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

The usability of rollators as part of the human-centred quality of mobility devices: a systematic narrative literature review

Purpose: The aim of this literature review was to identify and summarize aspects of the usability of rollators from the currently available research literature. Further objectives were the exploration of rollator requirements and the search for possible disciplinary differences in the consideration or elaboration of usability aspects.

Materials and Methods: Following the PRISMA guidelines, the databases CINAHL, Pubmed and Academic Search Elite were examined in the period from April - May 2023. For the synthesis of the quantitative and qualitative data and the identification of prominent themes in this work, a theory driven thematic analysis approach was used.

Results: A total of 45 publications were included (25 quantitative, 14 mixed methods, 6 qualitative) from various disciplines, the majority belonging to physiotherapy 42%, followed by engineering 16% and health sciences 16%. Aspects of usability were extracted using a deductive code catalogue based on QUEST 2.0. The categories "easy to use" (28/126), "comfort" (20/126), and "safety" (14/126) were most frequently assigned. While "repairs & servicing" (5/126), "service delivery" (4/126), and "durability" (3/126) were coded least frequently.

Conclusion: So far, no specific publications on the usability of rollators has been published, which made it necessary to summarize individual usability aspects using a deductive code catalogue. The results obtained, therefore, do not allow any generalized statement about the usability of rollators. However, this initiates discussions about the usability of rollators that should be studied in the future in a participatory and user-centred manner and, placing satisfaction more in the focus of usability engineering and evaluation of rollators.

User satisfaction and dissatisfaction with assistive technology devices and services in India

User satisfaction with Assistive Technology (AT) is one of the crucial factors in the success of any AT service. The current study aimed to estimate satisfaction with AT and the reasons for dissatisfaction and unsuitability among persons with functional difficulties in India. Using the WHO Rapid Assistive Technology Assessment tool, a cross-sectional study was conducted in eight districts, representing four zones of India. Multi-stage cluster random sampling and probability proportional to size techniques were used to select smaller administrative units from the larger ones. Satisfaction was reported in terms of assistive products and service delivery. In total, 8486 participants were surveyed out of which 8964 individuals were enumerated with a response rate of 94.6%. Around 22.2% (1888) of participants had functional difficulties and reported using AT, out of which 3.9% (74) were dissatisfied with their products. The assistive products, assessment and training, and repair and maintenance-related services were reported to be satisfied by approximately 92.2% (1740), 88.4% (1669), and 85.2% (1609) of respondents, respectively. Further, 3.2% (61) and 3.7% (70) of respondents reported that their AT was not suitable for home and public environments, respectively. According to 2.8% (53) respondents, their AT did not assist them in executing daily living activities. Discomfort (56.6%), poor fitting (37.7%), low quality of service (20.7%), and poor aesthetic values (18.9%) were identified as reasons for dissatisfaction. Satisfaction was good for AT received from friends and family but was poor for those received from the public sector. The study shows that overall satisfaction and suitability with AT were high among users with functional difficulties, but few have reported barriers to effective device use and facing challenges in accessing repair and follow-up services.

Wheelchair satisfaction and recommended improvements of manual wheelchairs in the UK

PURPOSE OF THE ARTICLE

The aim of this study was to determine user satisfaction with manual wheelchairs in the United Kingdom and to determine areas that could be improved to help drive future design and development.

MATERIALS AND METHODS

Manual wheelchair users, aged 18-65 years old living in the United Kingdom, were invited, to complete an online cross-sectional questionnaire. The link to the questionnaire was distributed using a range of methods to charities, organisations and wheelchair user groups via invitation by email and social media. Responses were gathered from 122 respondents and analysed using descriptive statistics, cross-tabulation and content analysis.

RESULTS

Respondents felt comfort (39.3%), weight (35.4%), manoeuvrability (34.3%) and durability (30.7%) were the most important features of a wheelchair. Seventy percent of respondents that were "not at all satisfied" with their current wheelchair were fitted by the National Health Service (NHS, X2 = 42.39, p < 0.001). Ninety percent of respondents who were "not at all satisfied" with their current wheelchair experienced issues with comfort (X2 = 17.82, p = 0.001). Sixty percent who were "not satisfied at all" with their wheelchair had not chosen their wheelchair (X2 = 25.15, p < 0.001).

CONCLUSION

Wheelchair satisfaction was largely determined by comfort, location of the users' wheelchair fitting (for example the NHS) and users choosing their own wheelchair. Future wheelchair designs should utilise a user centred and inclusive design approach to cater for a wider range of individual needs and requirements.

Patient Satisfaction with Occupational Therapy Services for Wheeled Mobility and Seating Devices

Satisfaction of 81 patients was evaluated before and after receiving occupational therapy services. There was a statistically significant difference between patients' scores before and after receiving occupational therapy services (p < .05). Over 85% indicated a high satisfaction in relation to quality and health outcomes attributed to occupational therapy services, 44% reported barriers related to limited availability, accessibility, and knowledge of occupational therapy services, and 35% made suggestions for improvements. Patient-therapist communication and easy access to occupational therapy services can enhance occupational therapy knowledge, lead to positive patient experience and quality health outcomes, and higher patient satisfaction.

A scoping review of cane use in people who have had a stroke

BACKGROUND: Various types of canes are frequently utilised in stroke rehabilitation to support walking ability by compensating for hemiplegic gait. However, Randomised Controlled Trial (RCT) design varies considerably in the area of cane use following stroke and there is no scoping review published to date on this topic. Thus, it is crucial for better evidence informed clinical care and future research that RCT evidence regarding specific assistive walking devices is examined. OBJECTIVES: Identify and map the types of canes that currently exist and review their impact on the rehabilitation of functional mobility post-stroke. METHOD: The following databases were searched: PubMed/MEDLINE, Web of Science, and CINAHL in Ebsco. Two authors independently screened 425 titles, identifying 16 RCT studies for inclusion in the review. RESULTS: 16 studies were selected for review. Five different cane designs were identified, including one-point cane, three-point cane, quad cane, weight-supported feedback cane, and rolling cane. Twelve studies were crossover RCT and four were parallel RCT. Stroke phase varied widely among subjects included in the studies and outcome measures utilised and resultant findings are heterogeneous. CONCLUSION: More evidence is required to clearly indicate the effect of canes on people who have had a stroke and parallel long-term RCTs with follow-up assessment are lacking. Furthermore, there is a lack of research examining variations in new cane designs that specifically target motor function in people who have had a stroke at specific stages. Future research should aim to address the identified inconsistencies and knowledge gaps to facilitate novel and evidence-informed clinical care regarding assistive walking devices for post stroke rehabilitation.

Assistive technology services: user experiences from the Faroe Islands, a small-scale society

PURPOSE

In the Faroe Islands, an Assistive Technology (AT) Centre allocates and finances AT for all AT users. This study aimed to provide a preliminary evaluation of the Faroese AT services from a user perspective by using recommendations from the Horizontal European Activity on Rehabilitation Technology (HEART) study.

METHOD

The study enrolled 101 persons aged 8-95 (mean 69 years) using a study-specific questionnaire. The AT service delivery process (AT-SDP) questions included questions about the application and the implementation. User satisfaction was assessed with KWAZO and the service subscale of QUEST with seven and four questions, respectively. The sample and the steps in the AT-SDP were described with frequency distribution. The KWAZO and QUEST results were analysed item-by-item and grouped in "Satisfied" and "Not fully satisfied". A threshold of 33% was used to identify items rated "Not fully satisfied". Associations between items rated "Not fully satisfied" and the AT-SDP were assessed with statistical analysis.

RESULTS

The participants were mostly satisfied, but Instruction, Professional services and Follow-up were rated "not fully satisfied". The AT centre helped with application and implementation in 9.6% and 12% of the cases, respectively, and other institutions in 62.3% and 43.7% of the cases. No contact had been with professionals in 28.7% and 37.6% of the cases.

CONCLUSIONS

There was a low degree of satisfaction in different quality parameters. The role of the AT-center seemed reduced to delivering AT and the whole service delivery process appeared to be fragmented and not in line with HEART recommendations.

Iranian translation and psychometric of the Quebec user evaluation of satisfaction with Assistive technology (QUEST2.0) on wheelchair users

PURPOSE

QUEST2.0 is a practical tool specifically applied to assessing the satisfaction for awide array of assistive technology in a standard manner. Therefore, this study set to translate and evaluate the validity and reliability of the Iranian version of the QUEST2.0in Persian-speaking users of manual and electronic wheelchairs in Iran.

METHODS

The present study recruited 130 users of manual and electric wheelchairs. Psychometric properties, including; content validity and construct validity and internal consistency and test-retest reliability, were testified.

RESULTS

The content validity index of the questionnaire was 92%. The internal consistency was determined to be 0.89,0.88 and 0.74, respectively, for the whole questionnaire and dimensions of the device, and services. The test-retest reliability was 0.85, 0.80, and 0.94, respectively, for the whole questionnaire and dimensions of the device and services. Factor analysis confirmed the two-factor structure of the questionnaire. In the two-factor model, 57.75% of the total variance was explained by these two factors, of which 45.8% pertained to the first factor (device) and 11.95% to the second factor (service).

CONCLUSIONS

The results showed that QUEST2.0 had both valid and reliable for measuring satisfaction with assistive technology among wheelchair users. The assessment will also help facilitate the quality improvement processes in using assistive technology devices.

Users' satisfaction and experiences in using assistive devices distributed by a rehabilitation centre in Bangladesh: a cross-sectional study

PURPOSE

This study aimed to understand Bangladeshi users' satisfaction with their assistive devices, including (a) device characteristics, e.g., size, weight, safety, ease of use, comfort, and effectiveness, and (b) availability of parts and repair services. We also described how frequently individuals with disabilities living in the community used assistive devices in their daily activities and how the use of assistive devices promoted individuals' wellbeing.

METHOD

We conducted a cross-sectional survey with assistive device users or their guardians (if under 18) in Bangladesh about their experience and satisfaction with their assistive device 6 months after receiving it. The research team developed a survey questionnaire consisting of both closed and open-ended questions. All data were collected via telephone interviews. We employed descriptive statistics to analyse quantitative data and inductive analysis for the qualitative data.

RESULTS

We found that out of the 376 participants, nearly 95% used assistive devices on a regular basis, and their satisfaction with the devices was high. Participants reported that assistive devices improved mobility, independence, and wellbeing of persons with disabilities. A few participants (6.4%) reported that their devices were damaged. Some participants identified concerns with their assistive devices, including (i) inappropriate size of ankle-foot orthoses, manual self-propelled wheelchairs, and prostheses, (ii) back slabs (a type of brace) being too short, and (iii) walking frames being too large. Several participants noted pain and discomfort when they used their assistive device. Additionally, some participants stated that environmental factors (e.g., muddy roads) contributed to the disrepair of their assistive devices. Finally, participants recounted that repair services were limited in rural areas of Bangladesh.

CONCLUSION

These findings indicate that the provision of assistive devices requires accommodating individuals' needs and ensuring appropriate environments in which to function. The results support the need for follow-up services after distributing assistive devices. Further research could explore the impact of assistive devices on the family quality of life of persons with disabilities.IMPLICATIONS FOR REHABILITATIONIt is essential for rehabilitation professionals to conduct follow-up services after distributing assistive devices among persons with disabilities.There is a need for the government of Bangladesh to revisit the Rights and Protection of Persons with Disability Act of 2013 and provide further clarity about their commitment to the provision of assistive devices and associated services (e.g., repair services) and its subsequent implementation.Policymakers in Bangladesh must be proactive to translate policy commitments into practice, as it relates to building an accessible environment for people using assistive devices. Further, government efforts are needed to educate policy implementers in all relevant ministries so that all responsible bodies are fully familiar with their national and international commitments regarding the rights of persons with disabilities.Future research could (i) include user's satisfaction with the service delivery process and (ii) measure the impact of assistive devices on family quality of life of persons with disabilities.

Evaluation of a new assistive technology: the StandBar

PURPOSE

Evaluate the potential of a wheelchair assistive technology (StandBar) to promote power wheelchair users' ability to safely stand independently from their power wheelchair and determine the impact of the device use on psychological well-being for both power wheelchair users and their caregivers.

MATERIALS AND METHODS

A convenience sample of 11 power wheelchair users and caregiver dyads provided study data. Participants included power wheelchair users who were existing StandBar users or currently in training with the StandBar as part of their rehabilitation. Assessments were conducted at baseline and at six-month follow-up and included physiological assessments and functional testing with and without the StandBar. Monthly follow-up phone calls were completed to collect information on adverse events (e.g., falls, hospitalizations, and skin breakdown). A qualitative interview assessed StandBar users' and caregivers' perception at six-month follow-up.

RESULTS AND CONCLUSIONS

StandBar use provided power wheelchair users a higher level of independence, confidence, and safety. All participants highly recommended StandBar use to others with similar levels of functional impairment. StandBar use allowed many participants the ability to complete functional tasks that were otherwise not possible without assistance. Qualitative interviews reported improved independence and psychological well-being for StandBar users as well as reduced levels of anxiety and burden of care by caregivers. The StandBar is a cost-effective assistive technology that promotes independence and functionality for power wheelchair users and improves the psychological well-being of users and their caregivers. Implications for RehabilitationStandBar allows power wheelchair users to:Minimize negative effects of immobilization.Increase independence for activities of daily living (grooming, hygiene, toileting, transfers) and instrumental activities of daily living (social experiences).Improve their quality of life through increasing independence and confidence.Reduce need for assistance and corresponding caregiver burden.

Mobility devices for children with physical disabilities: use, satisfaction and impact on participation

INTRODUCTION

Children with physical disabilities commonly use mobility devices. There is a lack of studies on the use and impact of mobility devices on activities and participation. Research is needed on satisfaction with the service delivery process of mobility devices.

PURPOSE

To examine the use and impact of mobility devices among children with physical disabilities and the satisfaction with the properties of their mobility devices and related services.

MATERIALS AND METHODS

A web-based survey was sent to parents of 6 - 18 years old children with physical disabilities who used mobility devices in Iceland. The use and effectiveness of mobility devices were assessed with a questionnaire designed for this study. The satisfaction was measured with Quebec user evaluation of satisfaction with assistive technology (QUEST) 2.0.

RESULTS

The survey was sent to 55 families and 36 replied. Most of the children used mobility devices in social activities. The number of participants who reported positive effects of devices on activities and participation, depended on environmental settings. There was no significant difference in participants' satisfaction between types of mobility devices. Also, there was no significant difference in participants' satisfaction with the properties of the device and the related service (for wheeled walkers p = 0.47, manual wheelchairs p = 0.08, powered wheelchairs p = 1.00).

CONCLUSIONS

The results indicate the importance of mobility devices for activities and participation and can guide healthcare workers when providing mobility devices where environmental factors across settings must be kept in mind. Stakeholders should be aware of the value of satisfaction with the devices and related services.Implications for Rehabilitation:Children with physical disabilities use mobility devices across different environmental settings and need to have more than one type of equipment.This study confirms results from earlier research that mobility devices are important for the activities and participation of children with disabilities.It is important to understand how the delivery process of devices is perceived by those who receive them. High satisfaction is an indicator of high quality of service.Environmental factors across settings must be kept in mind in the delivery process of assistive devices.

Wheelchair satisfaction among elderly Arab and Jewish patients - a cross-sectional survey

PURPOSE

To evaluate patient satisfaction with their wheelchairs among Jewish and Arab older adults.

MATERIALS AND METHOD

A cross-sectional study based on personal interviews. Participants were confined to a wheelchair (WC) Level 3. The Quebec User Evaluation of Satisfaction (scales 1-5) evaluated patient satisfaction. T test evaluated differences between continuous variables and χ2 or a Fisher's exact test between categorical variables. The contribution of background variables to the overall satisfaction with the wheelchair and related service was evaluated by multivariate regression.

RESULTS

A total of 74 Jewish and 24 Arab (mean age 78.4 ± 14.1), participated in the study. The overall satisfaction score was moderate/high (3.97 ± 0.8) with no difference between the groups. The most important items for all participants were WC safety, comfort and weight. Participants from the Arab sector were less educated, had higher BMI and were less satisfied with the chair dimensions.

CONCLUSIONS

A WC Level 3 may be effective and meets most of the basic needs of both Jewish and Arab patients at older ages. Higher BMI may result in difficulty to adopt to WC dimensions and can explain the less satisfaction of Arab patients with this component. A routine initial phone call follow-up is recommended to all patients after receiving a wheelchair. Those with problems will be scheduled for home visit. It is recommended to perform a study that will include more types of assistive devices and other groups of patients.Implication For RehabilitationApparently, despite lack of home visit follow-up, overall satisfaction with wheelchaires is relatively high. Therefore, initial phone calls may be monitored to all patients and home visits may be scheduled only for those unsatisfied with their chair.Converting a home visit to phone call can reduce the costs associated with routine home visits for all patients as is currently the case in some counties. This counts for both Jewish and Arab patients.

Exoskeleton home and community use in people with complete spinal cord injury

A consequence of a complete spinal cord injury (SCI) is the loss of gait capacity. Wearable exoskeletons for the lower extremity enable household and community ambulation in people with SCI. This study assessed the amount, purpose, and location of exoskeleton use in the home and community environment, without any restrictions. The number of steps taken was read from the exoskeleton software. Participants kept a daily logbook, and completed two user experience questionnaires (Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) and System Usability Scale (SUS)). Fourteen people with a complete SCI used the ReWalk exoskeleton a median of 9 (range [1-15]) out of 16 ([12-21]) days, in which participants took a median of 3,226 ([330-28,882]) steps. The exoskeleton was mostly used for exercise purposes (74%) and social interaction (20%). The main location of use was outdoors (48%). Overall, participants were satisfied with the exoskeleton (D-QUEST 3.7 ± 0.4) and its usability (SUS 72.5 [52.5-95.0]). Participants with complete SCI report satisfaction with the exoskeleton for exercise and social interaction in the home and community, but report limitations as an assistive device during daily life.

Preliminary test-retest reliability of the Wheelchair Satisfaction Questionnaire

PURPOSE

Economic realities in lower-and-middle-income countries (LMICs) present an increased need for outcome measures for wheelchair efficacy, as these measures enable optimized use of funds. As the provision level of wheelchairs is low in these areas, and many wheelchairs are inappropriate for their intended users, use of funds based on evidence is especially necessary. The Wheelchair Satisfaction Questionnaire (WSQ) was designed to be a snapshot of a wheelchair user's level of satisfaction with their wheelchair. The WSQ is comprised of 16 visual analogue scale questions. Each question includes an option for a qualitative explanatory comment. The current study examined initial test-retest reliability of the WSQ.

MATERIALS AND METHODS

The WSQ was administered twice to the same set of wheelchair users who were secondary students at a school for students with disabilities. A demonstration was given to the participants to explain how to mark the analogue scale. Participants were instructed to answer each item honestly and without peer input. A one-week time span separated test and retest. Scores for both sessions were entered into SPSS. An interclass coefficient of 0.70 or above indicates acceptable test-retest reliability.

RESULTS

The ages of participants ranged from 13 to 24, with a mean age of 17.86 years. Sixty-five participants completed the questionnaire fully in both test and retest and were included in this study. A high degree of reliability was found between scores from both tests. The interclass coefficient was r(63) = .863, p = .01, indicating statistically significant agreement between test and retest.

CONCLUSION

The results support the WSQ as a reliable measure, confirming the WSQ as a reliable tool for user feedback on wheelchair function. Because the WSQ is designed to provide user feedback with enough granularity to give data on particular aspects of wheelchair structure and function, data can facilitate repair and modifications to wheelchair parts. Studies using the WSQ to assess specific wheelchair types could indicate consistent patterns of user satisfaction and dissatisfaction, revealing relevant design issues. The WSQ is designed to give wheelchair users a voice that can empower user centred modification and design changes to facilitate improved health, opportunity, and social interaction.Implications for RehabilitationResults from the WSQ could enable manufacturers to utilize user feedback to improve the design of wheelchairs for use in LMIC's, and providers could be better-informed in the selection of wheelchair types for specific environments.The WSQ could provide immediate user feedback to inform wheelchair modification and selection to best serve a particular user.The WSQ could be used in clinical settings over time to collect longitudinal data from wheelchair users, which could identify the most commonly perceived reasons for user dissatisfaction in a particular clinical setting.

Predictors of adherence to wearing therapeutic footwear among people with diabetes

Aims

People at increased risk of developing diabetic foot ulcers often wear therapeutic footwear less frequently than is desirable. The aims were to identify patient groups prone to nonadherence to wearing therapeutic footwear and modifiable factors associated with adherence.

Materials and methods

A questionnaire was mailed to 1230 people with diabetes who had been fitted with therapeutic footwear. Independent variables were categorized into five domains. For each domain, variables that were associated with adherence in a univariate regression analysis were entered into a multiple regression analysis.

Results

A total of 429 (34.9%) questionnaires were analyzed. Multiple regression analyses showed significant associations (p < 0.05) between higher adherence and paid employment, current foot ulcer, previous foot ulcer, satisfaction with follow-up, self-efficacy, understanding of lost/reduced sensation as a risk factor for foot ulcerations, visible storage of therapeutic footwear at home, storage of conventional footwear out of sight, consistent choices about which footwear type to wear, and a belief that therapeutic footwear promotes ulcer healing. The five multivariate models explained 2–28% of the variance in adherence, with the strategies for footwear use domain explaining the most.

Conclusions

Patients without paid employment or without foot ulcer experience are more prone to nonadherence. To improve adherence, clinicians should advise patients to store therapeutic footwear in a visible place at home and put conventional footwear away and encourage patients’ self-efficacy and habitual use of therapeutic footwear. Future studies should investigate this topic further and explore ways to promote changes in habits. A study limitation was that all variables were self-reported.

A survey of client experiences with orthotics using the QUEST 2.0

INTRODUCTION

Hand orthoses are designed to relieve pain, immobilize a body part and protect the injury site, prevent or correct deformity, and promote healing in the body. Practitioners who prescribe and create orthoses are reliant on patient adherence to achieve desired outcomes in treatment. Understanding client preferences may promote better orthotic intervention outcomes.

PURPOSE OF THE STUDY

The purpose of this cross-sectional study was to determine the level of client satisfaction with device characteristics and service provision of custom-fabricated hand orthotics using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) version 2.0 questionnaire.

METHODS

After approval from an institutional review board, participants for this study were obtained through a convenience sample from a hand rehabilitation clinic. Seventy-two participants were administered the QUEST 2.0 to evaluate their satisfaction regarding various aspects of their orthotic devices. The 12 satisfaction categories in the QUEST are dimensions, weight, adjustments, safety, durability, easy to use, comfort, effectiveness, service delivery, repairs/services, professional service, and follow-up service. Each question was scored on a 5-point Likert scale and then recorded in the following 3 sections: device, service, and total score. The mean and standard deviation were calculated for each of the 12 items to determine the primary determinants of orthotic satisfaction.

RESULTS

The top 3 categories for a participant's orthotic device characteristics were comfort (81%), effectiveness (75%), and ease of use (74%). The participants' mean score for the device section was 4.53. The mean service score was 4.71. The total mean score was 4.61.

CONCLUSION

Therapists who are fabricating prescribed orthotic devices for individuals should consider comfort, effectiveness, and ease of use as they fabricate and adjust the device for their client. Identifying the client's desired aspects of the device can help the therapist create a better therapeutic relationship with the client and may improve their overall experience receiving orthotic intervention.

Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation

Background

In order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up.

Objective

This study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians.

Methods

On the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts.

Results

A total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up.

Conclusions

On the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype.

To tilt or not to tilt; the decision-making process

PURPOSE

This study's aim was to explore the complexities of how power tilt use is integrated within the context of daily life. Other studies have used mobility-type metrics of frequency, duration, and amplitude as measures of power tilt use in the context of daily life but results lack depth in explaining the complex interplay of participating in daily activities and power tilt use.

METHODS

This grounded theory study explored how power tilt was used in daily life from the perspectives of people experienced with using power tilt and therapists experienced with prescribing power tilt. Data collected from 22 in-depth interviews and five 3-day journals were analysed using a constant comparative approach.

RESULTS

The resultant substantive theory offers an avenue for examining the complex, iterative relationships of person, environment, technology and occupation that comprise daily life, influencing how power tilt is used at any point during the course of the day.

CONCLUSIONS

The knowledge generated from this research contributes to the advancement of understanding of how the decision to use tilt is integrated in daily life occupations. The theory can inform clinical practice related to individualizing power tilt use within the context of the person's own reality of daily life. IMPLICATIONS FOR REHABILITATION The decision to use tilt or not use tilt at any point during the day, is made contingent on the iterative transaction between environmental, functional and personal contexts at that point in time. Feedback from each experience where power tilt was used generates learning and knowledge about the context of power tilt use, informing subsequent occurrences where tilt use may be an option. The substantive theory generated in this study can provide an avenue to explore how and why context influences the decision-making process to foster an in-depth understanding of why tilt is chosen or not chosen to affect problems/issues/situations occurring in day-to-day life.

Gender differences in attitudes and attributes of people using therapeutic shoes for diabetic foot complications

Background

Therapeutic shoes can prevent diabetic foot reulcerations but their use is complicated by the fact that shoes have psychological and social meanings, which is believed to put a larger burden on women than men. The aim was to compare attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications.

Methods

A questionnaire was posted to 1230 people with diabetes who had been fitted with therapeutic shoes. Women’s and men’s answers were compared using t-tests, Mann–Whitney U tests and chi-square tests with Fischer’s exact tests. P-values < 0.05 were considered statistically significant.

Results

Questionnaires from 443 (36.0%) respondents (294 men, 149 women, mean age 69.2 years) were analyzed. More men than women (p < 0.05) had paid employment (20.4% vs 9.4%), had someone who reminded them to wear their therapeutic shoes (27.6% vs 10.0%), and had a history of foot ulcers (62.9% vs 46.3%) or minor amputation (17.7% vs 6.7%). More women than men received disability pension (18.8% vs 10.2%). Women reported worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes to the appearance and price of therapeutic shoes and how they felt about wearing them in public. Other comparisons were non-significant: other shoe attributes, education, diabetes type, current foot ulcers, major amputations, satisfaction with shoe services, understanding of neuropathy as a risk factor, locus of control regarding ulcer healing, belief in the shoes’ efficacy to prevent and heal ulcers, worries about ulcer healing and new ulcerations, self-efficacy, depression, shoe use/adherence, paying a fee for therapeutic shoes, and social support.

Conclusions

Men had worse foot complications. Women had worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes toward therapeutic shoes. Clinicians should pay more attention to their female patients’ concerns. Future research and development should focus on improving the weight and appearance of therapeutic shoes, particularly for women. Research is also needed on how to facilitate the adaption and reevaluation process where patients change from viewing shoes purely as items of clothing to also viewing them as medical interventions.

Different walk aids on gait parameters and kinematic analysis of the pelvis in patients with Adult Neuromuscular Disease

OBJECTIVE

To investigate the effects of different walking aids (single cane, bilateral forearm crutch and walker) on gait parameters and kinematic analysis of pelvis in patients having adult neuromuscular diseases.

METHODS

The study design was a self-controlled study. The study was conducted in the Department of Physiotherapy and Rehabilitation, Hacettepe University in Ankara, Turkey, between 2014-2015. The study included 18 adult patients with neuromuscular disease. The manual muscle test, the Rivermead mobility index, the motor function assessment scale, and the trunk control test were used as descriptive measurements. The 2-minute walking test, the modified Borg scale and the G-Walk gait analysis system (BTS Bioenginering S.p.A., Italy) were used as the outcome measures. The outcome measures were performed randomly during normal gait without walking aids (self control group), then during walking with single point cane, bilateral forearm crutch and walker.

RESULTS

It was observed that the walking aids have decreased the walking speed, walking distance and cadence. When the pelvis kinematic was analyzed, there was only a significant difference in the extension of the pelvis between the groups (p<0.05). The most useful (61%), most comfortable (44.4%) and the most preferred (61%) walking aid was determined as single cane by patients and the safest (55%) one was determined as a walker.

CONCLUSION

In the decision-making process for walking aids, the patient`s biomechanical, physiological and psychosocial needs, expectations, satisfactions and levels of independence should be considered before providing patients with aids for walking.

Subjective health status of multimorbidity: verifying the mediating effects of medical and assistive devices

Background

This study aimed to verify the mediating effect of using assistive devices as a factor that alleviates the relationship between multimorbidity and subjective health status.

Methods

This study used three-year data (2011–2013) from the Korea Health Panel (KHP). The data were jointly collected by the consortium of the National Health Insurance Service and Korea Institute for Health and Social Affairs.

Results

The mediating effect of using assistive devices was verified, but the direction of the effect was deteriorated subjective health. In other words, in terms of the impact of multimorbidity on subjective health, using assistive devices had a negative impact (−) on subjective health.

Conclusions

The current assessment system for medical devices, narrow scope for choice of assistive devices, and limited scope of health insurance benefits must change to ultimately lead to a positive mediating effect on using medical devices and on subjective health satisfaction of patients with chronic diseases. A system that embraces all ages and generations must be developed. To this end, it is necessary to expand the scope of medical devices and insurance payment in long-term care insurance for elderly users, as well as the active meaning of medical devices in terms of health insurance.

Satisfaction with assistive technology device in relation to the service delivery process-A systematic review

The service delivery process (SDP) of assistive technology devices (ATDs) is attracting interest, as the provision of ATDs is critical for the independence and participation in society of individuals with disabilities. The purpose of the current study was to investigate what impact the SDP has on satisfaction with ATDs in individuals with disabilities in relation to everyday activities. A systematic literature review was conducted, which resulted in 53 articles included. The results showed that there are factors in almost all the different steps of the SDP that affect the satisfaction with of the devices, which can lead to underutilization and abandonment of ATDs. Only a few studies have been conducted with a design robust enough to generalize the results; therefore, more research is needed. Therefore, the conclusion is the SDP as a whole contributes to the satisfaction with and usability of ATDs in individuals with disability in relation to achieving the desired goals of participation in everyday activities, for the articles included must be deemed as moderate. A client-centred approach in the process is advocated, and was found to be an important factor for an effective SDP and satisfied users.

Long-Term Performance and User Satisfaction With Implanted Neuroprostheses for Upright Mobility After Paraplegia: 2- to 14-Year Follow-Up

OBJECTIVE

To quantify the long-term (>2y) effects of lower extremity (LE) neuroprostheses (NPs) for standing, transfers, stepping, and seated stability after spinal cord injury.

DESIGN

Single-subject design case series with participants acting as their own concurrent controls, including retrospective data review.

SETTING

Hospital-based clinical biomechanics laboratory with experienced (>20y in the field) research biomedical engineers, a physical therapist, and medical monitoring review.

PARTICIPANTS

Long-term (6.2±2.7y) at-home users (N=22; 19 men, 3 women) of implanted NPs for trunk and LE function with chronic (14.4±7.1y) spinal cord injury resulting in full or partial paralysis.

INTERVENTIONS

Technical and clinical performance measurements, along with user satisfaction surveys.

MAIN OUTCOME MEASURES

Knee extension moment, maximum standing time, body weight supported by lower extremities, 3 functional standing tasks, 2 satisfaction surveys, NP usage, and stability of implanted components.

RESULTS

Stimulated knee extension strength and functional capabilities were maintained, with 94% of implant recipients reporting being very or moderately satisfied with their system. More than half (60%) of the participants were still using their implanted NPs for exercise and function for >10min/d on nearly half or more of the days monitored; however, maximum standing times and percentage body weight through LEs decreased slightly over the follow-up interval. Stimulus thresholds were uniformly stable. Six-year survival rates for the first-generation implanted pulse generator (IPG) and epimysial electrodes were close to 90%, whereas those for the second-generation IPG along with the intramuscular and nerve cuff electrodes were >98%.

CONCLUSIONS

Objective and subjective measures of the technical and clinical performances of implanted LE NPs generally remained consistent for 22 participants after an average of 6 years of unsupervised use at home. These findings suggest that implanted LE NPs can provide lasting benefits that recipients value.

Reasons for using power tilt: perspectives from clients and therapists

PURPOSE

A power tilt wheelchair allows independence in changing body position to address a variety of needs throughout the day; however, literature and clinical practice suggest that actual use varies greatly. This grounded theory study examined how power tilt was used in daily life from the perspectives of adults who used power tilt and therapists who prescribed this technology.

METHODS

A constant comparative approach was used to collect and analyze interview data from five people who use power tilt and six therapists who prescribe this technology.

RESULTS

This paper presents the findings specific to understanding the reasons why power tilt was used, focusing on the relationships between tilt use and (1) the reasons for use, (2) the reasons for prescribing power tilt and (3) the associated amplitudes of tilt.

CONCLUSIONS

This study advances knowledge related to how power tilt is used in daily life by elucidating that how the reasons for use are conceptualized is complex. The three relationships related to the reason for power tilt use identified in this paper have the potential to influence the quality of communication about power tilt use in clinical practice between therapist and client and in research between researcher and participant. Implications for Rehabilitation: Understanding the inconsistencies and variations in how power tilt is used in daily life is dependent on exploring the reasons beyond the words or terms expressed to describe use. Reasons for tilt use are context dependent, particularly the activity occurring at the time of tilt use, the associated amplitude of tilt and the influence of other reasons occurring at the same time.

Neurological patients and their lower limb orthotics: An observational pilot study about acceptance and satisfaction

BACKGROUND

Although an orthotic device of the lower limb improves the functionality of neurological patients, anecdotally clinical experience suggests that the compliance is rather limited.

OBJECTIVES

The aim was to determine the satisfaction and acceptance of a lower limb orthotic device.

STUDY DESIGN

A qualitative observational pilot study with a mix-method design.

METHODS

Adult neurological patients who had a prescribed lower limb orthotic device were included. One published and clinically used questionnaire about satisfaction (D-Quest) and one ad hoc constructed questionnaire about acceptance of the orthotic device (MIRAD-ACCORT questionnaire) were used for data collection.

RESULTS

In total, 33 patients participated (28 ankle-foot orthotic device, 3 knee-ankle-foot orthotic device and 2 other types). In general, they were satisfied about their orthotic device and the services. Less than one-fourth of the patients had some negative comments about the 'visual aspects' and the 'ability to hide' of their orthotic device. These, however, had a lower priority when compared with functionality, which was reported as a main advantage and is a reason for continuing the use of their orthotic device.

CONCLUSION

Patients were satisfied in relation to their lower limb orthotic device. With regard to acceptance, it can be concluded that factors associated with functionality and comfort are more important than the aesthetic and psychological aspects of the orthotic device. Clinical relevance Patients were satisfied with their lower limb orthotic device. Some patients had some negative comments about the 'aesthetics aspects' and the 'ability to hide' their orthotic device. However, improvements in functionality were mostly reported as a main advantage and a reason for continuing the use of their orthotic device.

Characterisation of rollator use using inertial sensors

The use of walking aids is prevalent among older people and people with mobility impairment. Rollators are designed to support outdoor mobility and require the user to negotiate curbs and slopes in the urban environment. Despite the prevalence of rollators, analysis of their use outside of controlled environments has received relatively little attention. This Letter reports on an initial study to characterise rollator movement. An inertial measurement unit (IMU) was used to measure the motion of the rollator and analytical approaches were developed to extract features characterising the rollator movement, properties of the surface and push events. The analytics were tested in two situations: first, a healthy participant used a rollator in a laboratory using a motion capture system to obtain ground truth. Second, the IMU was used to measure the movement of a rollator being used by a user with multiple sclerosis on a flat surface, cross-slope, up and down slopes and up and down a step. The results showed that surface inclination and distance travelled measured by the IMU have close approximation to the results from ground truth; therefore, demonstrating the potential for IMU-derived metrics to characterise rollator movement and user's pushing style in the outdoor environment.

Locally manufactured wheelchairs in Tanzania - are users satisfied?

BACKGROUND

The government of Tanzania created opportunity for the production of wheelchairs that would be appropriate to the local needs and environment.

OBJECTIVES

The study assessed the extent to which the wheelchairs met the activity and participation needs of the users, as well as the users' level of satisfaction with the provision, repair and maintenance of these wheelchairs.

METHODS

A descriptive cross-sectional analytical design was utilized to collect data through the administration of a questionnaire among 75 adult wheelchair users.

RESULTS

Participants had used wheelchairs for an average period of 9.3 years. Most participants (61%) had sustained spinal cord injuries, and used three-wheeler chairs (76%). More than 90% reported that their wheelchairs positively influenced their activity and participation needs, and 85% were satisfied with their ability to carry out daily activities. Participants expressed satisfaction with the durability of the wheelchairs (89%), and the professional services received (71%), but not with follow-up services (77%). There was difference in satisfaction with features of 3-wheeler and 4-wheeler rigid chairs (p=0.030).

CONCLUSION

The wheelchairs positively impacted participants' activity and participation needs. Participants were sat isfied with the features of the wheelchairs but not with follow-up services. The concerns of dissatisfied users should be addressed.

The impact of measures taken in the outdoor environment on an ageing population: a panel study over a ten-year period

For older people mobility and participation in activities can be restricted both by individual factors and by the environment. The aim of this paper was to examine the longitudinal impact of measures taken in the outdoor environment on an ageing population. The following factors were examined on three occasions over a nine-year period: frequency of walking; differences in report on environmental barriers; and reported valuation of the outdoor environment; and how these relate to different characteristics. At the second follow-up, the respondents experienced more functional limitations and more were using mobility devices than at baseline. At the first and second follow-up, the respondents did not experience as many environmental barriers in their outdoor environment compared to baseline. However, frequency of walking and evaluation of the outdoor environment decreased in general between baseline and first- and second follow-up. A quite promising result from the study is that compared to people not using mobility devices, mobility device users were more likely to be frequent walkers at first- and second follow-up than at baseline. Likewise, at second follow-up respondents having functional limitations were less likely to experience traffic barriers than at baseline. In terms of accessibility, usability and mobility for an ageing population, the results are promising, showing that measures in the outdoor environment can possibly facilitate walking for those who are more fragile, even in a longitudinal perspective.

Impact of structured wheelchair services on satisfaction and function of wheelchair users in Zimbabwe

BACKGROUND

Providing wheelchairs without comprehensive support services might be detrimental to user satisfaction and function.

OBJECTIVES

This paper compares wheelchair user satisfaction and function before and after implementation of comprehensive wheelchair services, based on the World Health Organization guidelines on wheelchair service provision in less resourced settings, in Zimbabwe.

METHOD

A pre- and post-test study with a qualitative component was done. Quantitative data were collected with the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and the 'Functioning Every day with a Wheelchair Questionnaire'. Data were collected from 55 consecutively sampled wheelchair users, who received a new wheelchair in the study period. Qualitative data were collected through two audio recorded focus groups and two case studies and are presented through narrative examples.

RESULTS

The proportion of adult users who were satisfied significantly increased for all wheelchair and service delivery aspects (p = 0.001 - 0.008), except follow-up (p = 0.128). The same was true for children's post-test ratings on all variables assessed (p = 0.001 - 0.04), except training in the use of the device (p = 0.052). The biggest improvement in satisfaction figures were for comfort needs (44.3%), indoor mobility (43.2%), outdoor mobility (37.2%), safe and efficient, independent operation (33.5%) and transport (31.4%). The qualitative data illustrated user satisfaction with wheelchair features and services.

CONCLUSION

The wheelchair service programme resulted in significant positive changes in user satisfaction with the wheelchair, wheelchair services and function. It is recommended that the Zimbabwean government and partner organisations continue to support and develop wheelchair services along these guidelines.

Actual use of and satisfaction associated with rollators and "shopping carts" among frail elderly Japanese people using day-service facilities

Purpose This study aimed at clarifying the actual use of and satisfaction with rollators and "shopping carts" (wheeled walkers with storage) among frail elderly people, who were certified by a long-term care insurance system as users of facilities that provide day-service nursing care and rehabilitation. Methods We identified 1247 frail elderly people who used day-service facilities, and evaluated their actual use of, and satisfaction with, rollators and shopping carts. Results Forty-four (3.5%) individuals used rollators, and 53 (4.3%) used shopping carts. The shopping cart group contained more individuals who were certified as care level 1 (26.4%), than the rollator group (20.5%), and 52.8% of the shopping cart group was certified as care levels 1-3. The scores for "repairs and services" and "follow-up" from the Quebec User Evaluation of Satisfaction with assistive Technology second version (QUEST 2.0) survey were significantly higher in the rollator group than in the shopping cart group. Conclusions The QUEST 2.0 scores revealed that shopping cart users exhibit insufficient "repairs and services" and "follow-up" scores. As frail elderly people with poor care status accounted for >50% of the shopping cart group, these individuals urgently need walking aids that are tailored to their care status. Implications for Rehabilitation We conclude that walking aid fitting must be tailored to each persons care status, and suggest that a system should be established to allow occupational or physical therapists to provide this fitting Moreover, our analysis of the QUEST2.0 service scores revealed that repairs, services, and follow-up are insufficient to meet the needs of shopping cart users.

Similar barriers and facilitators to physical activity across different clinical groups experiencing lower limb spasticity

Purpose Given the importance of physical activity in maintaining health and wellness, an improved understanding of physical activity patterns across different clinical populations is required. This study examines the facilitators for, and barriers to, participation in physical activity across multiple contexts for three clinical groups with chronic lower limb spasticity (individuals with stroke, multiple sclerosis and incomplete spinal cord injury). Method This cross-sectional study employed quantitative measures for spasticity, ankle range of motion, pain, falls, cognition, mobility, and physical activity as well as qualitative semi-structured interviews. Results There were similar impairments in body functions and structures and limitations in activities across the clinical groups. These impairments and limitations negatively impacted participation in physical activity, which was low. Environmental and personal factors exacerbated or mitigated the limiting effects of body functions and structures and activities on physical activity in many areas of life. Conclusions In this population, participation in physical activity includes activities such as housework which are different than what is typically considered as physical activity. Further, the presence of similar barriers and facilitators across the groups suggests that support and services to promote valued forms of physical activity could be organised and delivered based on limitations in mobility and functioning rather than clinical diagnosis. Implications for rehabilitation Physical activity is of utmost importance in maintaining health and wellness in clinical populations. This research highlights the desired and actual physical activity for these populations can look different than what may traditionally be considered as physical activity (e.g. housework is not typically considered participation physical activity). Therefore, rehabilitation interventions need to be directly designed to enhance clients' ability to perform these activities and these activities should be an integral focus of ongoing physical activity programs. Individuals who have lower limb spasticity shared similar impairments in body structures and functions and limitations in activities across the clinical groups and these impairments and limitations negatively impacted participation in physical in a similar way in all groups. Further, the environmental and personal factors exacerbated or mitigated the limiting effects of body functions and structures and activities on physical activity in many areas of life in a similar way in all groups. The presence of similar barriers and facilitators across the clinical groups suggests that rehabilitation assessment and treatment as well as support and services to promote valued forms of physical activity could be organised and delivered based on limitations in mobility and functioning rather than clinical diagnosis. This work affirms that a mixed methods research approach is critical for completely understanding the complexities of the barriers and facilitators engaging in physical activity across clinical groups, including multiple sclerosis, stroke, and incomplete spinal cord injury who have chronic lower limb spasticity.

Is any wheelchair better than no wheelchair? A Zimbabwean perspective

BACKGROUND

Within a rights-based paradigm, wheelchairs are essential in the promotion of user autonomy, dignity, freedom, inclusion and participation.

OBJECTIVES

This paper aimed to describe a group of Zimbabwean wheelchair users' satisfaction with wheelchairs, wheelchair services and wheelchair function.

METHOD

A mixed method, descriptive study was done. Quantitative data was collected from 94 consecutively sampled wheelchair users, who accessed wheelchair services at 16 clinics in five Zimbabwean provinces between October 2013 and February 2014, using the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and Functioning Every day with a Wheelchair questionnaire. Qualitative data were collected through two focus group discussions (22 participants) and two case studies with participants purposively sampled from those who participated in the quantitative phase.

RESULTS

More than 60% of participants were dissatisfied with the following wheelchair features: durability (78.6%), weight (75.6%), ease of adjustment (69.1%), effectiveness (69.0%), safety (66.7%), reliability (66.7%), and meeting user needs (60.6%). Similarly, more than 66% of participants were dissatisfied with various services aspects: professional services (69.0%), follow-up (67.0%), and service delivery (68.3%). Although 60% of participants agreed that the wheelchair contributed to specific functions, more than 50% of participants indicated that the features of the wheelchair did not allow in- (53.2%) and outdoor (52.7%) mobility.

CONCLUSION

Findings indicate high levels of dissatisfaction with wheelchair features and services, as well as mobility. It is recommended that policy and minimum service standards which incorporate evidence and good practice guidelines for wheelchair services and management of wheelchair donations are developed for Zimbabwe.

Development and feasibility of an automated call monitoring intervention for older wheelchair users: the MOvIT project

Background

Recent advances in wheeled mobility technology are multiplying opportunities for community integration and improved quality of life. The mobility needs of older wheelchair users are particularly complex due to a constellation of chronic conditions and comorbidities that may compromise optimal use of the device. The purpose of the Mobility Outcomes via Information Technologies (MOvIT) project is to examine the feasibility of automated calls for the systematic monitoring for adverse outcomes associated with wheelchair use.

Methods

A two-phase mixed methods approach was used. Phase I involved user-centered development and face validation of a monitoring questionnaire with end-users (seven wheelchair users and five healthcare providers). Phase II tested the feasibility of monitoring outcomes using automated calls to administer the MOvIT questionnaire 1 and 3 months after wheelchair delivery with a prospective cohort of older adults (50–84 years of age). When problems were identified, the computer monitoring system notified a clinical coordinator who followed up with respondents requiring interventions. Feasibility data were extracted from the web database and from individual interviews covering perceived ease of use, usefulness and intention to use the MOvIT questionnaire in the future.

Results

The MOvIT monitoring questionnaire developed in phase I tracks nine potential wheelchair-related adverse outcomes considered important for end-users: 1) non-use of wheelchair, 2) pain, 3) skin condition, 4) positioning, 5) wheelchair incidents, 6) psychosocial issues, 7) restricted wheelchair participation, 8) limited wheelchair skills and knowledge, and 9) technical problems. In phase II, 92 individuals who received a wheelchair were eligible, 71 out of 92 accepted (77 %) and 65 out of 71 (92 %) completed the 3-month follow-up. In the sample of 65 participants, a wheelchair-related adverse outcome was confirmed by a rehabilitation professional for 58.5 %, and at least one recommendation was given to 66.2 % during the 3-month monitoring period. A majority of participants found the intervention useful (82.8 %) and said they intended to use the MOvIT monitoring questionnaire in the future (81.5 %). Participants made suggestions to make the calls more adaptive to various ability profiles.

Conclusions

Automated calls tailored for individuals with mobility limitations and associated comorbidities are a promising approach to reach clients who need post-rehabilitation support.

Experiences of mobility device use over time: A multiple case study among very old Latvian women

AIM

To explore the experiences over time of using mobility devices (MDs) among very old women in the context of everyday life in Latvia.

METHODS

This study utilized a multiple case-study design that employed an explanatory mixed-methods approach. A combination of quantitative survey data on home and health and qualitative interview data for each participant were used to create three narratives to describe the experiences of MD use in everyday life over time, followed by a cross-case analysis.

RESULTS

The three cases illustrate that very old women accept and use MDs due to walking difficulties and related needs. Over time, functional decline combined with physical environmental barriers and changes in their social networks limited the supportive role that available MDs could offer these women.

CONCLUSIONS

The findings contribute to the understanding of the complexity of MD use in everyday life among very old women in Latvia and the need for different kinds of MDs. These findings illustrate the importance of considering the interaction between people's everyday life situation and their physical environment for their optimal use of MDs. This is important information for policy-makers who can optimize the services for old people in Latvia and support the need for occupational therapists' professional competence for the planning and development of MD provision.

[Needs, uses, cons-pros, good practices and opportunities about walker in elderly with loss of autonomy]

Non-use of the walker may be secondary to an initial inappropriate prescribing, a lack of adequate training, a lack of monitoring and side effects of using. Improving both stability and mobility in users is due to several biomechanical mechanisms. The benefits of walker are: general physiological effects, more confidence, better social life and decrease in the burden of care. The disadvantages of walker are: technical or practical aspects criticized by users, musculoskeletal disorders, delayed reaction time, fall risk and stigma. Few scientific data evaluating the interest of the walker concerning mobility exist, thus recommendations are low grade and are often taken from professional clinical experiences. The choice of technical walking assistance depends on the pathology and biomechanical mechanism. The walker robots are few distributed.

Users' satisfaction with assistive devices in South Korea

[Purpose] The objective of this study was to determine users’ satisfaction with assistive devices, and their serviceability and effectiveness. [Methods] A random sample of 138 users participated in this study. The Korean-Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 and an additional questionnaire were used for data collection. Data were analyzed by using descriptive statistics. [Results] Overall client satisfaction was high. Respondents most commonly reported use of their device for “personal activities of daily living” and “mobility”, and considered engagement in “activities of daily living”, and “social participation” to be most desirable, respectively. [Conclusion] This study will provide rehabilitation professionals with valuable information about client satisfaction with assistive devices.

Test-retest reliability and agreement of the Satisfaction with the Assistive Technology Services (SATS) instrument in two Nordic countries

PURPOSE

The purpose of this study was to investigate test-retest reliability, agreement, internal consistency, and floor- and ceiling effects of the Danish and Finnish versions of the Satisfaction with the Assistive Technology Services (SATS) instrument among adult users of powered wheelchairs (PWCs) or powered scooters (scooters).

METHOD

Test-retest design, two telephone interviews 7-18 days apart of 40 informants, with mean age of 67.5 (SD 13.09) years in the Danish; and 54 informants with mean age of 55.6 (SD 12.09) years in the Finnish sample.

RESULTS

The intra-class correlation coefficient varied between 0.57 and 0.93 for items in the Danish and between 0.41 and 0.93 in the Finnish sample. The percentage agreement varied between 54.2 and 79.5 for items in the Danish and between 69.2 and 81.1 in the Finnish sample, while the Cronbach's alpha values varied between 0.87 and 0.96 in the two samples. A ceiling effect was found in all items of both samples.

CONCLUSIONS

This study indicates that the SATS may be reliably administered for telephone interviews among adult PWC and scooter users, and give information about aspects of the service delivery process for quality development improvement purposes. Further psychometric testing of the SATS is required.

Development of clinical guidelines for the prescription of a seated wheelchair or mobility scooter for people with traumatic brain injury or spinal cord injury

BACKGROUND/AIM

Providing a wheelchair or scooter is a complex therapy intervention aimed at enhancing the person's functioning. The research and experience has shown that a wheelchair which is poorly matched to the individual, adversely affects potential activities and participation, lifestyle goals, health status and can be costly. The development of an evidence-based clinical guideline will provide a synthesis of the evidence and recommendations for best practice.

METHODS

The guidelines were developed using a rigorous methodology of systematic search for primary studies, critical appraisal and synthesis of the evidence using an adaptation of the National Health and Medical Research Council recommendation grades in conjunction with a multidisciplinary working party.

RESULTS

Seventy-six recommendations were developed from 44 clinical questions related to goals, assessment and review, capacity and performance, upper limb capacity and injury risk, wheelchair features, propulsion, training, transport and maintenance. Resources were developed to support the use of the guidelines. Only examples of recommendations are provided here. The complete guidelines and technical report should be downloaded from http://www.lifetimecare.nsw.gov.au/Brain_Injury.aspx.

CONCLUSION

The guidelines provide appraisal and synthesis of the literature and recommendations for best practice on the prescription of a wheelchair or scooter for adults with spinal cord injury and/or traumatic brain injury. The guidelines are intended to reduce the potential for poor wheelchair prescription, inform and guide practice to enhance outcomes. Through judicious application of the available research, these guidelines provide best practice recommendations for prescribing the most appropriate wheelchair for a person with a traumatic brain injury/spinal cord injury.

Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies

These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed.

Clinical standards for National Health Service wheelchair and seating services in Scotland

PURPOSE

To develop rigorous clinical standards for National Health Service (NHS) wheelchair and seating services in Scotland.

METHOD

Clinical standards and an evaluation tool were developed by a working group using a well-established methodology. The available evidence was reviewed and a person-centre, iterative, consensus decision-making approach was employed to draft the standards. A public consultation was undertaken. The draft evaluation tool was tested during pilot visits to two wheelchair and seating centres.

RESULTS

The majority of the 34 consultation responses were supportive, recognising the need to encourage and measure improvements and for a consistent approach to service delivery. Piloting found that the standards were challenging but achievable. The finalised standards and evaluation tool have been issued to health boards in Scotland.

CONCLUSIONS

Following a structured, interdisciplinary and consultative process, the first clinical standards for NHS wheelchair and seating services in the Scotland were developed. They emphasise the need for an anticipatory approach, shifting from a reactive model of service delivery to a proactive one. Although developed in the Scottish policy context and service delivery model, many aspects of the standards will be applicable to services based in other parts of the UK and beyond. Implications for Rehabilitation Clinical standards should be developed and validated using established, rigorous methodology with a person-centre and consensus decision-making approach that includes public consultation and piloting. Wheelchair and seating service provision should be anticipatory and person-centre. The clinical standards and the supporting evaluation tool provide the basis for consistent, high-quality services for those individuals who require wheelchair and seating provision.