INTRODUCTION

Mobility is a major goal of rehabilitation for persons with Spinal Cord Injury (SCI) which has substantial influence on independence and participation in the community [1-3]. Wheelchair is one of the most important rehabilitation tools which enable people with mobility disabilities to live independently, take care of basic needs, engage in social activities and be gainfully employed. However, wheelchairs may result in accidents, especially when inappropriate [4-6]. An appropriate wheelchair must meet a person’s physical and social needs, suits his/her environmental context, be safe and durable, and achieves correct fit and proper posture. Ideally, such wheelchairs must allow for maximal mobility, protect skin integrity, ensure even distribution of weight and maintain the normal anatomical posture [7]. However, in low- and middle-income countries, non-availability and non-affordability of quality mobility devices coupled with limited medical and rehabilitation services, hamper participation in all areas of personal and social life [8]. Often times, wheelchairs are donated by chari­table and non-governmental organizations to individuals who require them without proper fitting  [9]. In addition, overuse and lack of repair when damaged, predisposes to wheelchair-related injuries and dissatisfaction with use. Meanwhile, satisfaction with wheelchair and ergonomics are crucial to providing appropriate mobility, ensuring use and preventing complications. Evidence suggests that satisfaction with wheelchair use predicts better Health-Related Quality of Life (HRQoL), higher life satisfaction, and increased community participation [10]. Studies on satisfaction with wheelchair and its association with HRQoL are sparse among Nigerians with SCI. This study was conducted to investigate satisfaction with wheelchair and HRQoL among persons with SCI in South-west Nigeria.

METHODS

Participants for this cross sectional study were community-dwelling individuals with SCI who usually use wheelchair for mobility, are 18 years and older and have been using wheelchair for not less than six months prior to this study. A 16-item content-validated questionnaire comprising both opened- and closed-ended questions was used to obtain information on wheelchair characteristics among participants.

Satisfaction with wheelchair was assessed using the device domain of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) instrument. The QUEST 2.0 is a 12- item measure of a person's satisfaction with assistive technology. The satisfaction items related to the characteristics of the device are: dimensions, weight, adjustments, safety, durability, simplicity of use, comfort and effectiveness. Each item is scored on a 5-point Likert scale, with a score of 1 denoting "not satisfied at all" and 5 indicating "very satisfied" [11,12]. The device domain was used to assess satisfaction with wheelchair use in this study. The questionnaire was researcher-administered for all participants in the study.

The HRQoL of the participants was assessed using the Spinal Cord Injury–Quality of Life (SCI_QL) measure. The SCI-QL is a 23-item specific measure of quality of life in individuals with SCI [13]. The SCI-QL has 4 domains: Functioning (10 items assessing physical and social limitations), SCI-related problem (6 items assessing level of independence and other issues relating to injury), mood (six items concerning the psychological situation of the patients) and global HRQoL (shows the life situation of the patients and is assessed using a visual analogue scale). Scores are ranged on a scale from 0-100. A higher score in the Global HRQoL section is representative of a higher HRQOL while higher scores in each of the functioning, SCI-related problem and mood domains denote poorer HRQoL

Data were analysed using Kruskal Wallis, Spearman's rank correlation and Mann-Whitney U tests at α =0.05.

RESULTS

A total of 39 persons with SCI participated in this study. Participants’ ages ranged between 19 and 74 years with a mean of 47.1±14.9years. 22 (56.4%) of the participants were males. Majority of the

participants (82.1%) had traumatic SCI with lumbar spine (51.3%) being the most common site of injury. The mean time since onset of SCI was 3.9±3.6years. 31(79.5%) of the participants used manual wheelchair for mobility. Although, more than half of the participants (53.8%)  had their wheelchair prescribed by a physician/surgeon, none was fitted for it. About a third of the participants (35.9%) reported having fallen before from wheelchair. About half of the participants (51.3%; n=20) comprising 18 manual wheelchair and 2 powered wheelchair users were more or less satisfied with their wheelchair while only one participant (2.6%) was very satisfied with his wheelchair. There was a significant relationship between gender and satisfaction with wheelchair (r=0.32; p=0.04) and between time since onset of SCI and satisfaction with wheelchair use (r=0.42; p=0.01) among participants. There was however, no significant relationship between age of participants and satisfaction with wheelchair use. There was no significant difference in satisfaction with wheelchair use (χ2=1.03, p=0.59) across level of injury among the participants. Similarly, there was no significant difference in satisfaction with wheelchair use (χ2=3.36, p=0.19) across severity of injury. Gender and duration of SCI were also significantly related with satisfaction with wheelchair (p<0.05). Satisfaction with wheelchair was significantly different between manual and powered wheelchair users (p<0.01)

The health related quality of life of participants was assessed in 4 health domains. Participants had the highest mean score in PROB domain (70.71±20.09) and the lowest mean score in MOOD domain (32.60±19.55). Mean score in the FUNC and GQoL were 58.08±31.48 and 54.27±19.35 respectively.           

There were significant relationship between the functioning (r= -0.43; p<0.00), psychological situation (r= -0.35; p=0.03) and independence(r=0.46; p<0.00) domains of SCI-QoL and satisfaction with wheelchair use among the participants. There was no significant relationship between the MOOD domain of HRQoL (r= -0.29; p= 0.07) and satisfaction with wheelchair use among the participants (Table 1)..

DISCUSSION

Satisfaction with wheelchair is often dependent on the design and modification of wheelchair. A well-designed wheelchair can enhance the mobility and community participation in individuals with mobility impairments.

More than half of the participants (51.3%) rated their satisfaction with wheelchair as 3 (more or less satisfied). This is contrary to findings from earlier studies where between 73.5% and 80% reported being satisfied with wheelchair use [10,14]. Participants in the studies by Marchiori et al [10] and de Groot et al [14] reported satisfaction with simplicity and ease of use and other wheelchair-related factors such as safety and dimensions. Most users in the current study were not fitted for their wheelchairs. This could account for the disparities in the findings across these studies. It has been suggested that wheelchair dimensions should be user-specific improved function and comfort [15].

There were significant relationships between satisfaction with wheelchair use and major domains of health-related quality of life. This is similar to reports from earlier studies [16,17]. This authors found that satisfaction with wheelchair use and quality of life of persons with SCI were related. Similarly, de Groot et al [14] found a significant relationship between satisfaction with wheelchair and participation scores of persons with SCI. It was suggested that activity and participation of individuals with SCI were determined by individual factors such as wheelchair skills and physical capacity as well as external factors, such as architectural and social factors [14]. Individual factors rather than external factors are more likely to account for the similarity in the findings of this study and the earlier studies. There was no significant difference in the satisfaction with wheelchair use of individuals with SCI across severity and levels of injury. This is contrary to findings from previous study [14]. It has been suggested that persons with  complete SCIs are slightly less satisfied compared with persons with incomplete SCIs [14]. The reason for the difference in findings are not readily obvious. It could be that persons with complete SCIs in their study had other psychosocial issues which could affect satisfaction with wheel chair use. Satisfaction with wheelchair was significantly different between manual and powered wheelchair users. This is not surprising. Powered wheelchair are easier to maneuver and require no effort for propelling. Hence, better satisfaction with use among powered wheelchair users compared to manual wheelchair users. .

CONCLUSION

This study has demonstrated that persons with SCI who use wheelchair for mobility in South-west, Nigeria are not satisfied with their wheelchair and this had a negative impact on their health-related quality of life. Since this is the major mobility devise used by this population, it is important to improve satisfaction with the device among them. Individuals with SCI who use wheelchair for mobility should be appropriately fitted for their wheelchair and trained on how to use their wheelchair. Provision of suitable wheelchair for persons with SCI may enhance community participation and improve health-related quality among persons with spinal cord injury.