Changes that Occur Among New and Experienced Older Adult Power Wheelchair Users: A Three Month Follow Up
1Paula W Rushton, 1Louise Demers, 2François Routhier, and 3CanWheel Research Team
1. Université de Montréal and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada; 2. Université Laval and Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Québec, Québec, Canada; 3. www.canwheel.ca
ABSTRACT
The objective of this study was to present the characteristics of and compare new and experienced power wheelchair users at two time points, baseline and 3 months later. Fifty-six older adult power wheelchair users completed outcome measures assessing participation, life space travelled, wheelchair skills, wheelchair confidence, social support, anxiety and depression. Results of this study indicate that while new power wheelchair users experience trends towards change in many of these areas over three months, experienced wheelchair users do not. Improved participation, subjective perception of wheelchair skills, and wheelchair confidence, as well as decreased anxiety were the areas in which trends towards change were observed.
INTRODUCTION
Mobility disability is the number one form of disability for Canadians 50 years of age and older (Statistics Canada, 2001). The use of a power wheelchair is often used to compensate for mobility impairment and prevalence of use increases with age (Shields, 2004). In fact, wheelchair provision is one of the top three rehabilitation interventions that provide the greatest increase in function and quality of life for people with severe disability. Although there is evidence that power wheelchairs can have a positive influence on the quality of life of older adults, wheelchairs are also among the most commonly abandoned assistive technology devices (National Center for Health Statistics, 1994; Phillips & Zhao, 1993). To date, we have little comprehensive understanding of power wheelchair use among older adults and its impact on health and quality of life. It is important to address wheelchair abandonment issues and ensure that these devices meet users’ needs and skill levels.
OBJECTIVE
The long-term objective of this research is to describe the natural history of power wheelchair use during a 2 year period in new and experienced older adult power wheelchair users. In this report, we present the characteristics of and >compare new and experienced power wheelchair users at baseline and 3 months later.
METHODS
Design
A longitudinal (2 year) multi-cohort design is being used in this study.
Participants
A convenience sampling strategy is being used to recruit older adult power wheelchair users in two cohorts: those who have had at least six months of experience in using a power wheelchair (cohort 1) and those who are receiving their first power wheelchair (cohort 2). Participants who are ≥50 years of age and have the ability to operate their power wheelchair independently are eligible for this study. Wheelchair users are being recruited from six Canadian cities (Halifax, Quebec City, Montreal, Toronto, London, and Vancouver) using a variety of strategies, including recruitment through disability awareness programs, peer support groups, wheelchair seating programs, and equipment vendors. To date, a total of 56 older adult power wheelchair users have been recruited: 12 new and 44 experienced.
Procedure
Data is being collected based on the time of induction into the study at baseline, and 1, 3, 6, 12, 18, and 24 months post-baseline. Sociodemographic and clinical characteristics are being gathered. Primary outcomes being collected in this study include: activity and participation, life space travelled, objective and subjective assessment of wheelchair skills, and wheelchair confidence, as measured by the Assistive Technology Outcomes Profile for Mobility (ATOP/M), Life Space Assessment (LSA), Wheelchair Skills Test (WST), Wheelchair Skills Test Questionnaire (WST-Q), and the Wheelchair Use Confidence Scale (WheelCon) respectively. Secondary outcomes include measurement of social support using the Interpersonal Support Evaluation List (ISEL), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and performance of socially defined life tasks as measured by the Late Life Disability Instrument (LLDI). All outcome measures except for the WheelCon are available in both English and French and are completed at all time points, with the exception of the WST, which is completed only at baseline and 24 months.
Data Analysis
For the purpose of this report, baseline and 3 month data were analyzed. Descriptive statistics, including means, standard deviations (SD), and frequencies were calculated for the participant characteristics, primary and secondary outcome measures.
RESULTS
The participant demographic and clinical characteristics are presented in Table 1. The mean scores of the primary and secondary measures are presented in Tables 2 and 3.
| Variable | Power Wheelchair Users | ||
|---|---|---|---|
| New | Exp’d | All | |
| Age in years, mean (SD) | 60.8 (9.9) | 59.3 (6.2) | 59.6 (7.1) |
| Sex, male (%) | 41.7 | 54.5 | 51.8 |
| Living situation (%) | |||
| Alone | 41.7 |
59.1 | 55.4 |
| With Spouse | 50.0 | 27.3 | 32.1 |
| With Others | 25.0 | 6.8 | 10.7 |
| Language (%) | |||
English |
50.0 |
65.9 | 62.5 |
| French | 41.7 | 29.5 | 32.1 |
| Other | 8.3 | 4.6 | 5.4 |
| Diagnosis (%) | |||
Spinal Cord Injury |
0 |
25.0 | 19.6 |
| Multiple Sclerosis | 16.7 | 15.9 | 16.1 |
| Stroke | 25.0 | 9.0 | 12.5 |
| Lower Limb Amputation | 8.3 | 4.6 | 5.4 |
| Other | 50.0 | 45.5 | 46.4 |
Primary Mobility Device (%) |
|||
| Power Wheelchair | 66.7 | 84.1 | 80.4 |
Months Using Power Wheelchair, Mean (SD) |
1.8 (2.7) |
149.9 (120.7) | 122.0 (123.3) |
| Wheelchair Frame (%) | |||
Front Wheel Drive |
0 |
4.5 | 3.6 |
| Mid Wheel Drive | 66.7 | 56.8 | 58.9 |
| Rear Wheel Drive | 33.3 | 38.6 | 37.5 |
| Employment Status | |||
Unemployed |
58.3 |
40.9 | 44.6 |
| Retired | 41.7 | 52.3 | 50.0 |
| V olunteer | 8.3 | 31.8 | 26.8 |
Outcome Measure |
New Wheelchair Users Score |
|
|---|---|---|
| Baseline | 3 months | |
ATOP/M* |
||
| Activity | 47.9 (4.0) (n=12) |
48.5 (3.8 ) (n=9) |
| Participation | 46.9 (5.9) (n=12) | 52.4 (13.1) (n=9) |
| LSA | 43.6 (21.9) (n=9) |
39.0 (17.8) (n=12) |
| WST | 81.3 (7.7) (n=11) |
N/A† |
| WST-Q | 87.4 (7.0) (n=11) |
91.7 (10.6) (n=12) |
| WheelCon | 80.8 (17.5) (n=7) |
91.4 (7.7) (n=7) |
| ISEL | 13.9 (2.5) (n=12) |
13.9 (3.8) (n=12) |
| HADS | ||
Anxiety |
9.7 (5.3) (n=12) |
8.3 (5.8) (n=12) |
| Depression | 7.3 (3.8) (n=12) | 6.8 (5.1) (n=12) |
LLDI§ |
||
| Frequency | 46.2 (9.7) (n=12) |
46.7 (9.3) (n=12) |
| Limitation | 47.1 (11.2) (n=12) | 50.0 (10.2) (n=12) |
ATOP/M* |
||
| Activity | 46.2 (9.7) (n=12) | 46.7 (9.3) (n=12) |
| Participation | 47.1 (11.2) (n=12) | 50.0 (10.2) (n=12) |
Outcome Measure |
New Wheelchair Users Score |
|
|---|---|---|
| Baseline | 3 months | |
ATOP/M* |
||
| Activity | 47.1 (4.8) (n=44) |
46.9 (5.1) (n=35) |
| Participation | 54.9 (10.4) (n=44) | 52.5 (8.8) (n=35) |
| LSA | 43.6 (16.6) (n=39) |
41.1 (18.1) (n=43) |
| WST | 81.8 (12.1) (n=44) |
N/A† |
| WST-Q | 79.0 (19.7) (n=27) | 85.4 (12.7) (n=42) |
| WheelCon | 83.1 (14.6) (n=31) | 83.2 (16.9) (n=31) |
| ISEL | 13.2 (3.7) (n=43) |
13.3 (4.0) (n=44) |
HADS |
||
| Anxiety | 7.1 (4.7) (n=44) |
6.2 (4.7) (n=44) |
| Depression | 5.1 (3.7) (n=44) | 5.1 ± 3.7 (n=44) |
LLDI§ |
||
| Frequency | 50.4 (8.2) (n=43) |
50.3 (10.0) (n=44) |
| Limitation | 50.1 (8.7) (n=42) | 51.5 (11.4) (n=44) |
* T-scores are standardized scores on each dimension for each type. A score of 50 represents the mean. A difference of 10 from the mean indicates a difference of one standard deviation. |
||
DISCUSSION
This study described power wheelchair use at baseline and three months later in experienced and new power wheelchair users. Generally, the experienced power wheelchair users were stable with respect to the primary and secondary outcomes. However, there was a trend towards decreased anxiety and increased wheelchair skill from the users’ subjective perspective. More change between baseline and three months was observed in the new power wheelchair user cohort. The largest changes occurred in the areas of improved perception of wheelchair skill and wheelchair confidence, increased participation, as well as decreased anxiety. It is interesting to note that the new users’ subjective perception of their wheelchair skills was higher than their objective scores. This finding is consistent with previous research that reported that WST-Q scores were higher than WST scores by an average of 3.8% (p<0.004) for adult power wheelchair users (Rushton, Kirby, & CanWheel Research Team, 2012). Future directions for this research include following the trajectory of these two cohorts through the remaining four time points to allow us to describe the natural history over a two year period.
CONCLUSION
New power wheelchair users experience a trend towards improved participation, subjective perception of wheelchair skills, and wheelchair confidence, as well as decreased anxiety between receiving their first power wheelchair and three months later. Experienced power wheelchair users experience little change.
REFERENCES
Statistics Canada. (2001). A profile of disability in Canada. Statistics Canada (catalogue No. 89-577-X1E). Ottawa, CA.
Shields M. (2004). Use of wheelchairs and other mobility support devices. Health Reports, 15, 37-40.
National Center for Health Statistics. Trends and differential use of assistive technology devices. (1994). (1999, August 19).
Phillips, B., Zhao, H. (1993). Predictors of assistive technology abandonment. Assistive Technology, 5, 36-45.
Rushton, P.W., Kirby, R.L., CanWheel Research Team. (2012) Wheelchair Skills Test Version 4.1 for Power Wheelchairs: Comparison of Total Percentage Scores for the Objective and Questionnaire Versions. Submitted to the Annual Meeting of RESNA, June 28 – July 3, 2012 Baltimore, MD, USA.
ACKNOWLEDGEMENTS
This study was funded by the Canadian Institutes of Health Research (AMG 100925). Salary/scholarship funds were provided by the Canadian Institutes of Health Research (PWR).