W. Ben Mortenson

Association Between Mobility, Participation, and Wheelchair-Related Factors in Long-Term Care Residents Who Use Wheelchairs as Their Primary Means of Mobility

To explore how wheelchair‐related factors, mobility, and participation are associated in a sample of long‐term care residents who use wheelchairs as their primary means of mobility.

Challenges and strategies pertaining to recruitment and retention of frail elderly in research studies: A systematic review

INTRODUCTION Recruitment and retention of frail elderly in research studies can be difficult. OBJECTIVE To identify challenges and strategies pertaining to recruitment and retention of frail elderly in research studies. METHODS A systematic review was conducted. Four databases (MEDLINE, CINAHL, AgeLine, Embase) were searched from January 1992 to December 2012. Empirical studies were included if they explored barriers to or strategies for recruitment or retention of adults aged 60-plus who were identified as frail, vulnerable or housebound. Two researchers independently determined the eligibility of each abstract reviewed and assessed the level of evidence presented. Data concerning challenges encountered (type and impact) and strategies used (type and impact) were abstracted. RESULTS Of 916 articles identified in the searches, 15 met the inclusion criteria. The level of evidence of the studies retained varied from poor to good. Lack of perceived benefit, distrust of research staff, poor health and mobility problems were identified as common challenges. The most frequently reported strategies used were to establish a partnership with staff that participants knew and trusted, and be flexible about the time and place of the study. However, few studies performed analyses to compare the impact of specific challenges and strategies on refusal or drop-out rates. CONCLUSIONS This review highlights the need to improve knowledge about the impact of barriers and strategies on recruitment and retention of frail older adults. This knowledge will help to develop innovative and cost-effective ways to increase and maintain participation, which may improve the generalizability of research findings to this population.

Mixed methods research in occupational therapy: a survey and critique

Mixed qualitative and quantitative studies are becoming popular in social sciences research and are recognized as legitimate project designs. However, diverse definitions and applications are common and little consensus exists about exactly what constitutes a mixed methods approach. In this article, the authors provide an overview of various approaches to mixed methods and present the findings derived from a survey of mixed methods research published between 2000 and 2005 in nine occupational therapy journals. The results from this survey indicate that, although the use of mixed methods is relatively common (14% of all research articles published), there are several methodological issues to be considered. These include the subordinate positioning of qualitative findings and lack of justification for using mixed methods. Recommendations are offered to conceptually advance future applications and guide occupational therapy researchers considering the use of mixed methods.

A survey of stakeholder perspectives on exoskeleton technology

BackgroundExoskeleton technology has potential benefits for wheelchair users’ health and mobility. However, there are practical barriers to their everyday use as a mobility device. To further understand potential exoskeleton use, and facilitate the development of new technologies, a study was undertaken to explore perspectives of wheelchair users and healthcare professionals on reasons for use of exoskeleton technology, and the importance of a variety of device characteristics.MethodsAn online survey with quantitative and qualitative components was conducted with wheelchair users and healthcare professionals working directly with individuals with mobility impairments. Respondents rated whether they would use or recommend an exoskeleton for four potential reasons. Seventeen design features were rated and compared in terms of their importance. An exploratory factor analysis was conducted to categorize the 17 design features into meaningful groupings. Content analysis was used to identify themes for the open ended questions regarding reasons for use of an exoskeleton.Results481 survey responses were analyzed, 354 from wheelchair users and 127 from healthcare professionals. The most highly rated reason for potential use or recommendation of an exoskeleton was health benefits. Of the design features, 4 had a median rating of very important: minimization of falls risk, comfort, putting on/taking off the device, and purchase cost. Factor analysis identified two main categories of design features: Functional Activities and Technology Characteristics. Qualitative findings indicated that health and physical benefits, use for activity and access reasons, and psychosocial benefits were important considerations in whether to use or recommend an exoskeleton.ConclusionsThis study emphasizes the importance of developing future exoskeletons that are comfortable, affordable, minimize fall risk, and enable functional activities. Findings from this study can be utilized to inform the priorities for future development of this technology.

Broadening the Conceptualization of Participation of Persons With Physical Disabilities: A Configurative Review and Recommendations.

Within the context of physical disability, participation has typically been conceptualized in terms of ones performance of different roles and activities. This perspective, however, ignores the meanings and satisfactions that a person derives from participating. Without an accepted conceptualization of participation that accounts for peoples subjective perceptions and experiences, it is challenging for decision-makers and service providers to design meaningful participation-enhancing services, programs, and policies. Accordingly, our objectives were (1) to conduct a review of definitions and conceptualizations of participation that extend beyond performance and capture peoples subjective experiences of participating and (2) to identify key experiential aspects of participation that can be used as a basis for conceptualizing and operationalizing the concept more broadly. The project involved a systematic, configurative review of relevant literature. Ten relevant articles were identified. Information on characteristics associated with experiential aspects of participation was extracted and subjected to a thematic analysis. The following 6 themes emerged: autonomy, belongingness, challenge, engagement, mastery, and meaning. Drawing on these findings, it is recommended that the individuals subjective perceptions of autonomy, belongingness, challenge, engagement, mastery, and meaning associated with participating be incorporated into conceptualizations and operationalizations of the participation construct. This recommendation provides a starting point for clinicians, researchers, and policymakers to conceptualize and measure the participation concept more consistently and more broadly.

Prevalence of Wheelchair and Scooter Use Among Community-Dwelling Canadians

Background Mobility impairments are the third leading cause of disability for community-dwelling Canadians. Wheelchairs and scooters help compensate for these challenges. There are limited data within the last decade estimating the prevalence of wheelchair and scooter use in Canada. Objective The aims of this study were: (1) to estimate the prevalence of wheelchair and scooter use in Canada and (2) to explore relevant demographic characteristics of wheelchair and scooter users. Design This study was a secondary analysis of a cross-sectional national survey. Methods The Canadian Survey on Disability (2012) collected data on wheelchair and scooter use from community-dwelling individuals aged 15 years and over with a self-identified activity limitation on the National Household Survey. Prevalence estimates were calculated as weighted frequencies, with cross-tabulations to determine the number of wheelchair and scooter users in Canada, by province, and demographic characteristics (ie, age, sex) and bootstrapping to estimate the variance of all point estimates. Results There were approximately 288,800 community-dwelling wheelchair and scooter users aged 15 years and over, representing 1.0% of the Canadian population. The sample included 197,560 manual wheelchair users, 42,360 powered wheelchair users, and 108,550 scooter users. Wheelchair and scooter users were predominantly women, with a mean age of 65 years. Approximately 50,620 individuals used a combination of 2 different types of devices. Limitations The results are representative of individuals living in the community in Canada and exclude individuals in residential or group-based settings; estimates do not represent the true population prevalence. Conclusion This analysis is the first in more than 10 years to provide a prevalence estimate and description of wheelchair and scooter users in Canada. Since 2004, there has been an increase in the proportion of the population who use wheelchairs and scooters, likely related to an aging Canadian population. These new prevalence data have potential to inform policy, research, and clinical practice.

The power(s) of observation: theoretical perspectives on surveillance technologies and older people

ABSTRACT There is a long history of surveillance of older adults in institutional settings and it is becoming an increasingly common feature of modern society. New surveillance technologies that include activity monitoring, and ubiquitous computing, which are described as ambient assisted living (AAL), are being developed to provide unobtrusive monitoring and support of activities of daily living and to extend the quality and length of time older people can live in their homes. However, concerns have been raised with how these kinds of technologies may affect users privacy and autonomy. The objectives of this paper are (a) to describe the development of home-based surveillance technologies; (b) to examine how surveillance is being restructured with the use of this technology; and (c) to explore the potential outcomes associated with the adoption of AAL as a means of surveillance by drawing upon the theoretical work of Foucault and Goffman. The discussion suggests that future research needs to consider two key areas beyond the current discourse on technology and ageing, specifically: (a) how the new technology will encroach upon the private lived space of the individual, and (b) how it will affect formal and informal caring relationships. This is critical to ensure that the introduction of AAL does not contribute to the disempowerment of residents who receive this technology.

Predictors of mobility among wheelchair using residents in long-term care

OBJECTIVE To identify predictors of mobility among long-term care residents who use wheelchairs as their main means of mobility. Based on the Matching Person to Technology Model, we hypothesized that wheelchair-related, personal, and environmental factors would be independent predictors of mobility. DESIGN Cross-sectional study. SETTING Eleven long-term residential care facilities in the lower mainland of British Columbia, Canada. PARTICIPANTS Residents (N=268): self-responding residents (n=149) and residents who required proxy respondents (n=119). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mobility was measured using the Nursing Home Life-Space Diameter. Standardized measures of personal, wheelchair-related, and environmental factors were administered and sociodemographic data were collected as independent variables. RESULTS Independent mobility decreased as the distance from the residents room increased: 63% of participants were independently mobile on their units, 40% were independently mobile off their units within the facilities, and 20% were independently mobile outdoors. For the total sample, the significant predictors of mobility, in descending order of importance, were: wheelchair skills (including the capacity to engage brakes and maneuver), functional independence in activities of daily living, having 4 or more visits per week from friends or family, and use of a power wheelchair. This regression model accounted for 48% of variance in mobility scores. CONCLUSIONS Limited independent mobility is a common problem among facility residents. Residents may benefit from interventions such as wheelchair skills training or provision of powered mobility, but the effectiveness of these interventions needs to be evaluated.

Myofascial Treatment for Patients With Acetabular Labral Tears: A Single-Subject Research Design Study

STUDY DESIGN Single-subject research design using 4 consecutive patients. OBJECTIVE To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin. BACKGROUND Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients. METHODS This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention. RESULTS All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain. CONCLUSION Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles. Level of Evidence Therapy, level 4.

No Place Like Home?: Surveillance and What Home Means in Old Age

Les technologies de surveillance nouvelles, telles que celles inclus dans le logement avec assistance ambiante—les capteurs environnementaux portés sur le corps, les interfaces intelligentes, et les réseaux de communication—sont en cours d’élaboration afin d’améliorer la sécurité et la sûreté des personnes âgées qui sont à risque, mais des questions éthiques ont été soulevées quant à dans quelle mesure ils compromettraient les droits et la vie privée des personnes à surveiller. L’étude qualitative que nous avons mené a été conçu pour nous aider à comprendre les façons dont ces technologies de surveillance nouvelles seraient influencer les expériences quotidiennes des individus de leur maison. Les participants ont estimé que de nouvelles formes de surveillance auraient une influence sur leur sentiment de sécurité, de l’autonomie et de la confiance en soi, et modifieraient leurs perceptions chez soi. Les résultats soulignent la nécessité d’améliorer notre compréhension de la façon dont le logement assisté ambiant affectera la vie des personnes à surveiller.New surveillance technologies like those included in ambient assisted living – such as body-worn and passive environmental sensors, smart interfaces, and communications networks – are being developed to improve the security and safety of “at risk” older people, but ethical questions have been raised about the extent to which they compromise the rights and privacy of the people being monitored. The qualitative study we conducted was designed to help us understand the ways these novel surveillance technologies would influence individuals’ everyday experiences of home. Participants felt new forms of surveillance would influence their sense of security, autonomy, and self-confidence, and would alter perceptions of home. The findings emphasize the need to improve our understanding of how ambient assisted living will affect the lives of those being monitored.