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Wheeled Mobility and Seating Equipment

Characteristics of Power Wheelchair Use

Studying the characteristics of power wheelchair use sheds some light on how and why people use their power wheelchairs and if the devices are meeting their needs in everyday life. Gaining an understanding of actual power wheelchair use may provide guidance and direction in decision-making for the provision of power wheelchairs.

Author YearCountry
PEDro Score
Research Design
Total Sample Size
Methods Outcome
Daveler et al. 2015

USA

Observational

Phase 1 N=31

Phase 2 N=N/A

Phase 3 N=12

Phase IPopulation: Mean age:

55.9 yr, Gender: males=26, females=6; Mean w/c experience:13 yr.

Intervention: Survey regarding current wheelchair characteristics and perceived rating of difficult driving scenarios.

Outcome Measures: Ratings of 23 driving scenarios by degree of difficult; power wheelchair drive wheel location.

Phase III

Population: Mean age: 46.9 yr; Gender: males=7, females=5; Mean w/c experience:16.3 yr.

Intervention: Questionnaire about outdoor driving places visited in the past week, frequency encountering a terrain/architectural barrier and the action they performed at that time,

Outcome Measures: Obstacle frequency, action taken upon obstacle encounter, features most likely to use if avaialble.

Phase I1.      The position of the drive wheel (FWD, RWD, and MWD) showed the greatest differences in driving difficulty reported especially in mud, gravel and cross slope conditions.

2.      Avoidance of these conditions when encountered was reported: 1) in mud 70% of RWD and MWD, 33% of FWD; 2) in gravel 54% of RWD, 31% of MWD, 17% of FWD and: 3) in cross slope conditions 31% of RWD, 50% of FWD and 62% of MWD.

3.      >50% of participants mentioned that the conditions: uneven terrain, driving up and down steep hills, cross slopes, gravel, curb cuts, and ramps where particularly difficult to maneuver.

Phase III

1.      Top 5 obstacles encountered at 1-3 times/wk: small curb, cross slope, grass, dirt/mud, curbs); >3 times/wk: curb cuts door thresholds concrete, carpet up and down ramps.

2.      Top 5 avoided obstacles: sand, curbs, gravel, dirt/mud, small curbs.

3.      Top 4 obstacles that required assistance: grass, dirt/mud, door threshold, gravel.

4.      Curb climbing and traction control were featuring most likely to be used by study subjects in different terrain.

Hastings et al. 2011

USA

Observational

N=30

Population: Mean age: 47 yr; Level of injury: SCI, C6-C7, tetraplegia; Mean time since injury: 16 yr; Mean length of rehabilitation: 4.5 mo; Mean BMI: 23.7; W/c use: manual=18, power=12.Intervention: Demographic information and three questionnaires.

Outcome Measures: Rosenberg Self-Esteem Scale (RSES), Spinal Cord Independence Measure III (SCIM), Craig Handicap Assessment and Reporting Technique (CHART).

1.    No significant differences between manual and power group with respect to demographic information.2.    Significant differences found between wheelchair groups in SCIM III (F=11.088, p=0.003) and CHART subscales of Physical (F=7.402, p=0.011), Mobility (F=12.894, p=0.001), and Occupation (F=5.174, p=0.031).

3.    No difference between groups for self-esteem (RSES) and CHART cognitive and social subscales.

Sonenblum et al. 2008

USA

Observational

N=25

Population: Mean age: 43 yr; Gender: males=16, females=9; Injury etiology: SCI; Level of injury: cervical=12, thoracic=1; Level of severity: complete=8, incomplete=4; Median time since injury: 10 yr.Intervention: Tracked wheelchair mobility use for 13-15 days in-home and community using a data logger; telephone interview.

Outcome Measures: Wheelchair usage, location used, distance wheeled, time spent wheeling, time spent in the wheelchair, time in wheelchair spent wheeling.

1.        Most wheelchair use occurred at home; outdoor period of use were longer in time and distance and faster in speed than indoor periods (p<0.001).2.        Median time in wheelchair was 10.6 hr (5.0-16.6 h); distance wheeled ranged 0.24-10.9 km (median 1.1 km) over range of 16-173 min (mean 58 min).

3.        Mean of 9.2% of time in wheelchair was spent wheeling.

4.        Time spent wheeling and number of mobile periods had normal distribution.

5.        Occupancy time was most normally distributed and least varied variable.

6.        No consistent usage pattern across and within subjects.

7.        Day-to-day variability in mobility was igh regardless of how much a subject wheeled.

Hunt et al. 2004

USA

Observational

N=412

Population: Mean age: 42 yr; Gender: male=325, females=87; Level of injury: paraplegia=210, tetraplegia=202; Mean time since injury: 8.9 yr; Wheelchair: manual=251, power=161.Intervention: In-person or telephone survey on demographic, socioeconomic and assistive technology data.

Outcome Measures: Number and type (manual or power) wheelchair, Wheelchair customizability as defined by design features (e.g., axle adjustment, programmable controls).

1.      97% manual wheelchair users had customizable wheelchair.2.      46% power wheelchair users had programmable and 54% had customizable wheelchair.

3.      40% of manual wheelchair users had at least one additional wheelchair (73% had additional manual, 27% power) and 57% of power wheelchair users had at least one additional wheelchair (84% manual, 16% power).

4.      People with at least one additional wheelchair were more likely to be white (p=0.001), have higher income (p=0.001), and have private insurance (p=0.045).

Biering-Sorenson et al. 2004

Denmark

Observational

N=236

Population: Mean age: 50.5 yr; Gender: males=193, females=43; Level of injury: tetraplegia, paraplegia; Level of severity: complete=102, incomplete=134; Mean time since injury: 24.1 yr.Intervention: Medical chart review, Questionnaire regarding mobility aids.

Outcome Measures: Functional classification at time of injury, Rehabilitation discharge functional classification, Mobility aids, transportation at time of follow-up.

1.      3.4% had no mobility devices; only men used standing frame and stand-up wheelchair (gender difference, p=0.0026).2.      Manual and power wheelchair used by 83.5% and 27% respectively, with power used more by those with tetraplegia (p<0.001).

3.      9.3% had neither manual nor power wheelchair.

4.      majority of those who use their walking ability also use a manual wheelchair, power wheelchair or scooter for longer distances

5.      32% with manual wheelchair also had a power wheelchair or scooter.

6.

Cooper et al. 2002

USA

Observational

N=17

Population: Mean age: NR; Gender: males=11, females=7; Injury etiology: SCI=9, MS=1, spina bifida=1, polio=1, head injury=1, muscular dystrophy=1, lower motor neuron disease=1, CP=2; Level of injury: paraplegia=3, tetraplegia=6; Chronicity: chronic; Mean duration w/c use: 14.5 yr.Intervention: Wheelchair use monitoring using a data logger and standardized questions for both wheelchair athletes (n=10) and regular use individuals (n=7).

Outcomes Measures: Speed, Distance travelled, Time wheelchair was being used in 24 hr.

1.      Wheelchair athletes travelled faster than regular users, but this trend was significant only on day 1.2.      Wheelchair athletes were more likely to travel farther (significant difference day 4 (p=0.03) and day 5 (p=0.05).

3.      Total distance travelled over 5 days and average distance travelled per day were significantly different (p=0.02) with the active group travelling further (17164±8708 m versus 8335±7074 m).

4.      No significant difference between type of wheelchair and distance or speed over the 5 days.

Discussion

Cooper et al. (2002) examined the driving characteristics of two groups of people; group one was 10 athletes competing in a local wheelchair games, group two were seven people living in the community regularly using their power wheelchair. On average the athletic group travelled farther and faster than the regular use group, which the authors feel can be largely attributed to the amount of available activities, easily available transportation and social context available at the competition. Overall study findings indicated that the speed at which participants drove their wheelchairs most of the time, was much less than the available maximum speed, with full speed driving only for a few meters occasionally. This was the same for distance travelled; there was more battery life available than was used. This study found little variability in driving speed patterns across participants.

Sonenblum et al. (2008) found that bouts of mobility indoors occurred frequently but at slower speeds and shorter distances than bouts used outdoors. A bout was defined as transitional mobility between stationary activities. The average daily distance travelled was 1.9 kilometers; the distance that was travelled varied across participants as well as across days for the same person. The key finding from this study was that there was no typical pattern of power wheelchair use whether across people or across days for the same person.

Hastings et al. (2011) determined if differences existed between those who used power wheelchairs and those who used manual wheelchairs. The data was collected using questionnaires for self-esteem, function and participation. There were significant differences observed between manual and power wheelchair users, however, there were several confounding factors which the authors acknowledged as limitations but did not account for in the results. Of greatest concern is that the study did not account for varying motor function (e.g., complete versus incomplete injury, antigravity versus gravity-eliminated triceps function). The article suggests that people who sustained a C6-7 motor level injury are better able to maintain physical use of muscles above the injury, move around the environment more and attain employment in a manual wheelchair than power. Given these limitations the results should be interpreted carefully.

To understand the characteristics around the type of wheelchair a person uses, Hunt et al. (2004) surveyed 412 people with spinal cord injury who used a wheelchair for more than 40 hours a week. 97% of manual wheelchairs users had an ultralight, customizable wheelchair and 54% of power wheelchair users had programmable controls with customizable features. Findings also indicated that 40% of manual wheelchair users had at least one additional chair with 73% being an additional manual wheelchair and 27% being power. 57% of power wheelchair users had at least one additional chair with 84% being manual and 16% being power.

Biering-Sorensen et al. (2004) examined mobility aids being used at least 10 years post injury based on data gathered from a larger follow up study. The results from this paper highlight the wide variety of mobility devices are used by people with SCI and that many have more than one device. The study did not account for possible influence of neurological or functional recovery on device use between initial injury and this follow up study. It also did not account for possible changes in mobility devices during the time period from initial injury to post injury 10-45 years later.

Daveler et al. (2015) completed a three-phase observational study to understand the conditions and barriers that users of powered wheelchairs find difficult to drive in/over in the outdoor environment. The ultimate goal of this study was to develop a powered mobility device which addressed many of these issues/challenges. This review focused on the results as they relate to how power wheelchairs are used in the environment therefore only the results from phase 1 & 3 are presented as phase 3 was a trial of a prototype device. The findings indicate that people who use power wheelchairs encounter daily environmental challenges to mobility and that the location of the drive wheel affects how the wheelchair responds to that challenge. However, a particular drive wheel location did not stand out as preferable. Given that many of the difficult conditions identified by participants are similar to the items used in many of the wheelchair training programs it is questioned if the challenges could be addressed in part or in whole, with in-depth power wheelchair skills training (e.g. ascending/descending curbs and ramps and traversing door thresholds).

Conclusions

There is level 5 evidence (from one observational study: Hunt et al. 2004) that to meet full mobility needs, a wide variety of mobility devices are often used in conjunction with power wheelchairs.

There is level 5 evidence (from two observational studies: Sonenblum et al. 2008; Cooper et al. 2002) that there are no typical patterns of power wheelchair use in daily life but small bouts of movement or short distances at high speeds were more frequent.

There is level 5 evidence (from one observation study: Daveler et al. 2015) to suggest that there are people who drive power wheelchairs who experience daily driving challenges such as door thresholds, and frequently encountered driving situations such as uneven terrain, curb cuts, gravel, and mud.

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