Perfect—the Enemy of Good

Preliminary inter-rater reliability of the wheelchair components questionnaire for condition

PURPOSE

The Wheelchair Components Questionnaire for Condition (WCQ-C) enables the collection of data on wheelchair maintenance condition and durability in resource-limited environments. It can be used in large studies to indicate typical patterns of wear at a location, or for a type of wheelchair. It can also be used in clinical settings as an evidence based indication that a wheelchair may need repair or replacement. This type of data can enable effective use of limited funds by wheelchair providers, manufacturers and users. The goal of this study was to investigate the inter-rater reliability of the WCQ-C.

METHODS

Two therapists from North America who have worked extensively in low-resource areas used the WCQ-C to independently evaluate 46 wheelchairs at a primary school for children with disabilities in Kenya.

RESULTS

Mean scores of ratings for each wheelchair by the two raters were used to calculate a two-way random interclass correlation coefficient. A value of 0.82 with a 95% confidence interval of 0.67-0.89 indicated good preliminary reliability.

CONCLUSION

Preliminary results indicate that the WCQ-C is a reliable method of assessment. Additional studies are needed with larger and more diverse groups of raters. Because WCQ-C findings are specific to wheelchair wear and maintenance at each location, studies at other locations are also needed. Implications for rehabilitation The importance of inter-rater reliability testing in confirming the reliability of an assessment tool such as the WCQ-C. The use of the WCQ-C to monitor wheelchair condition in low-resource settings and other field settings. If used at regular interval can produce data that can be used to describe typical changes over time at each individual setting. This could enable proactive planning at that setting to avoid typical breakdowns and the injuries or clinical complications that could result. The use of the WCQ-C to monitor the condition of groups of wheelchairs of the same type. It can describe typical patterns of wear and failure in a way that enables responsive change by manufacturers and designers. This enables more effective use of limited funds. On an individual basis, the use of the WCQ-C to alert users and health professionals of a need for repair or replacement. This could minimize the clinical problems and accidents that can result from wheelchair breakdown. Assessment of a wheelchair using the WCQ-C could provide evidence based data to insurance companies or wheelchair providers which indicates a need for wheelchair repair or replacement.

Preliminary reliability and internal consistency of the Wheelchair Components Questionnaire for Condition

Wheelchair durability and maintenance condition are key factors of wheelchair function. Durability studies done with double drum and drop testers, although valuable, do not perfectly imitate conditions of use. Durability may be harvested from clinical records; however, these may be inconsistent because protocols for recording information differ from place to place. Wheelchair professionals with several years of experience often develop a good eye for wheelchair maintenance condition. The Wheelchair Components Questionnaire for Condition (WCQc) was developed as a professional report questionnaire to provide data specifically on the maintenance condition of a wheelchair. The goal of this study was to obtain preliminary test-retest reliability and internal consistency for the WCQc. Participants were a convenience sample of wheelchair professionals who self-reported more than two years' of wheelchair experience, and completed the WCQc on the same wheelchair twice. Results indicated preliminary reliability and internal consistency for domain related questions and the entire questionnaire. Implications for rehabilitation The WCQc, if administered routinely at regular intervals, can be used to monitor wheelchair condition and alert users and health professionals about the need for repair or replacement. The WCQc is not difficult to use, making early monitoring for wear or damage more feasible. The earlier a tool can detect need for maintenance, the higher likelihood that appropriate measures may be employed in a timely fashion to maximize the overall durability of wheelchairs and minimize clinical complications. Keeping wheelchairs appropriately maintained allows users to minimize effort expended when using them, and maximize their function. It also lowers the risk of injury due to component failure. When assessing groups of similar wheelchairs, organizations involved in funding wheelchairs can use data from the WCQc to make purchase decisions based on durability, and manufacturers can use WCQc data for responsive design change.

Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings

PURPOSE

This study was conducted to compare the performance of three types of chairs in a low-resource setting. The larger goal was to provide information which will enable more effective use of limited funds by wheelchair manufacturers and suppliers in low-resource settings.

METHODS

The Motivation Rough Terrain and Whirlwind Rough Rider were compared in six skills tests which participants completed in one wheelchair type and then a day later in the other. A hospital-style folding transport wheelchair was also included in one test. For all skills, participants rated the ease or difficulty on a visual analogue scale. For all tracks, distance traveled and the physiological cost index were recorded. Data were analyzed using repeated measures analysis of variance.

RESULTS

The Motivation wheelchair outperformed Whirlwind wheelchair on rough and smooth tracks, and in some metrics on the tight spaces track. Motivation and Whirlwind wheelchairs significantly outperformed the hospital transport wheelchair in all metrics on the rough track skills test.

CONCLUSION

This comparative study provides data that are valuable for manufacturers and for those who provide wheelchairs to users. The comparison with the hospital-style transport chair confirms the cost to users of inappropriate wheelchair provision. Implications for Rehabilitation For those with compromised lower limb function, wheelchairs are essential to enable full participation and improved quality of life. Therefore, provision of wheelchairs which effectively enable mobility in the cultures and environments in which people with disabilities live is crucial. This includes low-resource settings where the need for appropriate seating is especially urgent. A repeated measures study to measure wheelchair performances in everyday skills in the setting where wheelchairs are used gives information on the quality of mobility provided by those wheelchairs. This study highlights differences in the performance of three types of wheelchairs often distributed in low-resource settings. This information can improve mobility for wheelchair users in those settings by enabling wheelchair manufacturers to optimize wheelchair design and providers to optimize the use of limited funds.