The ambiguity of standing in standing devices: a qualitative interview study concerning children and parents experiences of the use of standing devices

Exploring powered wheelchair standing device use in children and adults: a longitudinal case series

PURPOSE

The purpose of this case series was to explore the influence of powered wheelchair standing device (PWSD) use on participants': (1) activities and participation; (2) quality of life; and (3) lower extremity passive range of motion (LE PROM).

CASE DESCRIPTION

Eight participants enrolled in the case series (five adults and three children). Outcome measures included: the Canadian Occupational Performance Measure (COPM), the EQ-5D-5L or the EQ-5D-Y, the Patient-Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), LE PROM measurements and PWSD use data automatically collected by each PWSD. Participants were provided with a front wheel-drive PWSD designed for both outdoor and indoor use for up to 12-months of use.

OUTCOMES

Four participants completed the 12-month case series. Three participants achieved clinically significant improvements in performance on the COPM. Three of the four participants reporting issues with constipation achieved clinically significant improvements in their total PAC-QOL scores. Almost all participants demonstrated changes in some LE PROM.

CONCLUSIONS

Applying the Human Activity Assistive Technology model may help to explain differences in both PWSD use and outcomes amongst the individual participants in this case series. The participants who were most successful in using the PWSD were in environments with sufficient space to use the PWSD to perform everyday activities and had higher frequencies of PWSD use. The outcomes of this case series may assist both researchers and clinicians when implementing future PWSD studies recommending PWSDs to their clients/patients. Implications for rehabilitationA wide variety of factors may influence powered wheelchair standing device (PWSD) use.PWSD use may lead to improvements in activities, participation, quality of life and lower extremity passive range of motion.The participants who were most successful in using the PWSD were in environments that permitted use of the PWSD during the performance of everyday activities.COVID-19 restrictions prohibited in-person sessions with a therapist, which could have assisted participants in better integrating the PWSD in their daily lives.

"I'm in a very good frame of mind": a qualitative exploration of the experience of standing frame use in people with progressive multiple sclerosis

OBJECTIVES

The study aim was to explore the experiences of people with progressive multiple sclerosis (MS) and their standing assistants during their participation in Standing Up in Multiple Sclerosis, a randomised controlled trial (RCT) of a home-based, self-managed standing frame programme.

DESIGN

A qualitative approach, using audio diary methodology was used to collect data contemporaneously. Diary data were transcribed verbatim and analysed using thematic analysis.

SETTING

Participants were recruited from eight healthcare organisations in two regions of the UK. The intervention was home-based.

PARTICIPANTS

As part of the RCT, 140 participants were randomly allocated to either usual care or usual care plus a standing frame programme. Using a sampling matrix 12 people with progressive MS (6 female, aged 35-71 years, Expanded Disability Status Scale 6.5-8.0) and 8 standing assistants (4 female) kept audio diaries of their experiences.

INTERVENTION

The standing frame programme involved two face-to-face home-based physiotherapy sessions to set up the standing frame programme, supplemented by educational material designed to optimise self-efficacy. Participants were encouraged to stand for at least 30 min, three times a week for the 36-week study period.

RESULTS

Four main themes were identified: "Feeling like the old me"; 'Noticing a difference'; "I want to do it right" and "You have a good day, you have a bad day".

CONCLUSIONS

Supported standing helped people with progressive MS feel more like their old selves and provided a sense of normality and enjoyment. People noticed improvements in physical and psychological symptoms, which were often associated with increased participation in activities they valued. Provision of support from a physiotherapist and recognition of the variable nature of the condition were highlighted as factors to consider when establishing a standing programme.

TRIAL REGISTRATION NUMBER

ISRCTN69614598.