Wheelchair use can be limited by falls and accidents resulting in injury and/or by repairs and maintenance issues. All these factors have potential to affect wheelchair use, and to decrease confidence in the equipment or user’s skill in operation. Three studies from the research literature (Nelson et al. 2010; Saunders & Krause, 2015; Chen et al. 2011) which explored accidents and falls related to wheelchair use identified predictive and modifiable behaviours associated with accidents and falls. Other studies (Worobey et al. 2012; Worobey et al. 2014) examined repairs and maintenance issues in relation to accidents and adverse effects.
Nelson et al. (2010) completed monthly monitoring with participants over a one year period to collect data related to wheelchair related falls and injuries for the purpose of identifying 1) the incidence of falls and related injuries, 2) the epidemiology of wheelchair related falls, 3) the severity of injury and 4) identifying associated risk factors that best predict wheelchair related falls and related injuries. The variables collected were compared and contrasted to the groups of no fall, fall and injurious fall to address these purposes. 82% of variances for wheelchair related falls were explained by the predictive factors of: increased pain in previous 2 months, positive for alcohol abuse, high FIM score for motor function; history of fall in past year; fewer years with SCI and; a shorter length of w/c (distance measured between front caster and centre of rear axle). 81% of the variance in wheelchair related falls with injuries was explained by four variables: increased pain in past two months, higher FIM score on motor subscales, history of falls in past year, and lack of accessibility at home entrance. Incidence rates found in this study, 31% reported falls with 14% reporting injurious falls, is reported by the authors to be slightly higher than the national (USA) estimate. The authors suggest that most of the predictive risk factors are modifiable, particularly the shorter wheelchair frame and the lack of accessibility to the home entrance. Therefore, they suggest that recommendations for preventing falls should be incorporated into rehabilitation and as part of all new wheelchair fittings.
Saunders and Krause, (2015) asked 759 people with traumatic SCI to recall the incidence of falls and/or injuries they incurred over the previous year related to wheelchair use. Almost 20% of the survey respondents reported a fall with 10.4% reporting a resultant injury and 22.8% having at least one hospitalization due to a fall or injury sustained. No differences or patterns were noted based on age, but the middle age groups were noted to be more likely to limit their activities due to an injury or fall and use of prescription medication was a predictor of both falls and injury. The authors do note that the results are based on self-report so generalization of the results should be done with caution.
Chen et al. (2011) sought to identify modifiable wheelchairs behaviours associated with increased incidence of wheelchair use related falls or accidents. Using a focus group the authors categorized wheelchair related accidents by the mechanism of the accident; tips and falls, accidental contact, and dangerous operation. Data was collected by telephone interviews, asking participants to recall accidents in the previous three years (response rate was 79.2%). Based on participant responses they were grouped as 1) non-accident, 2) single accident, 3) multi-accident; the data was then compared between groups. No differences in demographic information was found between groups (age, gender, type of w/c used, diagnosis, education), however the wheelchair-using behaviours (no seat belt use, no anti-tipper use, no regular w/c maintenance, professionally prescribed w/c) were found to be related to the number of accidents. A lack of regular maintenance and the w/c not being professionally prescribed found to be associated with increased risk of wheelchair accidents; lack of regular maintenance and not using seat belts were significant predictors of the cumulative number of accidents.
Worobey et al. (2014) completed surveys with 945 people who use power wheelchairs regarding the number of repairs required in the six months prior to the study. If repairs were reported, participants were asked if there were consequences: 1) no consequence; 2) being stranded; 3) missed work/school; 4) being injured; 5) missed a medical appointment. Demographics and characteristics of the wheelchair were also collected for comparison to the repair data. Comparison between manufacturers and incidence of reported repairs indicated repairs incidences were not significantly different between manufacturers. However, more than 25% of participants reported experiencing at least one repair in the previous six months, in each of the manufacturer groups. The authors indicate that the definition of a repair was left open for participant interpretation, so there was likely a wide range of repairs and severity of the consequence for the need for the repair. The authors note the most significant finding was that there has been an increase in reported repairs from the historical dataset to the current dataset. It is worth noting that data related to regular maintenance was not gathered.
Worobey et al. (2012) surveyed 723 participants who used their wheelchair for more than 40 hours per week, to report the incidence of wheelchair repairs, breakdowns and the resultant consequences over a six-month time period. Overall, 52.6% of participants experienced at least one wheelchair repair in the past 6 months with 32.2% experiencing at least one consequence because of the repair/breakdown. Unfortunately, the authors did not differentiate in the data between repair and breakdown, which potentially could hold different meaning and affects for the participants. 31% of participants reported experiencing the consequence of missing work or school and 32% of participants reported and injury. In this study, participants who used power wheelchairs reported more repairs and adverse consequences compared to reports for manual wheelchair use. Of all consequences reported, 65% were accounted for by participants who used power wheelchairs. Wheelchairs with power seat functions also reported significantly higher consequences of being stranded, being injured and missing appointments. The authors also compared results of this study (2006-2011) to historical results (2004-2006), finding that there has been an increase in the incidence of repairs/breakdowns and resultant consequences. The authors suggest that the increasing incidence may be related to a decrease in wheelchair quality due to a lack of standards enforcement and the funding structure in the author’s country, for which further investigation is required. It is questioned whether the separation of repairs versus breakdowns and if regular maintenance was completed would provide additional valuable data for this issue.
There is level 4 evidence (from one longitudinal prospective cohort study; Neslon et al. 2010 and two observational studies; Saunders and Krause, 2015 and Chen et al. 2011) which suggests that tipping or falling from the wheelchair is the most frequently experienced wheelchair-use related accident.
There is level 4 evidence (from one longitudinal prospective cohort study; Nelson et al. (2010) and one observational study; Chen et al. 2011) to suggest that there are a variety of predictive factors for wheelchair related falls and injuries including a recent increase in pain, recent history of falls, not using seat belts, lack of regular maintenance, the w/c not being professionally prescribed, high FIM scores on the motor subscale combined with a shorter w/c frame length and a lack of accessibility at home entrance.
There is level 3 evidence (from two cohort studies; Worobey et al. 2012; Worobey et al. 2014, one case series study; McClure et al. 2009 and one observational study: Saunders and Krause, 2015) to suggest that in a six month time period between one quarter and one half of wheelchairs will require a repair and that of these repairs up to one third will result in an adverse effect.
Many of the predictive risk factors for wheelchair related falls and resultant injuries are modifiable; therefore, considerations and education related to preventing falls should be included in wheelchair interventions.
Maintenance and repair issues arise frequently for people who use wheelchairs therefore are important considerations in the wheelchair service delivery process and the manufacturing process.