The maintenance and interface of two wheelchairs used by children with cerebral palsy in Kenya: a cross-sectional study.

Current wheelchairs used in low-resource settings lack the adjustability required for children with cerebral palsy and are not well-suited for rough terrain environments. This study aimed to examine the durability and functional interface of two wheelchairs specifically designed for use in low-resource settings. This descriptive study assessed 14 wheelchairs used by children with cerebral palsy living in Kenya, Africa (Momentum Wheels for Humanity's Liberty II wheelchair n = 6, Beeline's Honey Bee wheelchair n = 8). Four physical and occupational therapists evaluated durability using the Wheelchair Components Questionnaire (WCQ) and functionality using the Wheelchair Interface Questionnaire (WIQ). Medians were used to compare differences in the chair types using the Wilcoxon-Mann-Whitney test in Statistical Analysis Software (SAS) 9.4 with an alpha = 0.05. Median scores on the WCQ were 8.3/10 for the Liberty II and 7.8/10 for Beeline's Honey Bee wheelchair; however, the durability of the wheel locks was lower in the Beeline wheelchair (5.1/10 compared to the Liberty II 8.1/10 (p = 0.002). Median scores on the WIQ were lower and significantly different in the area of preventing distal lower extremity pain (Liberty II =3.7/10 and Beeline = 7.6/10, p = 0.045). Low scores occurred in both chairs in the areas of transfers and transporting the chairs in the community. The Beeline wheelchairs demonstrated higher average ratings for all areas of the WIQ, indicating the wheelchairs fit the children better and were more functional for use in the home and community environment.

Beeline Honey Bee and Clasp Liberty II wheelchairs demonstrate strengths supporting children in their communities, although no single type of wheelchair is perfect for children with cerebral palsy in low to middle-income countries with rough terrain.Rehabilitation professionals can use their physiological expertise to provide feedback on durability and functionality of wheelchairs in collaboration with wheelchair manufacturers to provide the most durable, cost-effective assistive technologies that support the user's physiological needs.The appropriate provision of wheelchairs can increase the quality of life for the child and their families, enabling them to participate in their local communities more fully.

Falls in people with mobility limitations: a cross-sectional analysis of a US registry of assistive device users.

Purpose of the Article: To (1) summarise the personal and clinical characteristics of persons with disabilities (PwDs) in the US who were evaluated for mobility assistive equipment (MAE) in the functional mobility assessment and uniform dataset (FMA/UDS) and (2) stratify subpopulations of PwD who reported falling versus those who do not report a fall.Materials and Methods: This study was a retrospective, descriptive cohort analysis of adults with disabilities using the FMA/UDS. Data are collected during a user's initial evaluation for a new mobility device. The sample is intentionally general to be inclusive of all mobility device users. The primary variable of interest was a patient-reported fall within the 3 months leading up to their evaluation for a new mobility device. Subpopulation characteristics were stratified by this binary fall variable.Results and Conclusions: This study provides descriptions of PwDs being evaluated for a new mobility device. There were 11,084 PwDs with 31 different primary diagnoses. During their new mobility device evaluation, 52.2% of PwDs reported at least one fall in the last 3 months. For those who reported a fall, 46.6% of PwDs were using a walking aid or no device at all before the new mobility device evaluation. Additionally, persons with progressively acquired disabilities (i.e., Parkinson's disease, osteoarthritis and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida). These findings will influence future studies comparing different types of devices and their influence on falls and user satisfaction.Implications for rehabilitation52.2% of persons with disabilities (PwDs) seeking a new wheelchair evaluation reported at least one fall in the last 3 months.Persons with progressively acquired disabilities (i.e., Parkinson's disease, osteoarthritis and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida).Earlier interventions for fall prevention including professional wheelchair evaluations may be warranted, but further research is necessary to explore long-term effectiveness.

Comparison of rolling resistance, propulsion technique and physiological demands between a rigid, folding and hybrid manual wheelchair frame.

BACKGROUND: When selecting a manual wheelchair frame, the choice between rigid and folding frames carries significant implications. Traditional folding frames are expected to have more rolling resistance and power dissipation caused by frame deformation, while they are more convenient for transportation, such as in a car. A new hybrid frame, designed to be more rigid, aims to minimize power dissipation while still retaining foldability. AIM: This study aimed to assess rolling resistance, power output, propulsion technique and physiological demands of handrim wheelchair propulsion across three different frames: a rigid frame, a hybrid frame and a conventional folding frame. MATERIALS AND METHODS: Forty-eight able-bodied participants performed coast-down tests using inertial measurement units to determine rolling resistance. Subsequently, four-minute submaximal exercise block under steady-state conditions at 1.11 m/s were performed on a wheelchair ergometer (n = 24) or treadmill (n = 24) to determine power output, propulsion technique and physiological demands. RESULTS: Repeated measures ANOVA revealed that the hybrid frame exhibited the lowest rolling resistance (7.0 ± 1.5N, p ≤ 0.001) and required less power output (8.3 ± 1.0W, p ≤ 0.001) at a given speed, compared to both the folding (9.3 ± 2.2N, 10.8 ± 1.4W) and rigid frame (8.0 ± 1.9N, 9.4 ± 1.6W). Subsequently, this resulted in significantly lower applied forces and push frequency for the hybrid frame. The folding frame had the highest energy expenditure (hybrid: 223 ± 44 W, rigid: 234 ± 51 W, folding: 240 ± 46 W, p ≤ 0.001). CONCLUSION: The hybrid frame demonstrated to be a biomechanically and physiologically beneficial solution compared to the folding frame, exhibiting lower rolling resistance, reduced power output, and consequently minimizing force application and push frequency, all while retaining its folding mechanism.

A hybrid frame, developed as an intermediary solution between a folding and rigid frame, presents reduced biomechanical and physiological demands compared to a folding frame. This is attributed to its decreased need for propulsive forces and energy expenditure, resulting from lower rolling resistanceDespite the hybrid frame offering lower rolling resistance and thus requiring less propulsive force as the rigid frame, it experiences internal power losses due to movement between its interconnected pieces. Consequently, the net mechanical efficiency of the hybrid frame is inferior to that of the rigid frame, resulting in a similar energy expenditure between the hybrid and rigid frames.The hybrid frame emerges as a potentially more advantageous option than a conventional folding frame, as it diminishes biomechanical and physiological strain while retaining a folding mechanism, to ensure easy transportation.

Effect of wheelchair seating systems on scoliosis progression for children with neurological and neuromuscular disorders: a retrospective study of Custom-Contoured Wheelchair Seating and Modular Wheelchair Seating.

OBJECTIVES: To retrospectively evaluate the comparative effect of two wheelchair seating systems, Custom-Contoured Wheelchair Seating (CCS) and Modular Wheelchair Seating (MWS), on scoliosis progression in children with neuromuscular and neurological disorders and to determine any predictors for scoliosis progression. DESIGN: Longitudinal, retrospective cohort study SETTING: National Health Service regional posture and mobility service PARTICIPANTS: Non-ambulant paediatric wheelchair users with neuromuscular and neurological disorders (N = 75; 36 male, 39 female; mean age at seating intervention, 10.50 ± 3.97 years) issued CCS and MWS by the South Wales Posture and Mobility Service from 2012 to 2022. INTERVENTIONS: Two specialized wheelchair seating systems, CCS and MWS. MAIN OUTCOME MEASURES: A generalized least squares (GLS) model was used to estimate the effect of seat type on Cobb angle over time. RESULTS: Of the 75 participants enrolled, 51% had cerebral palsy. Fifty were issued CCS and 25 were issued MWS. Baseline Cobb angle was 32.9±18.9° for the MWS group and 48.0±31.0° for the CCS group. The GLS model demonstrated that time since seating intervention (χ2 = 122, p < .0001), seating type (χ2 = 52.5, p < .0001), and baseline scoliosis severity (χ2 = 41.6, p < .0001) were predictive of scoliosis progression. Condition was not a strong predictor (χ2 = 9.96, p = .0069), and sex (χ2 = 5.67, p = .13) and age at intervention (χ2 = 4.47, p = .35) were not predictive. Estimated contrasts of medical condition with seat type over time demonstrated smaller differences between MWS and CCS over time. Predicted scoliosis velocity was found to attenuate with use of CCS over time compared to MWS, although, scoliosis deteriorated regardless of intervention. CONCLUSIONS: Our findings showed paediatric wheelchair users with neurological and neuromuscular disorders prescribed CCS showed greater mitigation of scoliosis progression over time compared to those issued MWS.

On the Move pad - a portable multipurpose pad: User feedback.

CONTEXT/OBJECTIVE: Hard-shell toilet seats may compromise safety and hinder the participation of individuals at risk for pressure injuries (PIs) when using these facilities away from home in public, hotel, or family/friend restrooms. Moreover, people often add "wash-cloths" for additional padding for comfort, and to reduce the risk of PIs due to pressure or shearing on their wheelchairs surfaces. This study investigated the utilization of portable pads, initially designed for toilet use but adaptable to various places and contexts, while examining pad usability. DESIGN: A cross-sectional descriptive survey design. SETTING: Inpatient care, outpatient care, and community setting. PARTICIPANTS: 45 individuals at risk of PIs. RESULTS: Participants extended the use of these pads beyond toilets, employing them as wheelchair armrest and leg rest pads in other settings. Feedback from a customized questionnaire indicated high levels of usefulness (8.5/10) and ease of use (9.1/10) attributed to the pads. Among the features, the top three favored were ease of use, comfort/cushioning, and function. Participants expressed a desire for a variety of sizes and colors to enable versatile usage and suggested incorporating a pocket for storing small items. CONCLUSIONS AND RELEVANCE: Individuals at risk of PIs require cushioning not only on hard-shell toilet seats, but also for additional padding, protection and enhancing the use of wheelchairs. Rehabilitation professionals can play a crucial role in educating and training both clients and caregivers to understand PI prevention, enabling them to effectively leverage the pads in appropriate situations, thereby enhancing their comfort in their wheelchairs during social engagement.

Wheeled repair alliance: Rolling out wheelchair repair and maintenance in community bicycle shops.

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.

A mixed-methods study examining perceptions of fear of falling among community-dwelling people who use wheelchairs full-time.

Objective: There is growing evidence that fear of falling (FOF) is common in people who use wheelchairs full-time and negatively influence their performance of daily activities and quality of life. The purpose of this study was to gain an in-depth understanding of perceptions related to FOF among people who use wheelchairs full-time.Methods: Mixed-method analysis was conducted using semi-structured interviews and surveys to gain insight into FOF. Surveys included demographic information; Spinal Cord Injury-Fall Concerns Scale (SCI-FCS); a questionnaire that directly assesses FOF and associated activity curtailment; and Fall Control Scale (FCS).Results: Among 39 participants (age = 43.1 ± 15.6 years, disability duration = 21.2 ± 11.1 years), 27 participants (69%) reported FOF. Participants with less perceived ability to control falls indexed by FCS reported higher SCI-FCS scores, indicating greater FOF (rs = -0.384, p = 0.016). Qualitative findings revealed that participants felt that FOF developed due to sustaining fall-related injuries or limited ability to recover from a fall. Some participants perceived falling as a part of their lives. They believed that it was not the cause of developing FOF.Conclusions: Among people who use wheelchairs full-time, FOF is prevalent and may develop due to fears of sustaining injuries or being unable to get up after falling. Developing an evidenced-based education protocol aimed at managing falls (e.g., establishing a fall recovery strategy and education on techniques to reduce injury during falls) is needed to minimize FOF people who use wheelchairs full-time.

Fear of falling and associated activity curtailment are prevalent among people who use wheelchairs full-time.Fear of falling often develops as a result of prior fall-related injuries or the inability to recover from a fall independently.Evidence-based education protocols to reduce fear of falling among people who use wheelchairs full-time should contain content related to fall recovery and injury prevention.

Accuracy of the Apple Watch Series 4 and Fitbit Versa for Assessing Energy Expenditure and Heart Rate of Wheelchair Users During Treadmill Wheelchair Propulsion: Cross-sectional Study.

BACKGROUND: The Apple Watch (AW) Series 1 provides energy expenditure (EE) for wheelchair users but was found to be inaccurate with an error of approximately 30%, and the corresponding error for heart rate (HR) provided by the Fitbit Charge 2 was approximately 10% to 20%. Improved accuracy of estimated EE and HR is expected with newer editions of these smart watches (SWs). OBJECTIVE: This study aims to assess the accuracy of the AW Series 4 (wheelchair-specific setting) and the Fitbit Versa (treadmill running mode) for estimating EE and HR during wheelchair propulsion at different intensities. METHODS: Data from 20 manual wheelchair users (male: n=11, female: n=9; body mass: mean 75, SD 19 kg) and 20 people without a disability (male: n=11, female: n=9; body mass: mean 75, SD 11 kg) were included. Three 4-minute wheelchair propulsion stages at increasing speed were performed on 3 separate test days (0.5%, 2.5%, or 5% incline), while EE and HR were collected by criterion devices and the AW or Fitbit. The mean absolute percentage error (MAPE) was used to indicate the absolute agreement between the criterion device and SWs for EE and HR. Additionally, linear mixed model analyses assessed the effect of exercise intensity, sex, and group on the SW error. Interclass correlation coefficients were used to assess relative agreement between criterion devices and SWs. RESULTS: The AW underestimated EE with MAPEs of 29.2% (SD 22%) in wheelchair users and 30% (SD 12%) in people without a disability. The Fitbit overestimated EE with MAPEs of 73.9% (SD 7%) in wheelchair users and 44.7% (SD 38%) in people without a disability. Both SWs underestimated HR. The device error for EE and HR increased with intensity for both SWs (all comparisons: P<.001), and the only significant difference between groups was found for HR in the AW (-5.27 beats/min for wheelchair users; P=.02). There was a significant effect of sex on the estimation error in EE, with worse accuracy for the AW (-0.69 kcal/min; P<.001) and better accuracy for the Fitbit (-2.08 kcal/min; P<.001) in female participants. For HR, sex differences were found only for the AW, with a smaller error in female participants (5.23 beats/min; P=.02). Interclass correlation coefficients showed poor to moderate relative agreement for both SWs apart from 2 stage-incline combinations (AW: 0.12-0.57 for EE and 0.11-0.86 for HR; Fitbit: 0.06-0.85 for EE and 0.03-0.29 for HR). CONCLUSIONS: Neither the AW nor Fitbit were sufficiently accurate for estimating EE or HR during wheelchair propulsion. The AW underestimated EE and the Fitbit overestimated EE, and both SWs underestimated HR. Caution is hence required when using SWs as a tool for training intensity regulation and energy balance or imbalance in wheelchair users.

Power wheelchair usage and repair are associated: a retrospective analysis.

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.

Proactive wheelchair servicing by repair technicians in collaboration with wheelchair users safeguards users against critical part failures and minimises repair-related operating costs for service providers.Providers should leverage wheelchair telemonitoring technologies and related research outputs to improve repair services and support their clients' continued mobility and community participation.It is important that healthcare plans and policies recognise the benefits of proactive wheelchair servicing and use data as a tool to allocate device usage and performance-based reimbursements.

User opinions about connected pressure detection systems to prevent wheelchair-related pressure injuries: An exploratory cross-sectional survey.

About 1% of the world's population uses a wheelchair. Wheelchair use is a well-known risk of pressure injury. A connected pressure detection system could help to prevent this complication that is linked to long durations of sitting, provided that user expectations are understood. The aim of this study was to explore the needs of wheelchair users (WU) regarding connected pressure detection systems to prevent pressure injury. A cross-section survey-based study of WU was conducted, using an anonymous electronic questionnaire posted from July 2019 to June 2020. Eighty-eight people responded. The majority were power wheelchair users (72.7%); one third (33.0%) had already sustained a pressure injury; only 17.0% knew of the existence of pressure detection systems, nevertheless 78.4% believed that they could be useful in daily life. The feature that received the highest rating was a pressure warning alarm (4.2/5 points). The majority (71.6%) preferred reminder-alerts to be set according to their habits and not according to medical guidelines. In conclusion, pressure detecting systems were perceived as useful to prevent pressure injuries by both manual and power wheelchair users. Work is needed to inform potential users of the existence of such systems.

Factors associated with employment of powered wheelchair users.

Purpose: To identify correlations between demographic, health-related, environmental factors and the employment status of power wheelchair (PWC) users.Method: We retrospectively analysed semi-structured interviews with 128 participants, their assistants or family members, and the participant's provided medical records. Participants were adult PWC users who applied for grants in purchasing a new PWC for gaining or keeping employment between 2019-2021 in Mazovian Province, Poland.Results: Forty-six PWC users (35.9%) were employed while applying for the financial support programme. Fischer's Exact Test of Independence identified positive correlations between employment and education level (p < 0.001), residing in an urban area (p = 0.02), being employed before starting PWC use (p < 0.001), having vocational rehabilitation (p < 0.001), and living in a relationship (p = 0.002). There were no associations between employment status and sex, age at study entry, age at disability onset, living alone or with others, duration of PWC use, or full or part-time PWC use. Our findings indicate that PWC users are at risk of non-employment and financial hardship. This research may support policies for PWC provision that would support gainful employment. The results show that access to quality education, vocational rehabilitation, and perhaps the physical/emotional support from others in close relationships matter. These aspects should be considered in educational policies, transportation, and physical environmental accessibility for PWC users, supporting their gainful employment.

Paid employment is recognised for its positive impact on the financial situation, health, and overall life satisfaction of power wheelchair users. Rehabilitation professionals can play a crucial role in facilitating the attainment and maintenance of employment throughout the clinical process.Educating power wheelchair users with factors conducive to supporting their employment, such as pursuing advanced education, utilising vocational rehabilitation services, residing in urban areas, fostering meaningful social relationships, and drawing upon previous employment experiences, may improve outcomes.Sex, age, disability cause, duration of disability, and reliance on a power wheelchair as the primary mode of mobility were found to be unrelated to employment status among power wheelchair users.Further investigation into the needs of the power wheelchair user population in their pursuit of gainful employment is justified.

Positive and negative experiences of caregivers helping power wheelchair users: a mixed-method study.

PURPOSE: This study aimed to better understand how the powered wheelchair (PWC) impacts the experiences of family caregivers of PWC users, and explore the strategies and resources used by caregivers to cope with their role. MATERIALS AND METHODS: This mixed-methods study was part of a larger cross-sectional research study conducted in four Canadian cities. Twenty-three family caregivers of PWC users, who provided at least 2 h of support per week, completed the Power Mobility Caregiver Assistive Technology Outcome (PM-CATOM), an 18-item measure assessing PWC-related and overall burden experienced by family caregivers. We also conducted semi-structured interviews and analysed them using inductive content analysis. RESULTS: From the quantitative PM-CATOM results, the caregivers perceived low level of burden for the wheelchair-related items, (Median:4.5; Range 3 to 5). Most perceived burden when physically helping the wheelchair user and when providing verbal hints. In terms of overall help, the caregivers experienced some level of burden (Median 3.5: Range 3 to 5). Most caregivers identified burden associated with the limitation to their recreational and/or leisure activities (52.2%) and feeling that they have more to do than they can handle. We identified 3 themes in the interviews: the burden experiences of caring for PWC users, the positive experiences of caregiving, and the coping strategies and resources used by caregivers of PWC users. CONCLUSION: Our study showed that understanding the experiences of caregivers of AT users is central as they are directly and indirectly impacted by the PWC in their lives and caregiving roles.

The caregivers experienced some burden related to wheelchair-related help, especially around the driving of the powered wheelchair (PWC).However, the PWC provide independence not only to the user but also to the family caregivers, allowing them to share quality time and helping each otherThe PWC impact the interaction with the social and physical environment of the caregivers.Caregiver-oriented interventions should build on the strengths of the caregivers and contribute to their well-being.

Wheelchair outcome measurement instruments for children: a scoping review protocol.

Purpose: The proposed scoping review aims to explore and map wheelchair outcome measurement instruments for children in the literature.Method: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology. The review question and eligibility criteria were developed using the PCC (population, concept, context) mnemonic as follows: (P) children manual or motorised wheelchair users (aged ≤ 18 years), (C) wheelchair outcome measurement instruments, (C) primary sources of literature. The search will be conducted in nine relevant electronic databases. including grey literature from Academic Google. Study screening, selection, and data extraction will be performed independently by two authors. A third reviewer will resolve discrepancies between the authors. General characteristics, population, feasibility, interpretability data will be extracted in accordance with the COSMIN methodology (Consensus-based Standards for the selection of health Measurement Instruments). This will encompass data pertaining to the measurement properties of the domains of reliability, validity and responsiveness. A descriptive analysis will be carried out, and the results will be classified into categories and presented in tables accompanied by a descriptive summary.Results: The results can inform future research directions, clinical practice and the development of wheelchair outcome measurement instruments. Furthermore, it will help professionals in rehabilitation and wheelchair services to find the wheelchair outcome measurement instruments according to the target population and cultural context.

IMPLICATIONS FOR REHABILITATIONThis review has the potential to enhance understanding of wheelchair outcome measurement instruments, thereby enabling rehabilitation professionals to assess the impact and progress of wheelchair use within the target population.The findings related to measurement properties may guide future research in the field of wheelchair outcome measurement instruments.Additionally it will assist clinical professionals in identifying appropriate wheelchair outcome measurement instruments based on the target population and cultural context.

Satisfação dos usuários de cadeiras de rodas da Região Metropolitana da Baixada Santista / Satisfaction of wheelchair users in the Baixada Santista Metropolitan Region

Resumo O objetivo deste artigo é identificar a satisfação dos usuários em relação às cadeiras de rodas e à prestação de serviços públicos e privados de saúde da Região Metropolitana da Baixada Santista. Estudo transversal com abordagem quantitativa. Os participantes responderam a um questionário sociodemográfico e à versão brasileira do Quebec Assistive Technology User Satisfaction Assessment. Os dados foram analisados utilizando a estatística descritiva e comparativa por meio do teste t de Student. Os tamanhos de efeito d de Cohen foram calculados. Os participantes (n = 42) estavam "mais ou menos satisfeitos" com as cadeiras de rodas e "pouco satisfeitos" com a prestação de serviços. Os usuários de cadeiras de rodas monobloco apresentaram satisfação significativamente maior com suas cadeiras em comparação com usuários de cadeiras de rodas acima de 90kg (p = 0,010, d = 1,04). Os usuários de serviços privados apresentaram satisfação significativamente maior com a prestação de serviço em comparação aos usuários de serviços públicos (p = 0,021, d = 0,75). Os usuários de cadeiras de rodas da Região Metropolitana da Baixada Santista estão mais satisfeitos com as cadeiras de rodas monobloco e menos satisfeitos com os serviços públicos.

Abstract This article seeks to identify user satisfaction in relation to wheelchairs and the provision of public and private health services in the Baixada Santista Metropolitan Region. It involved a cross-sectional study with a quantitative approach. Participants answered a sociodemographic questionnaire and the Brazilian version of the Quebec Assistive Technology User Satisfaction Assessment. Data were analyzed using descriptive and comparative statistics by means of Student's t test. Cohen's d effect sizes were also calculated. Participants (n = 42) were "more or less satisfied" with the wheelchairs and "quite satisfied" with the services provided. Rigid frame wheelchair users were significantly more satisfied with their wheelchairs compared to users of wheelchairs weighing over 198 lbs. (p = 0.010, d = 1.04). Users of private services showed significantly greater satisfaction with the provision of the service compared to public services users (p = 0.021, d = 0.75). Wheelchair users in the Baixada Santista Metropolitan Region are more satisfied with the rigid frame wheelchair and less satisfied with public services.

e-Seating - Aplicativo para apoiar o processo de avaliação e prescrição de cadeira de rodas e dispositivos de adequação postural: avaliação da experiência do usuário / e-Seating - Application to support evaluation and prescription process of wheelchairs and postural support devices: user experience evaluation

Objetivo: Avaliar a usabilidade do aplicativo e-Seating no estado de MVP, levando em consideração a experiência dos prescritores na prática clínica. Métodos: Foi utilizada a Design-Based Research (DBR) e a metodologia ágil Scrum com abordagem de desenvolvimento iterativo para aperfeiçoamento do e-Seating, considerando as avaliações dos usuários por um questionário de Experiência do Usuário - UEQ (sigla para User Experience Questionnaire) baseado em Schrepp, Hinderks e Thomaschewski. Foram realizados 3 testes com 17 profissionais prescritores de cadeira de rodas, sendo divididos para teste 1 com 6 profissionais, teste 2 com 5 e teste 3 com 6 profissionais. Os dados foram analisados por teste estatístico (teste t) e ferramenta de análise do UEQ. Resultados: Com a avaliação de experiência do usuário e aperfeiçoamento constante do e-Seating com base nas avaliações, conclui-se que o e-Seating teve maior aceitabilidade pelos prescritores que trabalham em locais privados e com profissionais autônomos do que com profissionais que atuam no setor público. Conclusão: O uso do App pode apoiar os profissionais de reabilitação no processo de prescrição de cadeira de rodas, ajudando a sistematizar e integrar as informações em toda jornada do paciente.

Objective: To evaluate the usability of the e-Seating application in the MVP state, taking into account the experience of prescribers in clinical practice. Methods: Design-Based Research (DBR) and agile Scrum methodology with an iterative development approach were used to improve e-Seating, considering user evaluations through a User Experience Questionnaire - UEQ based on Schrepp, Hinderks and Thomaschewski. Three tests were performed with 17 wheelchair prescribers, being divided into test 1 with 6 professionals, test 2 with 5 and test 3 with 6 professionals. Data were analyzed by statistical test (t test) and UEQ analysis tool. Results: With the evaluation of user experience and constant improvement of e-Seating based on the evaluations, it was concluded that e-Seating was more acceptable by prescribers who work in private places and with self-employed professionals than with professionals who work in the Public sector. Conclusion: The use of the App can support rehabilitation professionals in the wheelchair prescription process, helping to systematize and integrate information throughout the patient's journey.

Predictors of type of powered mobility aid for patients: a retrospective study in a Singapore acute hospital.

PURPOSE: Rehabilitation professionals prescribe patients with suitable powered mobility aids (PMAs) based on patient characteristics, e.g., age and mobility. However, there is paucity of literature examining patient characteristics associated with PMA types in Asian contexts. This research aims to study (i) characteristics of Singapore PMA users and (ii) correlations between characteristics and two PMA types - motorised wheelchairs and powered scooters. It is hypothesised that patients' age, mobility status and medical conditions have correlations with PMA types. METHODOLOGY: A cross-sectional, retrospective study design was used to investigate characteristics of patients (age ≥ 21 years) at Tan Tock Seng Hospital Occupational Therapy Seating Clinic between 2017 and 2019. Comparisons of proportions of motorised wheelchair users versus powered scooter users based on characteristics were analysed using Chi-square test. Subsequently, statistically significant patient characteristics were selected for a multiple logistic regression. RESULTS: Among 352 patients, 21% and 79% were prescribed motorised wheelchairs and powered scooters, respectively. Patients aged 61-90 years were twice those aged 21-60 years. Males were double of females. Patients of (i) an older age, (ii) more ambulant, (iii) independent in transfers and (iv) in activities of daily living (ADLs), were more likely powered scooter users. Conversely, patients of (i) a younger age, (ii) less ambulant, (iii) require assistance in transfers and (iv) in ADLs were more likely motorised wheelchair users. Patients' gender and caregiver status showed no statistically significant correlations with PMA types. CONCLUSIONS: Rehabilitation professionals could consider patients' age, mobility status, transfer status and ADL status when prescribing PMA for Asian populations.Implications for rehabilitationGuide rehabilitation professionals in making clinical decisions on the type of powered mobility aid (PMA) to prescribe based on patients' characteristics.Aid in the development of future guidelines for rehabilitation professionals in prescription of PMAs.

Functional balance assessment for predicting future recurrent falls in non-ambulatory individuals with spinal cord injury: a prospective pilot study.

BACKGROUND: Functional assessments easy to administer within the clinic to identify non-ambulatory individuals with spinal cord injury at risk of recurrent falls are needed. PURPOSE: To examine the ability of functional balance and transfer quality to predict recurrent falls. METHODS: This 6-month prospective study examined remote assessments of transfer quality using the Transfer Assessment Instrument and functional sitting balance with the Function in Sitting Test and the Trunk Control Test. Then, participants prospectively monitored their falls for 6-month using fall diaries. Frequency of falls was categorized as infrequent fallers (≤2 falls) and recurrent fallers (>2 falls). A multivariable logistic regression analysis was conducted. A Receiver Operating Characteristic curve was performed to determine the area under the curve, the sensitivity, and the specificity of the model. RESULTS: Eighteen non-ambulatory individuals (mean age = 44 ± 16 years, mean time since injury = 7.8 ± 32.6 years) participated in the study. Poor balance (lower Function in Sitting Test score) was associated with higher odds of future recurrent falls (Odds Ratio = 0.70, 95% CI, 0.48 to 1.00, p = 0.05), area under the receiving operating curve = 0.87, sensitivity = 88%, and specificity = 70%. CONCLUSIONS: A comprehensive sitting balance assessment that includes the static, proactive, and reactive components of balance with the integration of sensorial functions as evaluated within the Function in Sitting Test may be useful for predicting recurrent falls among non-ambulatory individuals with spinal cord injury. Replication of the findings in a larger sample is warranted.

Effects of the WHO 8-step wheelchair-service-delivery process on wheelchair users in El Salvador: a cohort study.

PURPOSE: To test the hypotheses that, after the delivery of manual wheelchairs following the WHO 8-step service-delivery process, wheelchair-related health and quality of life, wheelchair skills, wheelchair use, and poverty probability would improve; and that the number of wheelchair repairs required, adverse events, caregiver burden, and the level of assistance provided would decrease. METHODS: This was a longitudinal, prospective within-subject study including 247 manual wheelchair users, and 119 caregivers, in El Salvador who received a wheelchair following the WHO 8-step process as well as maintenance reminders. Outcome measurements were performed via structured questionnaires and dataloggers at the initial assessment, at wheelchair delivery, and at 3- and 6-month follow-up. RESULTS: Significant improvements in wheelchair-related health indicators (all with p < 0.004) and quality of life (p = 0.001), and a significant reduction in national and "extreme" poverty probability (p = 0.004 and p = 0.012) were observed by six months. Wheelchair use significantly decreased (p = 0.011 and p = 0.035) and wheelchair skills increased (p = 0.009). Caregiver burden did not change (p = 0.226) but the number of activities of daily living (ADLs) that required no assistance significantly increased (p = 0.001) by three months and those who required complete assistance decreased (p = 0.001). No changes were observed in wheelchair repairs (p = 0.967) and breakdowns over time with new wheelchairs. CONCLUSIONS: Wheelchair service delivery using the WHO 8-step process on manual wheelchair users in El Salvador has positive effects on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. Further research is needed to determine the relative contributions of the intervention components.Implications for RehabilitationProviding manual wheelchairs using the 8-step process of the WHO has benefits on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty.The WHO 8-steps service delivery process for manual wheelchairs can be used in less-resourced settings.

RESNA position on the application of ultralight manual wheelchairs.

The purpose of this RESNA Position Paper is to provide evidence from the literature and share typical clinical applications supporting the application of ultralight manual wheelchairs (ULWCs) to assist practitioners in decision-making and justification of wheelchair recommendations.

Factors clinicians consider when providing pediatric wheelchair skills training: a modified think aloud study.

PURPOSE: Children who use a manual wheelchair (WC) or a power WC may not receive adequate WC skills training. Clinicians report knowledge as a barrier to the provision of paediatric WC skills training. The purpose of this study was to explore the breadth and depth of specific factors clinicians consider when providing WC skills training for children. METHODS: Data in this modified Think Aloud study were gathered via one-on-one, Zoom-based, audio-recorded Think Aloud Sessions. Sessions consisted of participants viewing four videos, each of different children performing a different WC skill while thinking aloud (verbally expressing) about the factors they recognized, observed, and considered while watching the video. After each video, participants also responded to questions regarding the specific WC skill and the provision of WC skills training for the child in the video. Factors participants reported were independently identified by three researchers through a deductive process of directed content analysis and categorized using the International Classification of Functioning, Disability and Health (ICF) coding system. RESULTS: Twenty-eight English-speaking clinicians participated in the study. A total of 1246 distinct factors were mapped to 352 unique ICF codes spanning all four ICF Domains. The largest number of identified factors mapped to codes within the Activities and participation Domain (42.25%). CONCLUSION: Participants reported considering multiple factors across the ICF in the provision of WC skills training for children. Providing paediatric WC skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities.IMPLICATIONS FOR REHABILITATIONProviding paediatric wheelchair (WC) skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities.Clinicians should consider the child's Mental Functions, Activities and Participation, and Environmental Factors when providing wheelchair skills training for children.A lack of wheelchair-specific International Classification of Functioning, Disability, and Health codes was noted. Revising these codes to better capture the diverse range of the benefits and challenges involved in learning to use and using a wheelchair would be beneficial.