RESNA 27th International Annual Confence
Physical Independence and Mobility: A Study of Functional Performance of Individuals With and Without Service Dogs
To examine differences in functional performance, a cross-sectional study compared 145 adults with service dogs to 80 adults without service dogs. The groups differed demographically, as participants with service dogs were significantly older and had lived significantly longer with their disabilities than those not partnered with service dogs. Functional performance was defined as the “Physical Independence” and “Mobility” scores on the Craig Handicap Assessment and Reporting Technique. Though similar in “Physical Independence” scores, participants with service dogs scored significantly higher on “Mobility.” Thus, service dogs may be a viable intervention to improve the mobility of individuals who use wheelchairs.
CHART, mobility, physical independence, service dogs, wheelchairs
Quality of life and fulfillment result from striking a balance between functional demands and having the resources and opportunities available to meet those demands (1). Service dogs are one such resource to assist in meeting the daily functional needs of individuals who use wheelchairs. Service dogs have been reported to decrease reliance of human help and attenuate physical and social obstacles, thus enhancing the quality of life and fulfillment of their partners (2-5).
Changes in functional performance are primary outcome measures of rehabilitation interventions (5-6). Better functional performance permits individuals to live in more independent settings, and reduces the workload of caregivers and paid assistants (7). The tasks with which service dogs are trained to assist include self-care activities, such as dressing, transferring to and from a wheelchair, and mobility. Service dogs also help with household management and community activities as they open doors, pull manual wheelchairs, carry small packages, pay cashiers, and serve as social icebreakers (2-5).
Because functional limitations are significantly correlated to health care utilization, work disability, and socioeconomic status, enhancements in functional performance from partnering with service dogs would be positive indicators for recommending the use of these dogs (6-9). If service dogs do assist their partners as anticipated, they may allow their partners to live in their own homes and to remain in their communities (2,4). Thus, service dogs would improve the quality of life of their partners by being a resource to meet the daily demands of physical independence and mobility.
For individuals who use wheelchairs or scooters, do those partnered with service dogs differ from those not partnered with service dogs in the functional performance areas of “Physical Independence” and “Mobility” as measured by the Craig Handicap Assessment Reporting Technique (CHART)?
A cross-sectional study was conducted of 225 individuals who used wheelchairs or scooters for 80% or more of their daily mobility. One hundred forty-five participants with service dogs comprised the service dog group; 80 participants, without service dogs, comprised the comparison group. These two groups were compared demographically by age, years living with their disabilities, gender, ethnicity, marital status, type of wheelchair used, and type of disability or disabling condition. The functional performance outcomes included the “Physical Independence” and “Mobility” scores of the Craig Handicap Assessment Reporting Technique (CHART). The CHART assesses function, and has been widely used and validated (10). Several domains are included in the CHART: physical independence, mobility, occupation, social integration, and economic self-sufficiency. Higher scores indicate greater independence in the areas being assessed (10).
The service dog group participants were recruited by agencies such as Paws with a Cause® and Canine Companions for Independence. These agencies sent letters describing the study, along with study brochures, to their clients. Comparison group participants were recruited using advertisements placed in newsletters and websites of interest to individuals with disabilities, such as the Muscular Dystrophy Association website, Quest Magazine, and Wheelchairjunkie.com. Study brochures were also sent to registry participants of the Human Engineering Research Laboratory, University of Pittsburgh/VA Pittsburgh Healthcare System. Individuals who signed consent forms completed study questionnaires.
An alpha level of 0.05 was established a priori for all analyses. Distributions of the continuous variables were examined, and if skewed, were analyzed with nonparametric statistics. Chi-square or Fisher's exact statistics were used to compare categorical variables. T-tests were used to compare the groups in normally distributed, continuous variables (e.g., age, years living with a disability); Mann Whitney U statistics were employed to compare continuous variables not normally distributed (i.e., “Physical Independence” and “Mobility” scores from the CHART).
Study participants were predominately Caucasian (93.3%) women (74.2%) who used power wheelchairs for mobility (56.0%), were not married (53.3%), and averaged 14.8 years of education. Most of the participants reported having progressive conditions (76%) such as multiple sclerosis, muscular dystrophy, or rheumatoid arthritis. Those with service dogs were significantly older and had lived longer with their disabilities than did those without service dogs (Table 1). Though the groups did not differ in “Physical Independence,” those with service dogs scored significantly higher on “Mobility” than individuals without service dogs (Table 2).
|
Comparison Group |
Service Dog Group |
|---|---|---|
n=80 |
n=145 |
|
Age |
39.5 ( + 11.6)* |
43.3( + 12.8)* |
Years with Disability |
19.9 ( + 14.6)* |
25.1 ( + 15.4)* |
Female |
56 (70) |
111 (76.6) |
Use Power Wheelchair |
40 (50.6) |
81(59.1) |
Caucasian |
71 (88.75) |
139 (95.9) |
Married |
44 (55.0) |
61 (42.1) |
Years of Education |
14.7 ( + 1.9) |
15.0 ( + 2.0) |
Most Common Disability |
Progressive |
Progressive |
* p <0.05 |
||
|
Comparison |
Service Dog |
|---|---|---|
n=80 |
n=145 |
|
Physical Independence |
82.8 ( + 25.6) |
87.3 ( + 17.6) |
Mobility |
82.9 ( + 19.3)* |
88.7 ( + 15.7)* |
* p <0.05 |
||
Research by Kennedy and LaPlante indicated that as people age they are more likely to require assistance with daily tasks (9). Participants in the service dog group were significantly older and had lived significantly longer with their disabilities than those in the comparison group. As a result, those in the service dog group were expected to have greater functional limitations, and therefore, lower scores in “Physical Independence” and “Mobility” on the CHART. Surprisingly, despite their demographic differences, individuals in the service dog group were similar to the comparison group in “Physical Independence.” Further, individuals partnered with service dogs scored significantly higher on “Mobility” than those in the comparison group. Service dogs may remediate the problems anticipated with older individuals who have lived longer with disabilities.
These findings are positive indicators for recommending service dogs as viable assistance to improve the mobility of individuals who use wheelchairs or scooters. Service dogs may provide assistance for individuals aging with their disabilities.
Further studies should examine the relationship between “Physical Independence” and “Mobility” and the secondary conditions often found with disability—fatigue, pain, and depression. In addition, similar studies should be conducted to increase sample size of groups: males, users of manual wheelchairs, and non-progressive disabilities such as spinal cord injuries, cerebral palsy, or spina bifida.
Funding for this research was provided by the VA Merit Review Grant D3078R, by VA Stars and Stripes Funding, and the VA JRR&D Pre-doctoral Grant AHRRFP.
Diane M. Collins,
VA Pittsburgh
Healthcare System,
Human Engineering Research Laboratories,
7180 Highland Dr., 151R-1,
Pittsburgh, PA 15206;
dmcst84@pitt.edu