Organizational Unit:
Center for Inclusive Design and Innovation

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The Accuracy of New Wheelchair Users’ Predictions about their Future Wheelchair Use

2012-06 , Hoenig, Helen , Griffiths, Patricia , Ganesh, Shanti , Caves, Kevin , Harris, Frances

Objective—This study examined the accuracy of new wheelchair user predictions about their future wheelchair use. Design—Prospective cohort study of 84 community dwelling veterans provided a new manual wheelchair. Results—The association between predicted and actual wheelchair use was strong at 3-months (phi coefficient = .56), with 90% of those who anticipated using the wheelchair at 3-months still using it (i.e., positive predictive value 0.96) and 60% of those who anticipated not using it indeed no longer using the wheelchair (i.e., negative predictive value 0.60, overall accuracy 0.92). Predictive Accuracy diminished over time, with overall accuracy declining from 0.92 at 3-months to 0.66 at 6-months. At all time points, and for all types of use, patients better predicted use as opposed to disuse, with correspondingly higher positive than negative predictive values. Accuracy of prediction of usage in specific indoor and outdoor locations varied according to location. Conclusions—This study demonstrates the importance of better understanding the potential mismatch between the anticipated and actual patterns of wheelchair use. The findings suggest that users can be relied upon to accurately predict their basic wheelchair-related needs in the short term. Further exploration is needed to identify characteristics that will aid users and their providers in more accurately predicting mobility needs for the long-term.

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Outcomes of an Expert vs. Usual Care Intervention for Manual Wheelchairs

2008 , Hoenig, Helen , Harris, Frances , Griffiths, Patricia , Sanford, Jon , Sprigle, Stephen

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Impact of Tilt-in-Space Power Wheelchairs on Health, Activity, and Participation

2008 , Harris, Frances , Sonenblum, Sharon Eve , Sprigle, Stephen , Maurer, Christine L.

This paper reports the results of a pre-post outcomes study on the impact of tilt-in-space power wheelchairs on the health, activity, and participation of 5 subjects. Using a methodology which combines traditional self-reports and activity monitoring technology, subjects who had previously used an upright power wheelchair were monitored at baseline and 3 months following receipt of a new tilt-in-space power wheelchair. Subjects visited similar numbers of destinations pre and post. However, wheelchair use metrics - including occupancy time, distance wheeled, and number of bouts - varied pre and post, without a consistent direction of change. Quality of life measured as self-perceived health status increased in all subjects. Although subject population is too small to generalize results, this study illustrates the complexity of participation measurement and the utility of this methodology to provide insights into the relationship between wheelchair use and activity and participation.

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A Case Study Comparing Activity and Participation Measurement in Two Subjects

2007 , Harris, Frances , Sonenblum, Sharon Eve , Sprigle, Stephen

This case study compares the differences between complementary methodologies that measure activity and participation in two subjects who use wheeled mobility devices. Data collection consisted of 1) a self-report participation measure for people with mobility disabilities - the Community Participation and Perceived Receptivity Survey (CPPRS) - and 2) a passive instrumentation data-gathering methodology that includes a global positioning system (GPS) data logger, followed by a prompted recall interview (PRI) to confirm GPS data location and query activity purpose. Many of the destination types (e.g., grocery stores) named in the CPPRS were confirmed by GPS/PRI data. Issues affecting subject responses in both methods included ambiguous categories and researcher assumptions about the nature of activity. Differences between self-report and instrumentation data are discussed as they impact understanding activity and community participation among wheeled mobility users and the development of self-report participation instruments.

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The Accuracy Of New Wheelchair User Predictions About Their Future Wheelchair Use

2010-06 , Hoenig, Helen , Griffiths, Patricia , Harris, Frances , Caves, Kevin , Sprigle, Stephen

This study examined the accuracy of new wheelchair user predictions about their future wheelchair use. We used an existing database of 71 new manual wheelchair users with data obtained at baseline, 3-­‐ and 6-‐months to examine the specificity, sensitivity, positive and negative predictive value of user predictions about anticipated amount and locations of wheelchair use. At 3-­‐months, the correlation between predicted and actual use was strong, with 90% of those who thought they would still be using the wheelchair still using it, and 60% of those who said they would not be using it indeed were not using the wheelchair. By 6-­‐months the predictive utility diminished substantially. Only 70% of subjects accurately predicted their continued use, while only 50% correctly predicted they would not be using their wheelchairs. This study demonstrates the importance of better understanding the potential mismatch between the anticipated and actual patterns of wheelchairs use.

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Outcomes of an Expert vs. Usual Care Intervention for Manual Wheelchairs

2008 , Harris, Frances

The importance of the assistive technology (AT) device acquisition process is well documented. Service delivery has been cited as a key factor in the high rates of device nonuse or abandonment, accidents, and fraud and abuse. This paper reports the results of a quasiexperimental study that compared a "multifactorial" intervention (IG) with a "usual care" (UCG) intervention among 84 veterans at the Durham VA Medical Center. Post-intervention assessments were conducted at 2-weeks, 3-months, and 6-months. The IG intervention required on average 30 more minutes of therapy compared to the UCG. The IG reported more frequent wheelchair use than the UCG for up to 6-months after the intervention itself (p,0.01). More persons in the IG reported any use of wheelchair inside the home (p=0.008) and there was a trend to more use outside the home (p=0.091). Exploratory descriptive analyses showed a greater proportion of the IG implemented diverse home modifications (e.g., 25% of the IG vs 14% of the UCG reported a ramp), and fewer reported difficulty performing tasks inside the home (e.g., at 6-months 50% of the IG and 27% of the UCG reported difficulty). Slightly fewer persons in the IG reported experiencing environmental barriers outside the home, and when they did experience barriers a greater proportion reported being able to overcome the barrier (e.g., 18% of the IG and 22% of the UCG reported curbs were a barrier to them, but 100% of the IG group reported being able to overcome curbs when encountered compared to 25% of the UCG). These data may help AT providers and managers to better meet client needs. In addition, they provide insurers, social policy experts, AT users and other stakeholders with evidencebased data to assist in decision-making regarding appropriate treatments for specific clinical needs.

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Measuring Activity and Participation Among Wheeled Mobility Users

2007 , Sprigle, Stephen , Harris, Frances , Sonenblum, Sharon

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Understanding Wheelchair Use Patterns: Tilt-in-Space

2008-03 , Sonenblum, Sharon Eve , Sprigle, Stephen , Harris, Frances , Maurer, Chris

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Characterization of Power Wheelchair Use in the Home and Community

2008 , Sonenblum, Sharon Eve , Sprigle, Stephen , Harris, Frances , Maurer, Christine L.

Objective: To characterize the use of power wheelchairs and to determine if multiple measures of mobility and occupancy jointly provide a more comprehensive picture of wheelchair usage and daily activity in full-time power wheelchair users than daily distance alone. Design: Prospective observational study. Setting: Subjects’ everyday mobility was measured in their homes and communities for two weeks and prompted recall interviews were conducted by phone. Participants: A convenience sample of 25 non-ambulatory, full-time power wheelchair users. Interventions: Not applicable. Main Outcome Measures: Wheelchair usage was logged electronically and GPS / interview data were used to isolate chair use to home, indoors but not at home and outdoor environments. Distance wheeled, time spent wheeling, number of bouts, time spent in the wheelchair and the percent of time in the wheelchair spent wheeling were measured to describe wheelchair use. Results: The median wheelchair user spent 10.6 hours (5.0-16.6) in his/her wheelchair daily and wheeled 1.085 km (0.238-10.585) over 58 minutes (16-173) and 110 bouts (36-282). Wheelchair use varied across subjects, within subjects from day-to-day, and between environments. Mobility bouts outdoors were longer and faster than those wheeled indoors. In a regression analysis, distance wheeled explained only 33% of the variation in the number of bouts and 75% in the time spent wheeling. Conclusions: Power wheelchair use varies widely both within and between individuals. Measuring distance, time and number of bouts provides a clearer picture of mobility patterns than measuring distance alone, while occupancy helps to measure wheelchair function in daily activities.

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Outcomes of an Assistive Technology Intervention Among Wheeled Mobility Users

2007 , Harris, Frances , Sprigle, Stephen

This paper reports the outcomes of an assistive technology (AT) intervention among seating and mobility clients at an acute rehabilitation hospital between 2002 and 2004. Three instruments, OTFACT, PIADS, and the ATOM, were administered during baseline and assessments made at 1 and 12 months post-intervention. Results showed that the measures were not significantly correlated at baseline, post 1 and post 12 months, indicating the intervention had a dissimilar impact on their respective constructs. Results are discussed in terms of methodological implications for future outcomes studies.

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