Michelle L. Oyster

Manual Wheelchair Skills Capacity Predicts Quality of Life and Community Integration in Persons With Spinal Cord Injury

OBJECTIVES To determine wheelchair (WC) skills success rates for manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL). DESIGN Cross-sectional multisite study. SETTING Six Spinal Cord Injury Model Systems (SCIMS) centers. PARTICIPANTS Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a manual WC as their primary means of mobility. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation. RESULTS Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of ≤75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180° in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation. CONCLUSIONS For people with SCI who use a manual WC as their primary means of mobility, their ability to perform manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed.

Wheelchair Repairs, Breakdown, and Adverse Consequences for People With Traumatic Spinal Cord Injury

UNLABELLED McClure LA, Boninger ML, Oyster ML, Williams S, Houlihan B, Lieberman JA, Cooper RA. Wheelchair repairs, breakdown, and adverse consequences for people with traumatic spinal cord injury. OBJECTIVES To investigate the frequency of repairs that occurred in a 6-month period and the consequences of breakdowns on wheelchair users living with spinal cord injuries (SCIs), and to determine whether certain wheelchair and subject characteristics are associated with an increased number of repairs and adverse consequences. DESIGN Convenience sample survey. SETTING Sixteen Model Spinal Cord Injury Systems Centers that are part of the national database funded through the Department of Education, National Institute on Disability and Rehabilitation Research. PARTICIPANTS People with SCI who use a wheelchair for more than 40h/wk (N=2213). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The frequency of wheelchair repairs and occurrence of adverse consequences caused by a wheelchair breakdown in a 6-month period. RESULTS Within a 6-month period, 44.8% of full-time wheelchair users completed a repair, and 8.7% had an adverse consequence occur. People who use power wheelchairs required significantly more repairs (P<.001), and adverse consequences occurred more frequently (P<.001) compared with manual wheelchair users. The presence of power seat functions, and a persons occupational status or sex did not influence the number of repairs or adverse consequences. CONCLUSIONS Frequent repairs and breakdown can negatively impact a persons life by decreasing community participation and threatening health and safety. Mandatory compliance with the American National Standards Institute and the Rehabilitation Engineering and Assistive Technology Society of North America standards, changes in insurance reimbursement policy, and patient and clinician education are necessary to reduce the number of repairs and adverse consequences that occur.

The Relationship Between Quality of Life and Change in Mobility 1 Year Postinjury in Individuals With Spinal Cord Injury

OBJECTIVE To examine quality-of-life (QOL) factors and change in mobility in individuals with traumatic spinal cord injury (SCI) 1 year after injury. DESIGN Retrospective case study of National SCI Database data. SETTING SCI Model Systems (SCIMS) sites (N=18). PARTICIPANTS Subjects (N=1826; age >18y) who presented to an SCIMS site after traumatic SCI between June 2004 and July 2009 and returned for 1-year follow-up. All subjects had FIM mobility data for both assessments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Assessment of impairment based on Lower-Extremity Motor Score. Assessment of QOL based on Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire, Satisfaction With Life Scale, Self-perceived Health Status, and pain severity scores. RESULTS Of the sample, 55 individuals transitioned from walking to wheelchair use within 1 year of discharge. This group had the highest number of individuals from minority groups (52.8%) and the lowest employment rate (7.3%). Compared with individuals who transitioned from wheelchair use to walking or maintained wheelchair use or ambulation, the walking-to-wheelchair transition group had significantly lower QOL scores (P<.01), including higher depression (P<.01) and higher pain severity (P<.001). CONCLUSIONS Individuals with SCI who transitioned from walking at discharge to wheelchair use within 1 year had low QOL factors, including high pain and depression scores. Rehabilitation professionals should consider encouraging marginal ambulators to work toward functional independence from a wheelchair, rather than primary ambulation during acute inpatient rehabilitation.

Increases in wheelchair breakdowns, repairs, and adverse consequences for people with traumatic spinal cord injury.

Objective The aims of this study were to report the current incidence of wheelchair breakdowns, repairs, and consequences and to compare current data with historical data. Design A convenience sample survey of 723 participants with spinal cord injury who use a wheelchair for more than 40 hrs/wk treated at a Spinal Cord Injury Model Systems center was conducted. Results Significant increases were found in the number of participants reporting repairs (7.8%) and adverse consequences (23.5%) in a 6-mo period (2006–2011) compared with historical data (2004–2006) (P < 0.001). When examining current data, minorities experienced a greater frequency and higher number of reported consequences (P = 0.03). Power wheelchair users reported a higher number of repairs and consequences than did manual wheelchair users (P < 0.001). Wheelchairs equipped with seat functions were associated with a greater frequency of adverse consequences (P = 0.01). Repairs did not vary across funding source, but individuals with wheelchairs provided by Medicare and Medicaid reported a higher frequency of consequences than did the combined group of the Department of Vocational Rehabilitation, Worker’s Compensation, and the Veterans Administration (P = 0.034 and P = 0.013, respectively). Conclusions The incidence and consequences of repairs are increasing from what was already a very high statistic in this United States population. Further investigation into causality is required, and intervention is needed to reverse this potential trend.

Investigation of Factors Associated With Manual Wheelchair Mobility in Persons With Spinal Cord Injury

OBJECTIVE To quantify wheelchair mobility of persons with a spinal cord injury (SCI), and to assess the relationship between wheelchair mobility and demographics, type of manual wheelchair, and participation. DESIGN Cross-sectional study. SETTING Six Model Spinal Cord Injury Systems. PARTICIPANTS People (N=132) with SCI who use a manual wheelchair as their primary means of mobility. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Wheelchair-related mobility characteristics measured by a data-logging device, and community participation measured by the short form of the Craig Handicap Assessment Recording Technique (CHART). RESULTS Age was found to be significantly (r=-.225, P<.01) related to average speed traveled per day. Whites were found to travel significantly further (P<.01) and accumulate more minutes per day (P<.01) compared with minorities. Participants who were employed traveled significantly further (P<.01), faster (P<.01), and for more minutes per day (P<.01) compared with those who were not employed. A moderate relationship (r=.245-.390) was found between wheelchair mobility data and CHART total score. CONCLUSIONS Results suggest a need for future investigation of the factors that influence wheelchair mobility and community participation of persons with SCI. Findings indicate the efficacy of a quantitative method to track wheelchair mobility in community settings, which could serve as a way of identifying community participation for persons with SCI and possibly uncovering additional aspects of participation.

Examining implicit bias of physicians who care for individuals with spinal cord injury: A pilot study and future directions.

Abstract Context Despite evidence that healthcare providers have implicit biases that can impact clinical interactions and decisions, implicit bias among physicians caring for individuals with spinal cord injury (SCI) has not been examined. Objective Conduct a pilot study to examine implicit racial bias of SCI physicians and its association with functioning and wellbeing for individuals with SCI. Design Combined data from cross-sectional surveys of individuals with SCI and their SCI physicians. Setting Four national SCI Model Systems sites. Participants Individuals with SCI (N = 162) and their SCI physicians (N = 14). Outcome measures SCI physicians completed online surveys measuring implicit racial (pro-white/anti-black) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. We used multilevel regression analyses to examine the associations of physician bias and outcomes of individuals with SCI. Results Physicians had a mean bias score of 0.62 (SD = 0.35), indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration (odds ratio = 4.80, 95% confidence interval (CI) = 1.44, 16.04), as well as higher depression (B = 3.24, 95% CI = 1.06, 5.41) and lower life satisfaction (B = −4.54, 95% CI= −8.79, −0.28). Conclusion This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomes.

Criterion validity and accuracy of global positioning satellite and data logging devices for wheelchair tennis court movement

Abstract Purpose To compare the criterion validity and accuracy of a 1 Hz non-differential global positioning system (GPS) and data logger device (DL) for the measurement of wheelchair tennis court movement variables. Methods Initial validation of the DL device was performed. GPS and DL were fitted to the wheelchair and used to record distance (m) and speed (m/second) during (a) tennis field (b) linear track, and (c) match-play test scenarios. Fifteen participants were monitored at the Wheelchair British Tennis Open. Results Data logging validation showed underestimations for distance in right (DLR) and left (DLL) logging devices at speeds >2.5 m/second. In tennis-field tests, GPS underestimated distance in five drills. DLL was lower than both (a) criterion and (b) DLR in drills moving forward. Reversing drill direction showed that DLR was lower than (a) criterion and (b) DLL. GPS values for distance and average speed for match play were significantly lower than equivalent values obtained by DL (distance: 2816 (844) vs. 3952 (1109) m, P = 0.0001; average speed: 0.7 (0.2) vs. 1.0 (0.2) m/second, P = 0.0001). Higher peak speeds were observed in DL (3.4 (0.4) vs. 3.1 (0.5) m/second, P = 0.004) during tennis match play. Conclusions Sampling frequencies of 1 Hz are too low to accurately measure distance and speed during wheelchair tennis. GPS units with a higher sampling rate should be advocated in further studies. Modifications to existing DL devices may be required to increase measurement precision. Further research into the validity of movement devices during match play will further inform the demands and movement patterns associated with wheelchair tennis.

Manual wheelchair-related mobility characteristics of older adults in nursing homes

Aim. Manual wheelchairs are commonly prescribed for older adults in nursing homes (NH). The extent of their utilisation being unknown may result in the prescription of standard wheelchairs. The purpose of this study was to quantify manual wheelchair use by nursing home residents. Methods. Seventy-two independent wheelchair users were recruited from four NH (two VA-affiliated and two private). A customised wheelchair data logger was attached to each participants wheelchair for 1 month. Data were reduced and compared separately for VA- affiliated and private facilities by types of propulsion pattern (arms versus legs and the combination of arms and legs) using MANOVA. Results. Participants from the VA-affiliated facilities who used their arms were covering more distance (1451 m versus 806 m), with greater endurance (73 m versus 60 m) as compared to participants who used combination of arms and legs. However, no difference was observed between velocity of wheelchair propulsion between groups (0.48 m/s versus 0.58 m/s). For private facilities no notable difference was observed between the groups. Conclusion. Older adults who live in NH and use of wheelchairs represent a diverse cohort. The efficacy of using an objective assessment method to measure the extent of use of wheelchairs was demonstrated in this study.

The Relationship between Wheelchair Mobility Patterns and Community Participation among Individuals with Spinal Cord Injury

Participation is considered the most meaningful outcome of rehabilitation. The purpose of this study was to investigate whether there were correlations between wheelchair activity recorded with a data logger and community participation as measured by the Participation Survey/Mobility. Data from 16 participants were included in this study. Data collected during a two week period using a data logging device were analyzed to determine the mobility characteristics of participants. Among manual wheelchair users, significant positive correlations were found between average speed traveled and the community participation content areas of transportation (rs = .837, p = .019) and socialization (rs = .772, p = .042). In addition, for manual wheelchair users there was a trend toward a significant correlation between average speed traveled and total community participation score (rs = .714, p = .071). Among power wheelchair users, there was a trend toward a significant negative correlation between average speed traveled and the community participation content area of leisure activity (rs = −.635, p = .066). Understanding the relationship between wheelchair speed and community participation can be useful information to enable clinicians to recommend the most appropriate mobility devices designed to enhance community participation.

Emergency Evacuation Readiness of Full-Time Wheelchair Users With Spinal Cord Injury

OBJECTIVES To determine the percentage of full-time wheelchair users with spinal cord injuries who felt they could evacuate from various locations, and the percentage who have a plan for evacuation. Study results will help clinicians and emergency officials understand needs related to evacuation preparedness. DESIGN Convenience sample survey. SETTING Six Spinal Cord Injury Model System centers, part of the national database funded through the Department of Education, National Institute on Disability and Rehabilitation Research. PARTICIPANTS People (N=487) with spinal cord injuries who use a wheelchair more than 40 hours a week. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The percentage of wheelchair users who felt they would be able to safely evacuate, had a plan for safe evacuation, or reported a need for assistive technology and human assistance to evacuate from various locations in the event of an emergency. RESULTS The highest percentage of participants felt they would be able to safely evacuate and had a plan for work evacuation. The lowest percentage of participants reported they could evacuate from their city/town in the event of an emergency and had a plan to evacuate their city/town in the event of a natural disaster. A large difference exists between the percentage of participants who felt they could evacuate and those who have a plan for evacuation. CONCLUSIONS A large discrepancy exists between the perception that one can evacuate and actually having a plan. The perception that one can evacuate without a plan or the use of assistive technology is an area of concern that must be further addressed by educators. Education must emphasize the need to have a defined evacuation plan and effective utilization of assistive technology.