Wheelchair Satisfaction
In the literature, satisfaction with wheelchair use is reflected in satisfaction with wheelchair-related components and with performance as well as with the aspects of service delivery such as the provision process, repairs, and professional services. The highest level of evidence of the studies in this section is level 5, therefore the standard method of presentation using table, discussion and conclusions is used.
Discussion
Fitzgerald et al. (2005) explored the relationship between wheelchair satisfaction and wheelchair durability which they defined as requiring repairs and maintenance for both manual and power wheelchairs. The authors acknowledged the influence of frequency and type of use on durability they also collected data on diagnosis, number of hours a day of use, age, gender, years with diagnosis, and wheelchair characteristics including type, age, place of purchase, and completion of regular maintenance. Satisfaction with the wheelchair was completed on a 10 cm visual analog scale for 10 areas; use, durability, simplicity of use, comfort, overall appearance, dimensions, delivery, transportation, overall fit, and owner’s manual. 110 people with mixed diagnoses and from the United States, United Kingdom and Puerto Rico completed the questionnaire asking about their experiences with wheelchair maintenance, repairs and satisfaction for the past 6 months. The results indicated that the type of wheelchair used varies by diagnosis but the number of repairs and frequency of maintenance did not significantly differ between these groups. 69% of participants used manual wheelchairs with 95.6% of these being ultralight-weight. 62% of participants received their wheelchair through an assistive devices clinic, 18% through a rehabilitation clinic or hospital and 20% through direct sales. Study findings indicated that participants were generally satisfied with their wheelchair, with average Visual Analog (VAS) scores ranging from 7.0 to 8.2. Interestingly the researchers reported that highest scores were in wheelchair appearance and simplicity of use and the lowest were in comfort and service delivery, and people who used manual wheelchairs were significantly more satisfied with their wheelchair than people who used powered in all categories except appearance, delivery and owner’s manual. People who reported no repaired were significantly more satisfied with their wheelchair across all categories than those who reported repairs. 26% of participants reported repairs in the past six months and 43% reported regular maintenance (manual wheelchairs were more likely to be regularly maintained than power). Neither the age of the wheelchair nor the number of hours using the wheelchair was predictive of requiring repairs. However, the satisfaction with wheelchair durability was high on the VAS despite that 26% of participants reported needing repairs in the past six months.
De Groot et al. (2011) described the satisfaction expressed by people with spinal cord injury who use manual wheelchairs, in relation to aspects of the manual wheelchair and service delivery as well as the relationship between satisfaction with wheelchair use and participation. Findings indicate a high level of satisfaction with regards to simplicity of use, effectiveness, safety and dimensions of the wheelchair but lower scores for comfort. The authors discuss other similar studies which vary from their results, suggesting this variation is primarily related to funding availability for manual wheelchairs in different countries. The authors also indicated there was a higher wheelchair-related satisfaction, particularly wheelchair dimensions but also comfort and durability, which was associated with a more active lifestyle as per the PISIPD score albeit not a strong association. The authors suggest the link between wheelchair satisfaction and active lifestyle highlights the importance of a good wheelchair fit as noted in other studies. Satisfaction with service delivery was not as favourable as with wheelchair use aspects of satisfaction. Slowness of the process was a primary reason for dissatisfaction. Approximately 60% of participants indicating satisfaction with repairs/servicing, professional services and follow up services indicating moderate satisfaction with service delivery.
Rushton et al. (2012) linked the self-identified participation outcomes of 51 people with spinal cord injury with the domains of the International Classification of Functioning Disability and Health to at least the third level of sub-domains. The Wheelchair Outcome Measure (WhOM) was used to guide and develop the wheelchair use related participation outcomes as well as to rank level of satisfaction of these self-identified outcomes. The authors discuss that the high frequency of and satisfaction with indoor and outdoor outcomes in the “community, social and civil” domain is consistent with other research studies, including the higher focus on recreation and leisure pursuits found in this study. The authors note that self-identified participation outcomes did not link well to other ICF domains, as the participants were asked to identify those outcomes for which a wheelchair was required. Daily life participation outcomes for which a wheelchair is required as well as those for which a wheelchair is not required, may provide a more comprehensive understanding of how wheelchairs are integrated within daily life.
Chan and Chan. (2007) surveyed 31 people with spinal cord injury who used power or manual wheelchairs via telephone to explore the relationships between wheelchair users’ satisfaction, perceptions of participation, environmental influence and quality of life (QoL). The results presented here focus only on the findings related to wheelchair use satisfaction. Data gathered by review of teach participants’ medical record included age, gender, diagnosis and functional status at discharge. Participants confirmed demographic information and functional status, living placement, length of time of wheelchair use. Participants also completed the Chinese version of the Quebec User Evaluation of Satisfaction with Assistive Technology (C-QUEST), the Participation Restriction and Environmental factors sections of the ICF and the World Health Organization (WHO) Quality of Life Questionnaire (WHO QoL BREF(HK)), either in person or by telephone. Analyses of the results indicated a mild association between the C-QUEST Services scores and the ICF sub score of Health-related Professionals. The authors suggest these findings that the more supportive the relationship with the health-related professional the more satisfied the participant was with wheelchair use. The authors also suggest that the findings indicate satisfaction with wheelchair use was more associated with QoL than with participation and environmental influences, however some particular areas of community participation and environmental factors were associated with QoL such as travelling in the community, using public transport or driving, and engaging in leisure activities.
Gil-Agudo et al. (2013) conducted a pilot study to test a comprehensive product-centred approach to assessing performance and satisfaction of manual wheelchairs. The authors proposed, based on research literature, that the wheelchair is the most influential factor related to participation in daily life activities for people with limited mobility. As such, these authors chose to examine the effectiveness of wheelchair use based on product-centred evaluation approach including functional performance information, physiologic and kinetic information as well as perceptions of fit and performance from the person using the wheelchair, as means to design personally customized wheelchairs for people with SCI. The focus of the results was on comparison of the four difference wheelchair frames chosen, however given the study sample size was six participants, interpretation of the results related to the identifying the best performing wheelchair is limited. As wheelchair selection should be individualized, the process of reviewing performance and satisfaction outlined in this study may prove to be of assistance in individualizing wheelchair selection process as it provides a more structured means of individual wheelchair evaluation to ultimately improve wheelchair use satisfaction.
Conclusion
There is level 5 evidence (from 2 cross sectional studies: de Groot et al. 2011 and Rushton et al. 2012; and two observational studies: Fitzgerald et al. 2005 and Chan & Chan 2007) that satisfaction with wheelchair use is moderate to high for people with spinal cord injury who use wheelchairs.
There is level 5 evidence (from one cross sectional study: de Groot et al. 2011; and one observational study: Fitzgerald et al. 2005) that satisfaction with wheelchair-related service delivery is lower than satisfaction with wheelchair use, primarily due to the slowness of the process, and less so with regards to repairs/service, professional services and follow up services.
There is level 5 evidence (from one observational study: Rushton et al. 2012; and one observational study: Chan & Chan 2007) suggesting that wheelchair satisfaction is more highly focused on quality of life variables such as participation in leisure activities.
