AA

Wheelchair Usage

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In the wheelchair usage section, Oyster et al. (2011), Phang et al. (2012), Karmarker et al. (2011), Hosseini et al. (2012) and Chaves et al. (2004) explored different factors related to wheelchair use and participation. Hatchett et al. (2009) examined the gender differences in shoulder strength as it relates to propulsion and therefore wheelchair use.

Table 12: Characteristics of Wheelchair Usage

Discussion

Oyster et al. (2011) explored manual wheelchair use by 132 people who had a spinal cord injury. They compared average daily distance travelled, speed traveled and amount of time spent moving in a wheelchair (distances greater than 15 m) to participant demographics and to the Craig Handicap Assessment and Reporting Technique (CHART) subscales of social integration, mobility and occupation. Findings suggest that younger people with SCI travel faster than older counterparts but not significantly further. The average distance travelled was 1877 meters with a standard deviation of 1131, suggesting greater variability in the range of distance travelled. However, the average amount of time spent moving more than 15 meters in the wheelchair was on average 47 minutes per day. The authors suggest that the moderate correlation between wheelchair mobility metrics (distance and speed) and the CHART total score and scores on mobility is indicative that the CHART is capturing different aspects of participation than mobility metrics. The authors did not report on the average amount of time spent in the wheelchair compared to the time moving in the wheelchair. It is however, reasonable to assume that participants would have been in their wheelchairs for at least double the recorded time moving, which raises the question of what participation is occurring while stationary in the wheelchair, or in conjunction with the movement less than 15 meters, that were eliminated from this study.

Cooper et al. (2011) investigated the correlations between the mobility characteristics of distance travelled, speed, number of stops, and drive time, and frequency of participation in community activities areas of leaving home, transportation, active recreation, socialization and, leisure activities. Researchers recruited participants from the National Veteran’s Wheelchair Games, with a final 16 participants consenting to completing the PARTS/M questionnaire to gather community participation data and having a data-logger attached to their wheelchair for two weeks to gather the mobility characteristics data. Data for both manual and power wheelchairs were gathered. Findings indicated that on average participants travelled 3,374 meters per day, at an average speed of 0.77 meters per second, for an average driving time of 68.65 minutes a day, stopping an average of 146 times per day. A stop was determined when no mobility activity occurred for more than seven seconds; the authors did not provide reasoning for this decision. Significant correlations between average speed travelled and community participation areas of transportation and socialization, for participants who used manual wheelchairs. A trend towards significant correlation was found between community participation area of leisure activities and speed travelled for participants who used power wheelchairs. The authors identified a limitation of their study was that the data logger did not differentiate between home mobility and community mobility and that the community participation areas chosen from the PARTS/M questionnaire were limited to those where participants would be outside of the home. It is also interesting to note that the average driving time was 68.65 minutes per day, which is just over an hour a day; the range was 15.72 to 107.45 minutes per day which when considered over the course of a full day, it raises the question of what activities are people participating in that does not require mobility during the majority of their day.

Tolerico et al. (2007) observed the mobility characteristics of people with SCI who use manual wheelchairs in two different environments; the first was their residential setting and the second the National Veteran’s Wheelchair Games (NVWG). Recruitment occurred at these games for three subsequent years, June 2004 until July 2006. The study results indicated that participants were significantly more active during the games time period than when they were at home; average distance was 6,745.3±1,937.9 meters at 0.96±0.17 meters per second for 12.4±1.7 hours per day compared to an average distance of 2,457±1,195.7 meters at a speed of 0.79±0.19 meters per second for an average of 8.3±3.3 hours per day at home. The authors suggest these findings suggest that people are more active when the environment promotes activity, however, even people who participate in these games, are less active at home by almost half; they even spend less time in the wheelchair.

Karmarkar et al. (2011) observed the mobility patterns of adults over the age of 50 over 5 days during the National Veteran’s Wheelchair Games (NVWG) and compared them to patterns over a two week period in their home environment. Not surprisingly, the results indicated that regardless of type of wheelchair used, people were more active during the NVWGs than at home. The authors report that the secondary analyses indicate that age negatively affects MWC propulsion velocity but positively affects PWC driving velocity. The authors suggest that their findings support the use of data loggers to examine mobility patterns in the community as well as support that variation in wheelchair use exists depending on the environment therefore further research into this area is needed to fully understand wheelchair use.

Phang et al. (2012) proposed that a contributing factor to the low Leisure Time Physical Activity (LTPA) identified in previous studies may be related to wheelchair skills and therefore self-efficacy. Therefore, the purpose of their study was to determine whether self-efficacy could account for the relationship between wheelchair skills and LTPA in people with SCI. The authors suggest that their findings of a significant relationship between wheelchairs skills and LTPA is consistent with other study results, but the modest size of the relationship suggest other factors in addition to wheelchair skills affect LTPA. The authors also suggest that due to their study design that it is not possible to conclude that better wheelchair skills lead to greater LTPA or vice versa. They do however, suggest that insight into why people with better skills may be more inclined to participate in physical activities can be gained from their results that indicate 50% of the relationship between wheelchairs skills and LTPA were explained by barrier-free self-efficacy. They offer that having better wheelchair skills may bolster self-efficacy to overcome barriers to participation. Interestingly, wheelchair use self-efficacy was found to not be a mediator of the wheelchair skills – LTPA relationship, however, the scores of the wheel-con used for wheelchair use self-efficacy were high, potentially affecting the ability to detect changes. The authors suggest that further research is needed to determine the role of wheelchair skills, in wheelchair use and in overcoming barriers to physical activity participation.

Tsai et al. (2014) reported on correlations between the type of mobility device use, that is externally modified vehicles and powered wheelchairs (power or manual with power assist wheels), and social participation, based on data collected in the National Spinal Cord Injury Database (NSCID). Data examined from 2986 entries suggest that correlations exist between social participation and using a modified vehicle but between social participation and a wheelchair. The authors suggest their results differ from other studies due to limiting their data to those entries where the person used a wheelchair for more than 40 hours per week and are unable to ambulate more than 150 feet at home.

Chaves et al. (2004) surveyed 70 people with spinal cord injury who use wheelchairs to explore factors that affect the perception of participation in activities in home, in community and during transportation related to the wheelchair, their impairment and the environment. Their primary finding was that the wheelchair was the primary reason cited as a limitation in participation in home, in the community and during transportation with physical impairment being the second reason most often cited and the wheelchair seating being the third. The top four factors that limited access to participation in the community and transportation use were the wheelchair, the physical environment, lack of assistance and wheelchair seating. The authors surveyed people from two centres in different cities, finding significant differences in the characteristics of the participants and in the perception of participation limitations between the cities/centres.

Hatchett et al. (2009) examined shoulder muscle strength and manual wheelchair usage differences based on gender for people with paraplegic level SCI, indicating that the prevalence of SCI for women is increasing and that women have unique attributes that affect these parameters. The strength of all shoulder muscles examined was found to be significantly different between men and women with women’s strength being less than men’s. Hatchett et al. indicated that shoulder torque, after being normalized for body weight, was the strongest predictor of average daily distance travelled in the community, which for women was almost half of the average distance men propelled daily. However, there was no significant difference in average velocity of propulsion between women and men. The authors identify one of the study limitations being the gender disparity in that 60 participants were male and only seven were females; however, they felt it is enough for a preliminary analysis to support further research into gender differences.

Conclusion

There is level 5 evidence (from one observational study; Hatchett et al. 2009) that suggests that shoulder strength is a strong predictor for average daily distance propelled, and that there are differences in shoulder strength with women’s strength being lower than men’s.

There is level 4 evidence (from one pre-post study; Karmarker et al. 2011 and two observational studies; Phang et al. 2012 and Tolerico et al. 2007) to suggest that 1) wheelchair use varies, particularly propulsion distances, 2) propulsion distance are environmentally dependent and 3) distances decrease with increasing age.

There is level 5 evidence (from two observational studies; Cooper et al. 2011 and Oyster et al. 2011) to suggest that of the cumulative time spent in a wheelchair over the course of a day, a small proportion is spent propelling distances, typically just over an hour a day.

There is level 4 evidence (from one case series study; Tsai et al. 2014) to suggest that the type of wheelchair used is not correlated with social participation.

  • Wheelchair use varies between individuals, however daily propulsion distance is small amongst most users. Shoulder strength, the user’s environment, and age all contribute to propulsion distance amongst wheelchair users, these factors should be considered when developing rehabilitation plans for these individuals.