User satisfaction with mobility assistive devices: An important element in the rehabilitation process

A quality-of-life scale for assistive technology: results of a pilot study of aging and technology

BACKGROUND

In an aging society, it is increasingly important to understand how assistive devices can be used by older people to maintain quality of life despite chronic disabilities. Assistive technology is a mainstay of physical therapist practice, but the potential for device use to affect psychosocial well-being is not yet understood at the population level.

OBJECTIVE

The objective of this study was to develop a parsimonious indicator that can be used in population-based surveys to represent the effect of assistive technologies on quality of life for older people, separate from personal assistance.

DESIGN

This study was a cross-sectional survey.

METHODS

/b> The methods used in this study were psychometric scale development and structural equation modeling.

RESULTS

The results indicated that a parsimonious, valid, and reliable scale reflecting quality of life related to assistive device use can be created from 3 questions designed to measure improvements in safety, control, and participation due to technology. The findings also suggested that assistive technology may more effectively improve quality of life for people with greater levels of functional limitations.

LIMITATIONS

The data were derived from a cross-sectional survey conducted by telephone. The use of personal assistance, on average, was low; thus, the applicability to a population with more profound care needs has yet to be confirmed.

CONCLUSIONS

Determining the broader impact of assistive technology on quality of life with population-level measures may provide insight into how best to leverage technologies to prevent dependence in aging adults.

Getting used to assistive devices: ambivalent experiences by frail elderly persons

The aim was to learn how frail elderly people experienced becoming assistive device users and how assistive devices affected their independence in daily activities. Focus-group methodology was used, including people 80 and older with multiple health problems. Five group discussions were conducted with a total of 18 people including 14 women and four men. Each group met once, for 90-120 minutes, and all discussions were audiotaped. Two themes emerged: Confidence in knowledge and experience and getting used to assistive devices in daily activities. Confidence in knowledge and experience was formed by two categories of experiences from the prescription procedure: trust the expert and trust yourself, and to have confidence in having the right information about assistive devices. Getting used to assistive devices in daily activities was formed by five categories of ambivalent experiences when using assistive devices in daily activities: creates opportunities and limitations; provides security but also raises concerns; the need is seen as transient or permanent; the social environment both encourages and restricts; the physical environment both facilitates and complicates, with less extreme experiences in between. This study indicates that frail elderly people need specifically developed support in the process of becoming assistive device users.

Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury?

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

To describe the satisfaction of the manual wheelchair user with hand rim wheelchair-related aspects (for example, dimensions, weight and comfort) and wheelchair service-related aspects and to determine the relationship between wheelchair users' satisfaction, personal and lesion characteristics, and active lifestyle and participation in persons with a spinal cord injury (SCI).

SETTING

Eight Dutch rehabilitation centers with a specialized SCI unit.

METHODS

The Dutch version of the Quebec user evaluation of satisfaction with assistive technology (D-QUEST) was filled out by 109 participants 1 year after discharge from inpatient SCI rehabilitation. Relationships between the D-QUEST scores and personal and lesion characteristics, and active lifestyle and participation (physical activity scale for individuals with physical disabilities (PASIPD), Utrecht activity list (UAL), mobility range and social behavior subscales of the SIP68 (SIPSOC)) were determined.

RESULTS

A high level of satisfaction was found with wheelchair-related aspects. The participants were less satisfied with the service-related aspects. Participants with an incomplete lesion were slightly more satisfied regarding both aspects than those with a complete lesion. A higher satisfaction regarding wheelchair dimensions and a higher overall satisfaction were related to a more active lifestyle. Persons who were more satisfied with the simplicity of use of the wheelchair had a better participation score.

CONCLUSION

Dutch persons with SCI are in general quite satisfied with their hand rim wheelchair. Some aspects of the wheelchair (dimensions and simplicity of use) are important to optimize as these are related to an active lifestyle and participation.

Changes in ability, perceived difficulty and use of assistive devices in everyday life: a 4-year follow-up study in people with late effects of polio

BACKGROUND

There are numbers of persons living in the community with late effects of polio, of which many develop new symptoms, but the course of progression is unclear.

OBJECTIVES

To assess changes after 4 years in ability and perceived difficulty in persons with late effects of polio.

MATERIAL AND METHODS

Community dwelling persons from a polio clinic. Information was gathered by questionnaire and interview on demographics, age at polio onset, affected body parts, health problems, the use of assistive devices, housing condition and activities of daily living (ADL) function as well as perceived difficulties.

RESULTS

There were no significant increase in frequency of ADL dependency but perceived difficulties increased significantly and more used mobility devices.

CONCLUSIONS

Over 4 years, more persons perceived difficulties and the use of assistive devices increased. This is might reflect adaptation and acknowledgement of problems previously ignored. Time is a factor in integrating knowledge and adaptation.

Effect of different walking aids on walking capacity of patients with poststroke hemiparesis

OBJECTIVE

To examine the effects of 3 different walking aids on walking capacity, temporo-spatial gait parameters, and patient satisfaction.

DESIGN

Observational study.

SETTING

University Hospital of Geneva.

PARTICIPANTS

Hemiparetic inpatients (N=25) with impaired gait, at an early stage of rehabilitation, unfamiliar with any of the walking aids tested.

INTERVENTIONS

On 3 consecutive days subjects used, in random order, 1 of 3 walking aids: 4-point cane, simple cane with ergonomic handgrip, and Nordic stick.

MAIN OUTCOME MEASURES

Maximal walking distance in 6 minutes, temporo-spatial gait parameters determined with a commercial electronic gait analysis system, and patients' preference on a subjective ranking scale.

RESULTS

Walking distance was greatest with the simple cane with an ergonomic handgrip, followed by the 4-point cane and the Nordic walking stick. Walking velocity was highest with the simple cane, which was also indicated as the preferred walking aid by the patients. There was no significant difference in step length symmetry.

CONCLUSIONS

The simple cane with the ergonomic handgrip was not only preferred by patients, but was also the most efficient among 3 commonly used walking aids. It appears justified to take patients' subjective preference into account when prescribing a walking aid.

Fostering locomotor behavior of children with developmental disabilities: An overview of studies using treadmills and walkers with microswitches

This paper provides an overview of studies using programs with treadmills or walkers with microswitches and contingent stimulation to foster locomotor behavior of children with developmental disabilities. Twenty-six studies were identified in the period 2000-2008 (i.e., the period in which research in this area has actually taken shape). Twenty-one of the studies involved the use of treadmills (i.e., 13 were aimed at children with cerebral palsy, 6 at children with Down syndrome, and 2 at children with Rett syndome or cerebellar ataxia). The remaining five studies concerned the use of walkers with microswitches and contingent stimulation with children with multiple disabilities. The outcomes of the studies tended to be positive but occasional failures also occurred. The outcomes were analyzed considering the characteristics of the approaches employed, the implications of the approaches for the participants' overall functioning situation (development), as well as methodological and practical aspects related to those approaches. Issues for future research were also examined.