RESNA 28th Annual Conference - Atlanta, Georgia
Eliana Chaves, B.S., Rory A. Cooper, Ph.D, Michael L. Boninger, M.D. Rosemarie Cooper M.P.T., A.T.P, Shirley G. Fitzgerald, Ph.D., David Gray, Ph.D.
Departments of Rehabilitation Science & Technology, University of Pittsburgh,
Human Engineering Research Laboratories, VA Pittsburgh Healthcare System
Washington University School of Medicine
The purpose of this study was to investigate the level satisfaction of community participation of individuals with SCI. The first specific aim was to compare the level of satisfaction of community participation of individuals with SCI who received their wheelchair through two methods of wheelchair service delivery: 1) a specialized assistive technology (AT) clinic in Pittsburgh (Pitt) and 2) community based rehabilitation suppliers in Saint Louis (SL). The second specific aim was to determine if differences exist between individuals with tetraplegia and paraplegia regarding level satisfaction of community participation. No significant difference was found between Pitt and SL regarding level of importance and satisfaction of community participation. Also, no significant difference was found between paraplegic and tetraplegic regarding level of importance and satisfaction of community participation. We did not control for differences in the community accessibility for each city tested here, which is likely an important factor in determining community participation satisfaction. Future studies should incorporate a larger sample size and investigate environmental limitations to community participation. Hence, looking a more questions would be useful. Studying a larger number of individuals with a greater degree of physical impairment may provide greater insight into the benefit of a specialized seating clinic in a wheelchair service delivery and community participation.
Keywords: Assistive technology; wheelchair; spinal cord injury; outcomes; participation; activities of daily living.
Being able to fully participate in social and community activities is desired by a large number of individual with spinal cord injury (SCI). Individuals with SCI use wheelchairs as their primary source of mobility and therefore, rely on them to return to as many pre-injury activities as possible [1]. Wheelchairs are used to enhance function, improve independence and enable a person to successfully live in the home and community [2]. On the other hand, a wheelchair may be perceived as a negatively impacting a person’s life if it does not enable him/her to perform all daily activities [3]. Therefore, the wheelchair and seating system can limit or facilitate participation depending on how well the seating and wheelchair match the person’s needs and environment. It is also known that the process of wheelchair service delivery plays an essential role in the wheelchair outcomes [1]. The successful use of wheelchair is dependent on a full range of services. How the devices are applied and the training techniques that are implemented affect outcome. Current research in wheelchair outcomes is essential to produce evidence that today’s practices are producing the expected and desired outcomes.
The overall aim of this study was to investigate the level satisfaction of community participation of individuals with SCI. The first specific aim was to compare the level of satisfaction of community participation of individuals with SCI who received their wheelchair through two methods of wheelchair service delivery: 1) a specialized assistive technology (AT) clinic in Pittsburgh (Pitt) and 2) community based rehabilitation suppliers in Saint Louis (SL). It was hypothesized that individuals who received their wheelchair from the AT clinic would have a higher level of satisfaction of community participation when compared with individuals who received their wheelchair from a local vendor. The second specific aim was to determine if differences exist between individuals with tetraplegia and paraplegia regarding level satisfaction of community participation. It was hypothesized that the level of satisfaction of community participation of individuals with paraplegia would be higher than individuals with tetraplegia.
Eighteen individuals (13 males) with SCI who use wheelchairs for mobility provided written informed consent. The average age of the participants was 36 ( ± 10) years. Ten individuals had paraplegia and 8 had tetraplegia. All participants had been discharged from rehabilitation for at least one year and lived in a community setting. Protocol: A written survey that recorded AT usage in daily activities was distributed among clients from Pittsburgh (Pitt) and Saint Louis (SL). Pitt subjects were recruited through research centers and through an AT clinic. SL subjects were recruited from research centers and rehabilitation centers. In both locations, subjects were recruited via a flyer or approached by clinical study coordinators, who asked if they were interested in participating.
The questionnaire used in this study was a combination of two surveys: 1) Participation Survey/Mobility (PARTS/M) and, 2) Facilitators and Barriers Survey/Mobility (FABS/M). The PARTS/M is composed of 25 major life activities. The FABS/M consists of 191 items that probe the situational specificity of activity limitations, requests information on the type of assistive technology used in activities, and asks respondents to categorize aspects of their environments as barriers or facilitators to participation. For this study, only activity performance in the community was analyzed. Subjects were asked two questions related to their level of importance and satisfaction of community participation (Table 2&3).
SPSS software (SPSS, Inc.) was used to calculate the level of importance and satisfaction of community participation. The differences in the level of importance and satisfaction of community participation at the Pitt and SL were examined for each task using a chi-square test or Fishers Exact if appropriate. Differences between level of importance and satisfaction of community participation for individuals with paraplegia and tetraplegia were analyzed using a chi-square test. The significance level was set a priori at < 0.05.
No significant difference was found regarding level of satisfaction (p= 0.4) and importance (p= 0.5) between individuals who received their wheelchair from a specialized AT clinic in Pitt and a community based rehabilitation suppliers in SL. No difference was found between paraplegic and tetraplegic regarding level of importance (p=. 571) and satisfaction (p=. 532). Table 1 shows the individual’s percentage regarding level of satisfaction of community participation. Table 2 shows individual percentage regarding level of importance of community participation.
| How satisfied are you with your participation in leaving your home? | Very Satisfied (% of participants) | Satisfied (% of participants) | Somewhat satisfied (% of participants) | Dissatisfied (% of participants) |
|---|---|---|---|---|
| Pitt | 33 | 33 | 11 | 22 |
| SL | 33 | 56 | 11 | 0 |
| Paraplegic | 22 | 44 | 22 | 11 |
| Tetraplegic | 44 | 44 | 0 | 11 |
| How important is it for you to leave your home? | Very important (% of participants) | Somewhat important (% of participants) | Somewhat unimportant (% of participants) | Not important (% of participants) |
|---|---|---|---|---|
| Pitt | 89 | 11 | 0 | 0 |
| SL | 89 | 11 | 0 | 0 |
| Paraplegic | 77 | 22 | 0 | 0 |
| Tetraplegic | 89 | 11 | 0 | 0 |
No significant difference was found between Pitt and SL regarding level of importance and satisfaction of community participation. Also, no significant difference was found between paraplegia and tetraplegia regarding level of importance and satisfaction of community participation. A wheelchair is an extension of the user’s body [4] and has an impact on a user’s community participation [5]. Greater satisfaction with a wheelchair should result in enhanced use of that technology and make possible a better subjective quality of life [6]. Studies have shown that the wheelchair is the most common limiting factor of community participation [5]. The wheelchair is most likely the user most important mobility device but also the one that is most associated with barriers [5]. It is likely that our small sample size was the reason we did not detect difference between the two service deliver methods tested here. Furthermore, we did not control for differences in the community accessibility for each city tested here, which is likely an important factor in determining community participation satisfaction. Future studies should incorporate a larger sample size and investigate environmental limitations to community participation. Hence, looking a more questions would be useful. Studying a larger number of individuals with a greater degree of physical impairment may provide greater insight into the benefit of a specialized seating clinic in a wheelchair service delivery and community participation. Such studies could be used to advocate for social policy change in support of the provision of AT.
This study was supported by NIDRR Model Systems for SCI (# B2311-T).
Eliana Chaves
7180 Highland Drive building 4
2 nd floor, East Wing, 151R-1
Pittsburgh, PA, 15206.
Ph: (412) 365-4850
e-mail: esc14@pitt.edu