Åse Brandt

Older people's use of powered wheelchairs for activity and participation

OBJECTIVE The aims of this study were to investigate outcomes of older peoples use of powered wheelchairs and risk factors for negative outcomes. DESIGN The study was a cross-sectional interview-study including 111 powered wheelchair users over 65 years of age. RESULTS All participants used their powered wheelchair in the summer; nearly all users regarded it as important and found that it gave them independence. The wheelchair made activity and participation possible for the users. The most frequent activity in the summer was going for a ride, and in the winter it was shopping. However, some could not use the wheelchair for visits, and supplementary travel modes are called for. Users who could not walk at all or who could not transfer without assistance were more likely not to be able to carry out prioritized activities. Furthermore, other risk factors for negative outcomes and need for further research were identified. CONCLUSION The use of powered wheelchairs is a relevant societal intervention in relation to older people with limited walking ability in order to make activity and participation possible. It is likely that a larger proportion of older people could benefit from this intervention, in particular if current practices are improved taking activity and participation outcomes into consideration.

Mobility and mobility-related participation outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use.

Purpose: The aim was to investigate outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use regarding need for assistance when moving around, frequency of mobility-related participation, easiness/difficulty in mobility during participation, and number of participation aspects performed in everyday life. Method: The study was a prospective cohort study, using an instrument focusing on mobility-related participation outcomes of mobility device interventions (NOMO 1.0), at baseline, after 4-months and 1-year use. Results: The results show that the outcomes in terms of participation frequency and easiness in mobility occur in a short time perspective, and that the effects remained stable at 1-year follow-up. The frequency of going for a walk increased most prominently (26%). Even though the majority of the participation aspects were not performed, more often they became easier to perform: 56–91% found that shopping, walking and visiting family/friends were easier. Moreover, independence outdoors and indoors increased. Conclusions: This small study provides knowledge about the outcomes of powered wheelchairs and scooters in terms of mobility and mobility-related participation in real-life situations. The study supports results from former studies, but even so, larger studies are required in order to provide evidence for the effectiveness of powered wheelchairs and scooters. Implications for Rehabilitation Powered wheelchair and scoter interventions increased independence in mobility and easiness in mobility-related participation in everyday life. Easiness in participation can be considered an important follow-up dimension after powered wheelchair and scooter interventions. A 4-month follow-up time after powered wheelchair and scooter intervention seems adequate.

Very old Swedish women's experiences of mobility devices in everyday occupation: A longitudinal case study.

The use of mobility devices, such as walking sticks and rollators, increases during the ageing process. Our aim was to explore how very old single-living Swedish women experience the use of mobility devices over time, in relation to everyday occupation. A multiple case study strategy involving quantitative and qualitative data was used. The findings indicate that the use of mobility devices, rollators in particular, starts off as support for walking but over time becomes more involved in occupational performance, resulting in complex transactions between personal, environmental, and task components. Personal factors such as ability to adjust and adapt to different situations seem to be crucial for optimal mobility device use. Strategies and adaptive behavior were developed over the years while striving for maintained independence and participation. The use of mobility devices was described as something one has to accept, but also a constant reminder of your limitations, or as a possibility to remain active and to manage everyday occupation. The findings stress the need to adopt a comprehensive view when trying to facilitate everyday occupations in very old age. Physical, social, psychological aspects, combinations among assistive devices, and home modification all need to be reflected on and monitored over time.

Effects of lower limb prosthesis on activity, participation, and quality of life: a systematic review

Background: Effects presented on the use of assistive devices such as prosthesis are often based on laboratory findings (i.e. efficacy). Objectives: To summarise and evaluate findings from studies on effectiveness of lower limb prostheses for adults in real life contexts, primarily in terms of activity, participation, and quality of life (QoL) and secondarily in terms of user satisfaction, use/non-use, and/or cost-effectiveness. Study Design: Systematic review. Methods: We included controlled studies and non-controlled follow-up studies including both baseline and follow-up data. Using 14 different databases supplemented with manual searches, we searched for studies published from 1998 until June 2009. Results: Out of an initial 818 identified publications, eight met the inclusion criteria. Four studies reported on the effectiveness of a microprocessor-controlled knee (MP-knee) compared to a non-microprocessor-controlled knee (NMP-knee). Results were inconsistent except for quality of life and use/non-use, where the authors reported an improvement with the MP-knee compared to the NMP-knee. The remaining four studies included a diversity of prosthetic intervention measures and types of endpoints. Conclusions: Overall, there was an inconsistency in results and study quality. This review highlights the need for high-quality research studies that reflect the effectiveness of different prosthesis interventions in terms of users’ daily living and QoL. Clinical relevance Clinical guidelines are important to every practitioner. Information on expected effectiveness from assistive devices should be well founded and contain both facts about the device quality and its contribution to users’ daily lives. Thus, studies based on users’ experiences from prosthetic use in everyday life activities are of great importance.

Documentation of and satisfaction with the service delivery process of electric powered scooters among adult users in different national contexts

Purpose: The purpose of this study was to investigate how different service delivery systems for assistive devices were associated with the service delivery process (SDP) and user satisfaction in two national contexts when electric powered scooters were provided. Method: The study had a follow-up design based on a consecutive inclusion of 50 Danish and 86 Norwegian adults as they were about to be provided a scooter. A study-specific structured questionnaire for documentation of the SDP was administered. The Satisfaction with Assistive Technology Services was used for documenting user satisfaction with the SDP. Besides descriptive statistics, regression analysis was used to identify contributors of variance and predictors of user satisfaction. Results: The various steps of the SDP were carried out to a various degree. Significantly more total time was spent in the SDP in the Danish sample (p < 0.001). About 80% of the informants were satisfied/very satisfied with different aspects of the SDP. Time spent in the different steps was not associated with user satisfaction with the SDP. Conclusion: This study supports the assumption that structure of the service impacts on the SDP, but not that the process impacts on outcomes in terms of user satisfaction with the SDP. It may, however, be questioned whether this actually is an outcome. Implications for Rehabilitation The structure of assistive technology services impacts on the service delivery process Complex regulations for assistive technology grants increases the time use for assessment and administration User satisfaction with the service delivery process may not be an outcome dimension in the sense that outcomes are effects on the lives of users and their environments, but rather a quality indicator and therefore an evidence for more or less successful service delivery processes

Quality of evidence of assistive technology interventions for people with disability: An overview of systematic reviews

This overview summarizes the available evidence from systematic reviews of outcomes studies on various assistive technologies (AT) for persons with disabilities. Systematic reviews published betwee ...

Men's and women's perspectives on using a powered mobility device: benefits and societal challenges.

Abstract Objective: To describe how men and women experience their use of powered wheelchairs (PW) and powered scooters (PS) in everyday occupations, in the home and in society at large. Methods: A qualitative research approach with focus-group methodology was used. Four focus groups were created, with men and women as well as PW and PS users in different groups. Applying a descriptive approach, data were analysed according to the principles described by Krueger. Findings: Three categories emerged and revealed that even though use of PW and PS increased independence and enabled everyday occupations, participants struggled to be independent powered mobility device (PMD) users. They experienced many accessibility problems in dwellings and in society, described similarly by users of PW and PS. Men and women experienced their use of (PMD) differently, especially in relation to the service delivery process. Conclusions: The study contributes with new knowledge on accessibility for PW and PS users and related service delivery processes, stating that gender differences regarding provision and training must be taken into account. Occupational therapists can contribute to an enhanced understanding of PMD users’ challenges in person–environment–occupation transactions in the home and society, and thereby promote occupational justice for PMD users.

Effectiveness of Powered Mobility Devices in Enabling Community Mobility-Related Participation: A Prospective Study Among People With Mobility Restrictions

To investigate the effectiveness of powered mobility device (ie, powered wheelchair and scooter) interventions over a 1‐year period in Nordic countries.

Mobility-related participation and user satisfaction: Construct validity in the context of powered wheelchair use.

Purpose. The aim of this study was to investigate the constructs of mobility-related participation and user satisfaction, two important outcome dimensions within praxis and research on mobility device interventions. Method. To fulfill this aim, validity and reliability of a 12-item scale on mobility-related participation and a 10-item scale on user satisfaction were examined in the context of older peoples powered wheelchair use (n = 111). Rasch analysis and correlation analysis were applied. Results. Construct validity of both scales was confirmed. The reliability of the user satisfaction scale was good, while the mobility-related participation scale was not optimal in discriminating between persons with a high degree of mobility-related participation. It was demonstrated that mobility-related participation and user satisfaction are separate, not related constructs. Conclusions. It can be concluded that the investigated mobility-related participation and user satisfaction constructs appear to be valid. Since the two constructs are not related and both yield important information, both dimensions should be evaluated in outcomes research and praxis targeting powered wheelchair interventions. Reliability problems of the mobility-related participation scale indicate the complexity of this construct. The results have been instrumental in the development of a new scale for measuring mobility-related participation ‘The NOMO 1.0’.

Validation of housing standards addressing accessibility exploration of an activity-based approach

The aim was to explore the use of an activity-based approach to determine the validity of a set of housing standards addressing accessibility. This included examination of the frequency and the extent of accessibility problems among older people with physical functional limitations who used no mobility device (n = 10) or who used a wheelchair (n = 10) or a rollator (n = 10). The setting was a kitchen designed according to present housing standards. The participants prepared lunch in the kitchen. Accessibility problems were assessed by observation and self-report. Differences between the three participant groups were examined. Performing well-known kitchen activities was associated with accessibility problems for all three participant groups, in particular those using a wheelchair. The overall validity of the housing standards examined was poor. Observing older people interacting with realistic environments while performing real everyday activities seems to be an appropriate method for assessing accessibility problems.