William B. Mortenson

Issues for the Selection of Wheelchair-Specific Activity and Participation Outcome Measures: A Review

OBJECTIVESnTo use the World Health Organizations International Classification of Functioning, Disability and Health as a framework to identify and to evaluate wheelchair-specific outcome instruments that are useful for measuring activity and participation.nnnDATA SOURCESnCINHAL, PsychInfo, EMBASE, Google Scholar, Dissertation Abstracts Medline databases, and conference proceedings.nnnSTUDY SELECTIONnActivity and participation measures that were specifically intended for adults who use wheelchairs and that were published in English in a peer-reviewed journal were included in this review. Based on electronic database searches using a variety of search terms, articles were identified by title, and appropriate abstracts were retrieved. Articles were obtained for all relevant abstracts. For peer-reviewed measures included in the review, we obtained any instruction manuals and related publications, frequently published in conference proceedings and theses or available electronically, on the development and testing of the measure.nnnDATA EXTRACTIONnTools included in the review were evaluated based on their conceptual coverage, reliability, validity, responsiveness, usefulness, and wheelchair contribution, which indicated how well the tool isolated the effect of the wheelchair on activity and participation outcomes.nnnDATA SYNTHESISnA number of conceptual, psychometric, and applicability issues were identified with the 11 wheelchair-specific measures included in the review. A majority of the measures were mobility focused. No single tool received excellent ratings in all areas of the review. Some of the most frequent issues identified included a failure to account for differences attributable to different wheelchairs and wheelchair seating, limited psychometric testing, and high administrative and respondent burden.nnnCONCLUSIONSnGood reliability evidence was reported for most of the measures, but validity information was only available for 6 of the 11 measures, and responsiveness information for 3. This review suggests that these measures could be improved with further psychometric testing and with some modification to ensure that the contribution of the wheelchair to activity and participation outcomes is clearly identified.

Measuring wheelchair intervention outcomes: Development of the Wheelchair Outcome Measure

Purpose. Provision of a wheelchair has immediate intuitive benefits; however, it can be difficult to evaluate which wheelchair and seating components best meet an individuals needs. As well, funding agencies now prefer evidence of outcomes; and therefore measurement upon prescription of a wheelchair or its components is essential to demonstrate the efficacy of intervention. As no existing tool can provide individualized goal-oriented measure of outcome after wheelchair prescription, a research project was undertaken to create the Wheelchair Outcome Measure (WhOM). Method. A mixed methods research design was employed to develop the instrument, which used in-depth interviews of prescribers, individuals who use wheelchairs and their associates, supplemented by additional questions in which participant preferences in key areas of the measure were quantified. Results. The WhOM is a client-specific wheelchair intervention measurement tool that is based on the World Health Organizations International Classification of Function, Disability, and Health. It identifies desired outcomes at a participation level and also acknowledges concerns about body structure and function. Conclusion. The new outcome instrument will allow clients to identify and evaluate the outcomes they wish to achieve with their wheelchairs and seating and provide clinicians a way to quantify outcomes of their interventions in a way that is meaningful to the client and potential funding sources.

Reliability and validity of the telephone administration of the wheelchair outcome measure (WhOM) for middle-aged and older users of power mobility devices

OBJECTIVEnTo examine the measurement properties of the tele-phone administration of the Wheelchair Outcome Measure (WhOM).nnnSUBJECTSnPower mobility device users aged 50-89 years.nnnMETHODSnTwo independent cohorts were recruited: (i) a prospective cohort (n = 40) to estimate test-retest reliability and to determine the applicability of the telephone format, and (ii) a cross-sectional cohort to examine construct validity with 3 groups: (a) people waiting for a first power mobility device (n = 44); (b) initial users (n = 35; 1-6 months); and (c) long-term users (n = 39; 12-18 months).nnnRESULTSnThe tool demonstrated good test-retest reliability (intraclass correlation coefficient 0.77-1.00), took 10.9 min (standard deviation = 5.2) to administer and was practical to use over the telephone. Validity testing showed moderate correlations with the Quebec User Evaluation of Satisfaction with Technology (rS = 0.36-0.45) and the Psychosocial Impact of Assistive Devices Scale (rS = 0.31-0.43). WhOM scores could discriminate non-users from users (wait-list vs initial users; wait-list vs long-term users, p < 0.001) and power wheelchair from scooter users (total WhOM scores, p < 0.05).nnnCONCLUSIONnThe WhOM is a stable, valid and applicable measure for telephone administration with older power mobility device users. It is moderately linked to satisfaction with the device and to the psychosocial impact of the device, and therefore complements rather than replaces those measures.

Measurement properties of the wheelchair outcome measure in individuals with spinal cord injury

Study design:One-week retest methodological study.Objectives:To assess the reliability and validity of the wheelchair outcome measure (WhOM) in a sample of individuals with spinal cord injury (SCI).Setting:Vancouver, British Columbia, Canada.Methods:The WhOM measures the impact of wheelchair interventions on a users self-selected participation outcomes. The WhOM was administered to 50 participants on two occasions by the same rater, 1 week apart, to assess test-retest reliability. To determine inter-rater reliability, the WhOM was administered a third time approximately 72u2009h later by a different rater. Validity was evaluated by correlating scores from the WhOM with scores from the Assessment of Life Habits (LIFE-H).Results:The test-retest intraclass correlation coefficients (ICC2, 2) for the WhOM satisfaction (Sat) and WhOM importance (Impt) × Sat scores were 0.83 (95% confidence interval (CI), 0.72–0.90) and 0.88 (95% CI, 0.79–0.93), respectively. The inter-rater ICC for the WhOM Sat and WhOM Impt × Sat scores were 0.91 (95% CI, 0.85–0.95) and 0.90 (95% CI, 0.83–0.94), respectively. As hypothesized, most scores on the WhOM were fair to moderate (r=0.3–0.5) and positively correlated with scores on the LIFE-H.Conclusion:The WhOM is a new outcome measure that demonstrates good reliability and validity among individuals with SCI. It is designed to assist wheelchair users identify and evaluate the impact of wheelchair interventions on participation level outcomes. The WhOM may be applicable for clinical- or research-oriented purposes.

Prevalence and Predictors of Need for Seating Intervention and Mobility for Persons in Long-Term Care

Une étude transversale descriptive a été effectuée afin de déterminer la prévalence du besoin de places de fauteuil roulant dans deux établissements de soins de longue duréeà Vancouver, en Colombie-Britannique; de déterminer l’étendue de la mobilité autonome des résidents dans ces établissements; et d’explorer la relation entre les places de fauteuil roulant appropriées et le positionnement et la mobilité autonome. La population étudiée comprenait 99 adultes âgés en fauteuil roulant. Quatre évaluateurs expérimentés ont estimé les besoins d’intervention en matière de places à l’aide du Seating Identification Tool (outil de détermination des places) et quantifié l’étendue et la fréquence de la mobilité en chaise roulante à l’aide du Nursing Home Life-Space Diameter (diamètre de l’espace vital dans les centres d’hébergement et de soins de longue durée). Les résultats ont indiqué qu’une intervention était moins pressante pour des places de fauteuil roulant dans les deux établissements; que la moitié des résidents pouvaient se déplacer de façon autonome dans leurs propres chambres et leurs unités, mais que la mobilité autonome diminuait lorsque les distances à parcourir étaient plus grandes; et que le besoin d’intervention en matière de places de fauteuil roulant était le seul prédicteur significatif de l’étendue de la mobilité autonome. Ces résultats suggèrent que, si l’établissement possède des ressources adéquates en matière de personnel spécialisé et d’équipements, le besoin d’une intervention pour des places de fauteuil roulant peut être réduit et que la mobilité autonome des résidents des établissements de soins de longue durée peut être maximisée. A descriptive cross-sectional study was conducted to (a) determine the prevalence of need for wheel-chair seating intervention in two long-term care facilities in Vancouver, BC, (b) determine the extent of the residents’ independent mobility within these facilities, and (c) explore the relationship between proper wheel-chair seating and positioning and independent mobility. The study population comprised 99 wheel-chair-using older adults. Four trained raters assessed need for seating intervention, using the Seating Identification Tool, and quantified extent and frequency of wheel-chair mobility, using the Nursing Home Life-Space Diameter. Results indicated that (a) there was a low need (overall 22%) for wheel-chair seating intervention in the two facilities, (b) half of the residents were independently mobile in their own rooms and on their units, but independent mobility decreased when greater distances needed to be travelled, and (c) the need for wheel-chair seating intervention was the only significant predictor of extent of independent mobility. These findings suggest that, where there are dedicated staff and equipment resources, the need for wheel-chair seating intervention can be minimized and independent mobility for long-term care residents maximized.

The power of power wheelchairs: Mobility choices of community-dwelling, older adults

Abstract Background: Power wheelchairs are purported to have a positive effect on health, occupation, and quality of life. However, there is limited knowledge about what factors shape power wheelchair use decisions. Aims/objectives: A study was undertaken to understand the mobility choices of community-dwelling, power wheelchair users. Methods: A series of semi-structured qualitative interviews was conducted with 13 older adult power wheelchair users. Participants were interviewed at enrollment and four months later. Data analysis was informed by Bourdieu’s theoretical constructs of habitus, capital, and field. Results: Three main styles of power wheelchair use were identified: reluctant use, strategic use, and essential use, and each type is illustrated using an aggregate case study. Conclusion/significance: These findings highlight the need to alter the power relationship that exists between prescribers and device users and to effect policy changes that enable people with physical impairments to make as wide a range of mobility choices as possible.

Satisfaction with participation using a manual wheelchair among individuals with spinal cord injury.

Study design:Cross-sectional.Objectives:To describe self-identified indoor and outdoor wheelchair-oriented participation outcomes and to report satisfaction with the identified outcomes by people with spinal cord injury (SCI).Setting:Vancouver, British Columbia.Methods:Participation outcomes were identified using the Wheelchair Outcome Measure and classified using the International Classification of Functioning, Disability, and Health (ICF).Results:The average age of the 51 community-dwelling subjects with SCI was 43.7(±10.7) years. Of them, 84% were men, 64% had tetraplegia and 66% used a manual wheelchair. There were 258 indoor and 257 outdoor participation outcomes identified by this sample with most outcomes falling into the ‘community, social, and civil life’ (36.5%), ‘domestic life’ (23.7%) and ‘mobility’ (18%) domains of the ICF. All domains had a mean satisfaction score of 7.1/10 or greater except for the indoor ‘mobility’ domain that had a mean satisfaction score of 6.1/10. Satisfaction scores with performance of the specific participation outcomes ranged from high (10/10) to low (2/10) with most scores falling above 7/10.Conclusion:Community-dwelling people with SCI commonly engage in wheelchair-oriented participation outcomes related to ‘community, social, and civil life’, ‘domestic life’ and ‘mobility’ and tend to be satisfied with their performance of these participation outcomes. This information is useful for clinicians and may help to guide assessment and intervention.

Older Adults' Online Dating Profiles and Successful Aging

RÉSUMÉ: Cette étude a examiné la pertinence des trois critères de Rowe et Kahn pour le vieillissement réussi à des représentations de soi dans profils de recontre en ligne des aînés: faible probabilité de maladie ou d’invalidité; fonctionnement élevé et l’engagement de la vie active. Dans cette étude transversale, 320 profils de rencontre en ligne des personnes âgées ont été choisis aléatoirement et codés selon ces critères. Les analyses de régression logistique ont déterminé si l’âge, le sexe et la race / ethnicité prédit l’auto-présentation. Peu de profils étaient révélateurs du vieillissement réussi en raison de la faible prévalence des deux premiers critères. Cependant, le troisième critère a été identifié dans de nombreux profils. Les Amérindiens étaient beaucoup moins susceptibles que les autres groupes ethniques pour mettre en évidence les premier et deuxième critères. Présentant le premier critère prédit le jeune âge. Profils de présentations des femmes du troisième critère sont restés très élevés avec l’âge. Les résultats suggèrent que les critères peuvent être sans importance pour les personnes âgées qui cherchent des partenaires, ou peuvent refléter l’exclusivité de cette idée. This study examined how relevant Rowe and Kahn’s three criteria of successful aging were to older adults’ self-portrayals in online dating profiles: low probability of disease and disability, high functioning, and active life engagement. In this cross-sectional study, 320 online dating profiles of older adults were randomly selected and coded based on the criteria. Logistic regression analyses determined whether age, gender, and race/ethnicity predicted self-presentation. Few profiles were indicative of successful aging due to the low prevalence of the first two criteria; the third criterion, however, was identified in many profiles. Native Americans were significantly less likely than other ethnic groups to highlight the first two criteria. Younger age predicted presenting the first criterion. Women’s presentation of the third criterion remained significantly high with age. The findings suggest that the criteria may be unimportant to older adults when seeking partners, or they may reflect the exclusivity of this construct.

Validating the wheelchair outcome measure for residents in long-term care.

Abstract Purpose: To determine the retest reliability and construct validity of the self-report and proxy versions of the wheelchair outcome measure (WhOM) among residents in long-term care. Method: The WhOM was administered to 55 wheelchair users living in residential care (38 self-respondents and 17 proxy respondents). Retest data were collected to estimate reliability using intraclass correlation coefficients (ICCs) for each of the tool scores (Importance, Satisfaction and Importanceu2009×u2009Satisfaction). For construct validity testing, Spearman’s correlation coefficients were used to assess whether WhOM scores were correlated with scores from the Late Life Function and Disability Instrument (LLDI) and Geriatric Depression Scale (GDS). Results: The ICCs for the WhOM scores were between 0.68 and 0.84. Moderate correlations were found between the self-respondents and proxy respondents groups with Importanceu2009×u2009Satisfaction and LLDI (ru2009=u20090.46–0.50). No other significant correlations were found. Conclusions: This study provides evidence for the reliability and validity of the WhOM for adults in residential care, but further testing is warranted to ensure it can facilitate prescription of the right device at the right time for residents in these settings. Implications for Rehabilitation Clients who reside in long-term care (LTC) institutions represent a population who have unique needs because of the varied types of activities in which they participate. This study provides support for use of the WhOM on an individual basis among self-responding residents. The study provides some support and use of the WhOM with groups of residents who require proxy respondents. Additional studies with a larger sample size are needed to further explore the psychometrics of the measure.

Understanding the Burden Experienced by Caregivers of Older Adults Who Use a Powered Wheelchair: A Cross-Sectional Study

Objective: In this study, we aimed to describe the burden of family caregivers providing powered wheelchair-related and overall assistance and test the hypotheses that caregiver burden correlates with participation, wheelchair skills capacity, anxiety, depression, and social support. Methods: Cross-sectional study. Participants included 35 family caregivers of powered wheelchair users. Caregivers were assessed using the Power Mobility Caregiver Assistive Technology Outcome Measure, Late Life Disability Instrument, Wheelchair Skills Test Questionnaire for caregivers, Hospital Anxiety and Depression Scale, and Interpersonal Support Evaluation List–12. Results: The most burdensome powered wheelchair assistance items were providing verbal hints/directions, needing to be nearby, anxiety, and fear that user may be harmed. The most burdensome overall assistance item was feeling limited in recreational/leisure activities. Caregiver burden was significantly correlated with participation limitations, anxiety, depression, and social support. Discussion: Caregivers experience burden for wheelchair-related and overall help, especially psychological burden. Such results have implications for the type of resources required to support family caregivers.