Table 13: Falls, Accidents, Repair and Maintenance Issues with Adverse Effects Related to Wheelchair Use

Author
Year
Country
Research Design
PEDro Score
Sample Size
Methods Outcome

Worobey et al. 2012

USA

Cohort

N=726

Population: Mean age: 42.9 yr; Gender: males=576, females=150; Level of injury: paraplegia=353, tetraplegia=373; Mean time since injury: 12.5 yr.

Intervention: Two groups of participants completed surveys at different time points (2004-2006 and 2006-2001).
Outcome Measures:
Demographic data; wheelchair characteristics and occupational status; Type of wheelchair repair and/or breakdown in past 6 mo and; Consequences of breakdown including 1) no consequence, 2) been stranded, 3) been injured, 4) missed work or school, 5) missed a medical appointment.

1. Compared to the historical group (2004-2006), the current group (2006-2011) showed a significant increase in the number of repairs (7.8%) and adverse consequences (23.5%) (p<0.001 for both).

2. Compared to manual wheelchair users, power wheelchair users experienced consequences, being stranded, and missing a medical appointment (p<0.001 for all).

3. 64.6% of reported consequences were with power wheelchairs.

4. For wheelchairs with seat functions (tilt, recline, elevating seat/leg rests) there was not a significant number of repairs reported (p=0.156).

5. For wheelchairs with seat functions reported more and higher number of adverse consequences (p=0.011 and 0.008 respectively) including greater number of reports of being stranded (p=0.46), of being injured (p=0.004) and missing medical appointments (p=0.024).

6. No significant differences in number of repairs or adverse consequences based on age, years since injury, gender, occupational status or level of education.

Nelson et al. 2010

USA

Cohort

N=659

Population: Mean age: 55 yr; Gender: males=632, females=27; Level of Injury: cervical=277, thoracic=337, lumbar=45; Severity of Injury: complete=283, incomplete=376; Mean time since injury: 21 yr.

Intervention: Questionnaire

Outcome Measure: Number of falls and fall related injuries, Comparisons between baseline characteristics and no fall, fall, and injurious fall groups, Comparison of above fall categories with all variables to determine predictors.

1. Average of w/c use per day=10.9±4.3 hr

2. 31% of the 659 participants reported 553 fall events; 14% of these sustained an injury; 1 reported death related to fall.

3. Of the 204 participants who reported a fall, 109 (53%) reported more than 1 fall (range 2-53).

4. Of the 208 reported injuries, 179 (85%) were minor, 29 (14%) were serious

5. Predictors of wheelchair related falls included: increased pain in previous 2 mo (p<0.001); positive for alcohol abuse (p=0.01); high FIM score for motor function (p<0.001); history of fall in past year (p<0.001); fewer years with SCI (p=0.007); a shorter length of w/c (p=0.005).

6. Predictors of falls with injuries were; increased pain in previous 2 mo (p<0.001); high FIM score for motor function (p=0.1); history of fall in previous year (p<0.001) and lack of accessibility of home entrance (p=0.01).

McClure 2009

USA

Case Series

N=2213

Population: Mean age: 42.4 yr; Gender: males=1758 , females=455; Level of injury: tetraplegia=1121, paraplegia=1061, Mean time since injury: 12.2 yr.

Intervention: As part of a larger database data collection survey about assistive technology, the questions specific to wheelchair breakdown and adverse events for people with SCI who use a wheelchair for more than 40 hr/wk were analyzed.

Outcome Measures: Frequency of a repair occurrence in the past 6 mo, Frequency of breakdown in the past 6 mo, Consequences of breakdown – participants could choose all that applied:1) No consequences, 2) Being stranded, 3) Being injured, 4) Missed work or school, 5) Missed a medical appointment.

1. 971 (44.8%) participants reported at least 1 wheelchair repair within a 6 mo period.

2. Out of 2101 participants that had remembered the number of repairs, 427 (20.3%) had 1 repair, 348 (16.6%) had 2-3 repairs, and 130 (6.2%) completed ≥4 repairs.

3. Participants that reported ≥1 repair (n=192, 19.7%) reported 262 adverse events; stranded (n=140), being injured (n=42), missing work/school (n=33), or missing a medical appointment (n=47).

4. 8.7% of 2213 participants reported ≥1 adverse event.

5. Participants with power wheelchairs had significantly more repairs than participants with manual wheelchairs (power=1.39±3.675, manual=0.81±1.820, p<0.001).

6. Participants with power wheelchairs reported significantly more adverse events compared to participants with manual wheelchairs (106/192, p<0.001) and also experienced more adverse consequences (p<0.001).

7. There were no significant differences in reported repairs between participants with power wheelchairs with seat functions compared to participants without seat functions (seat=1.32±2.234, no seat=1.20±1.668, p=0.488); the occurrence of adverse consequences was not associated with power seat functions (p=0.208).

 

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