses of the users - a qualitative study.

PURPOSE: To explore spouses' experiences of the value of mobility scooters prescribed to their partner. MATERIAL AND METHODS: A descriptive design with a qualitative approach was used. Thirteen spouses (11 females) aged 65-86 years participated. Semi-structured interviews were conducted when the spouse's partner had had the mobility scooter for 4-6 months. The interviews were analysed using qualitative content analysis. RESULTS: The interviews showed primarily that the spouses experienced that their everyday lives and life situation had improved since their partner had received a mobility scooter. They reported that they could engage in activities of their own choice to a greater extent. The prescription of a mobility scooter to their partner had also yielded a sense of freedom related to shared activities. On the other hand, the spouses described some of the scooter's limitations. Three categories emerged: a sense of freedom related to the spouse's own activities, a sense of freedom related to shared activities and a somewhat restricted freedom. CONCLUSION: Prescription of a powered mobility scooter was of value to the users' spouses because it facilitated independent and shared activities and participation in the community. The value was mainly expressed as a sense of freedom when doing things on their own or together with their partner. Spouses are key persons in the rehabilitation of people with mobility restrictions. Their views on the assistive device may influence the rehabilitation process. Knowledge of spouses' experiences is thus crucial, as this may influence the future rehabilitation outcome.IMPLICATIONS FOR REHABILITATIONA powered mobility scooter prescribed to one partner eases everyday life and increases activity and participation for the spouse, which in turn may further improve the quality of life for the scooter user.The spouses' perspectives on their partners' mobility scooter use could be helpful in developing the design of the mobility device and in the prescription process.A mobility scooter has an added value by giving a sense of freedom and freedom to choose for the spouse as well as the scooter user.

Attitudes is the most important environmental factor for use of powered mobility devices - users' perspectives.

Introduction: Different factors in the environment influence the use of powered wheelchairs or powered scooters, i.e. powered mobility devices (PMDs), but there is limited knowledge about how these factors interact and if any factor has a greater impact. According to the ICF the environment consists of five areas.Aim: To describe users' experiences of how environmental factors from all ICF areas influence the use of PMDs.Methods: Descriptive qualitative design including 14 interviews with PMD users, analyzed using inductive qualitative content analysis.Findings: Use of PMDs means a conditional freedom depending on the interaction of several environmental factors. Regardless of environmental factor the societal attitudes were always present, directly or indirectly, and influenced the participants' feeling of being included and involved in society. The environmental factors and how they influence PMD use are described in four categories, comprising the following subjects: societal attitudes, the service delivery process, accessibility to the physical environment and financial resources.Conclusion: The findings show that societal attitudes influence all other factors, directly by others people's attitudes, or indirectly by how legislation and guidelines are formulated, interpreted and applied. Therefore, a change of societal attitudes seems necessary to increase accessibility and participation for PMD users.

The influence of environment: Experiences of users of myoelectric arm prosthesis-a qualitative study.

BACKGROUND: Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use. OBJECTIVES: To describe users' experiences of how environmental factors influence their use of a myoelectric arm prosthesis. STUDY DESIGN: Qualitative and descriptive. METHODS: A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis. RESULTS: Four categories were created from the data: "Prosthesis function," "Other people's attitudes," "Support from family and healthcare," and "Individual's attitude and strategies." The overarching theme, "Various degrees of embodiment lead to different experiences of environmental barriers and facilitators," emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings. CONCLUSION: Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use. Clinical relevance For successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.

Cost-effectiveness of powered mobility devices for elderly people with disability.

PURPOSE: The aim of this study was to analyse the cost-effectiveness of prescribing powered mobility devices (PMDs) to elderly users. METHODS: Forty-five persons participated in the pre- and post-intervention study with a follow-up at four months. All participants were prescribed a scooter model and were offered individual support to get started using the PMD. In the analysis, the use of the PMD was compared to the situation prior to its use. The cost-utility analysis takes a societal perspective and considers costs, savings and quality of life (QoL) using answers to the EQ-5D questionnaire. RESULTS: Costs for the first year with the PMD were 1395 USD and then 592 USD per subsequent year. There was a significant decrease in transportation costs and in relatives' time use, but the increase in QoL of 0.041 was not significant. Costs per gained quality adjusted life year (QALY) were 12 400-14 700 USD/QALY if the value of time saved not was considered and 600-2900 USD/QALY when an hour was valued at 3.6 USD. CONCLUSION: Prescription of PMDs to elderly users might be cost-effective. However, there are shortcomings in measuring QALY gains from the use of a PMD, and it is unclear how time savings among relatives should be valued. Implications for Rehabilitation Prescription of powered mobility devices for the elderly with disability seems to be cost effective and should be a standard intervention. In economic evaluations of powered mobility devices and other assistive devices, the commonly used analyses methods are not always appropriate and therefore need to be adjusted.

Perception of the influence of environmental factors in the use of electronic planning devices in adults with cognitive disabilities.

BACKGROUND: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs. OBJECTIVE: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs. METHODS: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses. RESULTS: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken. CONCLUSIONS: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons. Implications for Rehabilitation The users should have access to specially trained prescribers. There is a need for development of user-friendly and manageable products to function in any climate. Knowledge is lacking on how to implement the users in all stages of the prescribing process. Prescribers should increase knowledge in the use of EPDs to influence the attitudes of the social environment.

The effect of powered scooters on activity, participation and quality of life in elderly users.

PURPOSE: The aim was to explore the effect of using a powered mobility device (PMD) on older peoples' activity, participation and quality of life (QoL). METHOD: A pre- and post-intervention design with outcome measures for activity, participation (Individually Prioritized Problem Assessment, IPPA; World Health Organization Disability Assessment Schedule, WHODAS 2.0) and QoL (SF-36) were used. T-test was used to analyse the data. The magnitude of the effects was measured by Cohen's criteria for effect sizes (d). RESULTS: The sample consisted of 45 individuals (36 men) aged 66-88 years referred for prescription of a PMD. All were prescribed a powered scooter (PS). A statistically significant improvement with a large effect on IPPA in the ICF domains of Self-care (d = 2.47), Domestic life (d = 2.40), Interpersonal interactions and relationships (d = 2.08), and Community, social, and civic life (d = 2.36) was found. Medium-sized improvement on the WHODAS 2.0 domain of Participation and small improvements in the SF-36 domains of Physical Health and Role-Physical were also found. CONCLUSION: A PS has significant effects on the areas of activity, participation and QoL in elderly people. These findings have implications for prescriptions of a PS to this population. Implications for Rehabilitation Powered scooter interventions increased the performance of activities and increased participation in elderly people with mobility limitations. Actions from several parts of the community are required to prevent from mishaps from using powered scooters. The Individually Prioritized Problem Assessment is an adequate method to measure goal attainment in elderly users of powered scooters.

ICF from an occupational therapy perspective in adult care: an integrative literature review.

Since its launch there has been increasing interest in the International Classification of Functioning, Disability and Health (ICF) within occupational therapy (OT). The aim of this study was to perform an integrative literature review, in order to present an overview of knowledge, where the ICF constitutes a significant part in relation to OT. A systematic literature search, covering the period 2001-2008, was performed in the databases MEDLINE, AMED, and CINAHL. A total of 112 articles were included and the majority had exploratory and descriptive designs. The results showed that ICF was valuable for research, clinical practice, and education. ICF was used to link existing instruments and to construct new outcome measures. Occupational therapists have been members of expert groups involved in the development of Core Sets for certain health conditions. Several positive aspects were described, e.g. an effective medium for communication at different levels. Many limitations were mentioned, such as unclear concepts and lack of subjective experiences. Suggestions for improvements were described. The conclusion was that the ICF has been used for a broad spectrum of purposes. The results indicated that further research is needed concerning application of the ICF in clinical practice and education.

Roles of assistive devices for home care staff in Sweden: a qualitative study.

PURPOSE: To explore home care staff experiences in relation to assistive devices and the use of assistive device at work. METHOD: Individual conversational interviews with 14 home care staff were used. Qualitative content analysis was used to analyse the data. RESULTS: A broad meaning attached to the use of assistive devices at work emerged in three themes. In 'staff's role at work in relation to assistive devices', their different roles emerged in relation to knowledge and instruction as well as safeguarding the user. 'Assistive devices as a product and their significance for staff' showed that devices were an integrated part of staff work in the users' home. Devices influenced staff cooperation, feelings and were significant in relation to time and finance. Regarding 'assistive devices and their significance for the user from the staff's perspective', the staff felt that devices were a prerequisite for the user coping with everyday life and they also had an emotional significance. CONCLUSION: Assistive devices play a significant and important role for home care staff. An increased understanding among prescribers and other health care staff about home care staff knowledge about, work with and experience from assistive devices could contribute to a better care and rehabilitation for home care recipients.

The value of an outdoor powered wheelchair with regard to the quality of life of persons with stroke: a follow-up study.

Evaluating the use of a powered wheelchair is of importance because of the increasing number of people with disabilities who are provided with one. The aim of this study is to describe characteristics of persons with stroke using an outdoor powered wheelchair and to evaluate the impact of the wheelchair on quality of life. A further aim is to compare the impact on quality of life in respect to age, gender, different disability characteristics, and living conditions. The 32 participants with stroke were recruited consecutively from three county council areas in Sweden. A follow-up design was applied including the EuroQol-5D questionnaires at baseline before the persons were prescribed an outdoor powered wheelchair, and after the participants had used the wheelchair for 3 to 5 months, data were collected by means of the EuroQol-5D and the Psychosocial Impact of Assistive Devices Scale (PIADS). The results indicated an improved quality of life with respect to the items competence, independence, capability, quality of life, well-being, happiness, and self-esteem on the PIADS. The usual activity dimension on the EuroQol-5D showed a significant improvement after wheelchair use. The group who drove the powered wheelchair at least once a day in the summer showed a more positive score on the total PIADS and its Competence subscale than persons who drove less. Furthermore, the group with higher rankings of the importance of the powered wheelchair scored higher on psychosocial impact than did the group with lower rankings. The conclusion is that the powered wheelchair mostly has a positive impact on the quality of life of users with stroke. Service providers should be alert, however, to the possible negative impact of a powered wheelchair on quality of life and support the user.

Lifeworld perspectives utilizing assistive devices: individuals, lived experience following a stroke.

BACKGROUND: In lifeworld research, the individual's experience of meaning is of primary importance. PURPOSE: This paper explores how individuals post stroke who have a disability, described their personal meaning and lived experiences associated with the use of assistive devices. METHODS: A hermeneutic-phenomenological research approach was used. A conversational interview was conducted with 22 post-stroke individuals regarding their daily experiences utilizing assistive devices. RESULTS: The results showed a dual experience regarding the use of assistive devices, which is often complex and contradictory. The devices were viewed as a prerequisite for well-being and independence but at the same time, the devices gave rise to negative feelings because of the restrictions implied by their use. These dual experiences were explored in relation to the lived body, space, relations to others, and time. PRACTICE IMPLICATIONS: The results of this study will facilitate occupational therapists understanding of an individual's experiences utilizing assistive devices and their need for support with this process.

The effect of an outdoor powered wheelchair on activity and participation in users with stroke.

PURPOSE: Persons with disabilities after stroke are often restricted in activity and participation in society because of mobility limitations. An outdoor powered wheelchair may be one among other interventions in a rehabilitation programme. The aim of this study was to describe and compare activity limitations and participation restrictions in persons with stroke from their own perspective, before and after using an outdoor powered wheelchair. METHOD: At baseline and follow-up two instruments were used: Individually Prioritized Problem Assessment (IPPA) and World Health Organization Disability Assessment Schedule II (WHODAS II). RESULTS: The results indicated that the powered wheelchair has a great positive effect on activity and participation assessed with IPPA. The results also showed that most of the participants' problems could be categorised as belonging to the domain of 'Community, social and civic life' according to the International Classification of Functioning, Disability and Health (ICF), and the effect size in this domain was large (2.4) after the participants had used the wheelchair. CONCLUSION: An outdoor powered wheelchair is an essential device for persons with disability after stroke with regard to overcoming activity limitations and participation restrictions in everyday life.

Lifeworld perspectives on assistive devices: lived experiences of spouses of persons with stroke.

The purpose of this study was to explore how spouses of persons with a disability following stroke describe their lived experiences regarding assistive devices in everyday life. A phenomenological lifeworld approach was used and conversational interviews were conducted with 12 spouses. Their lived experiences of assistive devices were explored in relation to four lifeworld existentials intertwined in everyday life. The results showed that lived body concerns aspects of feelings, habits, and incorporation of the devices with one's own body. The devices are, from the spouses' perspective, a prerequisite for their partner with stroke living at home. Successively the devices are incorporated into the couples' homes, and they provide a new view of the environment, aspects related to lived space. The devices bring about a changed relation to lived time, related to past, present, and future. Further, lived human relation concerns changed relationships to husbands/wives with stroke, including a great responsibility due to the devices and their usage. The results also included stigmatizing aspects and a twofold relationship to health professionals regarding participation in decisions about prescribing assistive devices. Understanding the unique meaning of assistive devices from the spouses' perspective is vital for occupational therapists prescribing such devices.