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Satisfaction Related To Wheelchair Use in Older Adults
Satisfaction Related To Wheelchair Use in Older Adults
To cite this article: Amol M. Karmarkar, Diane M. Collins, Annmarie Kelleher & Rory A. Cooper
PhD (2009) Satisfaction related to wheelchair use in older adults in both nursing homes and
community dwelling, Disability and Rehabilitation: Assistive Technology, 4:5, 337-343
Download by: [Shanghai Institute of Physical Education] Date: 05 November 2015, At: 16:53
Disability and Rehabilitation: Assistive Technology, September 2009; 4(5): 337–343
RESEARCH PAPER
1
Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA and
2
Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Abstract
Purpose. Older adults commonly use wheelchairs for mobility impairments regardless of their living situations. However,
limited outcomes data are available to determine quality of the wheelchairs that older Americans are receiving, as well as their
satisfaction with wheelchair service delivery programs. The purpose of this article was to analyze satisfaction data collected
from three cohorts of older individuals living at nursing homes and in community settings. Ninety participants were residents
in VA (n ¼ 60).
Methods. One hundred thirty two older adults completed the standardized Quebec User Evaluation of Satisfaction with
Assistive Technology. Ninety participants were residents in VA (n ¼ 30) or private nursing homes (n ¼ 30), and 42 were
community dwelling participants. Those enrolled were either independent manual or power wheelchairs users.
Results. The community dwelling group reported significantly higher levels of satisfaction with their manual wheelchairs
and service delivery when compared with the private nursing home participants (4.3 versus 2.9, p ¼ 0.002). The satisfaction
was also higher for VA nursing homes than private (3.9 versus 2.9, p ¼ 0.004). No significant differences were reported for
satisfaction levels regarding powered wheelchairs use between three groups.
Conclusion. Level of satisfaction should be incorporated as an outcomes measure for evaluating wheelchair prescriptions
and service delivery programs. This study also supports the establishment of a re-evaluation process of wheelchair fit as the
users’ age, to aide in provision of the best quality wheelchairs and service delivery programs.
Correspondence: Rory A. Cooper, PhD, VAPHS-Human Engineering Research Laboratories, 7180 Highland Dr., Bldg. 4, 2nd Floor, 151R1-HD, Pittsburgh,
PA 15206, USA. Tel: þ1-412-954-5287. Fax: þ1-412-954-5340. E-mail: rcooper@pitt.edu
ISSN 1748-3107 print/ISSN 1748-3115 online ª 2009 Informa UK Ltd.
DOI: 10.1080/17483100903038543
338 A. M. Karmarkar et al.
Age (years) 73.9 + 8.1* 77.5 + 5.8 83.8 + 5.4 82.4 + 4.9 63.23 + 5.6{,{ 67.87 + 7.4{,{
Genderx Male 42 10 6 2 27 13
Female 6 2 19 3 0 2
Veterans status Yes 44 10 2 1 27 15
No 4 2 23 4 0 0
Diagnosisx,{ SCI 0 0 0 0 19 11
CVA 21 5 7 1 1 0
Other 25 7 18 4 6 4
satisfaction with a broad range of AT devices in a SCI was higher among the community dwelling cohort
structured manner. The QUEST consists of 12 (71%) compared to larger proportions of individuals
items, of which eight items are related to device with CVA in the VA NH group (43%).
characteristics and four are related to the service With respect to the type of MWC used, a notable
delivery. Previous research studies have determined proportion of participants from the VA facilities were
validity and reliability of the QUEST, and also using an Invacare 9000 XT (60%), whereas those
indicated its sensitivity in determining satisfaction from the private NH were using an Invacare Tracer
levels with use of AT devices in various populations SX5 (28%). A significant proportion of the commu-
[10–12]. nity dwelling cohort was using a Quickie 2 (23%). A
significant difference was identified between groups
regarding quality of MWC. The community dwelling
Data analysis group was using more ultra lightweight MWC, the
VA cohort who were using lightweight MWC, and
Data were analyzed separately for manual wheelchair last the private NH group was primarily using the
and power wheelchair group. Demographics and the depot style wheelchairs (Table II). With respect to
wheelchair characteristics data were analyzed using use of PWC, a large proportion of the VA NH group
descriptive statistical methods (independent t test and the private NH group reported using the same
and Chi-square statistics). The composite QUEST type of wheelchair (Jazzy 1113 ATS), whereas the
scores (device, service delivery, and total score) were community dwelling group was typically using the
compared between three cohorts using Univariate Invacare Arrow (Table II).
Analysis of Covariance (ANCOVA) controlling for For manual wheelchairs users, the level of satisfac-
differences in age, gender, and diagnosis between the tion related to wheelchairs was found to be sig-
three cohorts followed. All statistical analyses were nificantly different between the three cohorts.
computed using SPSS 16.0 with a level of .017 (0.05/ Satisfaction levels for the community dwelling cohort
3) set a-priori. was highest and that for the private NH cohort was
the lowest (4.3 versus 2.9, p ¼ 0.003). The VA NH
cohort also reported higher levels of satisfaction
Results when compared with the Private NH cohort (3.9
versus 2.9, p ¼ 0.004). For the wheelchair service
For both the MWC and PWC groups, participants in delivery, a positive trend towards significant differ-
the private NH group were the oldest cohort (83.8 years ence was observed with the community dwelling
and 82.4 years), and the community dwelling group cohort reported higher levels of satisfaction as
was the youngest cohort (63.2 years and 67.8 years). compared to both Private NH cohort (4.4 versus
Also, the private NH group represented the highest 2.8), and the VA NH cohort (4.4 versus 3.6). No
non-veteran female participants, compared to male notable differences were observed between the VA
veterans from both the VA NH and the community NH cohort to those of Private NH cohort (3.6 versus
dwelling cohort. The proportion of individuals with 2.9) (Table III).
340 A. M. Karmarkar et al.
Community
VA NH Private NH dwelling
Satisfaction-related to wheelchair
Dimensions 3.9 + 1.1 3.5 + 1.2 3.7 + 1.3
Weight 3.8 + 1.1 2.9 + 1.3 3.9 + 1.1
Adjustment 3.8 + 1.3 3.2 + 1.5 3.8 + 1.1
Safety 4 + 1.2 4.2 + .98 4 + 0.9
Durability 4.2 + 1 3.8 + 1.3 4+1
Ease of use 3.8 + 1.4 2.8 + 1.2 4.1 + 1.1
Comfort 3.7 + 1.4 2.9 + 1.2 3.9 + .9
Effectiveness 3.8 + 1.3 3.2 + 1.4 3.9 + 1.2
Satisfaction-related to wheelchair service delivery
Service delivery 4 + 1.2 3.7 + 1.3 3.9 + 1.2
Repairs and services 3.4 + 1.6 2.5 + 1.4 3.8 + 1.1
Professional services 3.7 + 1.4 3.1 + 1.3 4.1 + 1.2
Follow-up services 3.3 + 1.5 2.4 + 1.1 4.1 + 1.3
QUEST composite scores
Device combined 3.9 + 0.15{ 2.9 + 0.28 4.3 + 0.25{ 0.009*
Services combined 3.6 + 0.18 2.8 + 0.38 4.4 + 0.29 0.020
QUEST total 3.9 + 0.15{ 2.9 + 0.30 4.3 + 0.25{ 0.006*
For powered wheelchairs users, the community of the contributors for these differences were: weight
dwelling cohort reported higher levels of satisfaction of wheelchairs, ease of use, and comfort related to
without significant differences related to both wheel- wheelchair use. Satisfaction levels were related to the
chairs (4.1 versus 3.7, p ¼ 0.53) and service delivery type of the MWC that the participants were using,
(4 versus 2.3, p ¼ 0.21) when compared with the with the community dwelling participants using
Private NH cohort. No differences were observed mostly the ultra lightweight wheelchairs, whereas a
between the community dwelling cohort to that of significant portion of the private NH group using the
VA NH cohort related to both powered wheelchairs depot style wheelchairs. The difference between the
and to the service delivery aspects (Table IV). weight of an ultra light weight MWC and that of a
depot style MWC is approximately 30 pounds, which
explains the lower satisfaction rates with the latter
Discussion [21]. Also, the VA NH group reported significantly
higher level of satisfaction compared to that reported
The results showed differences in level of satisfaction by the private NH group, which can be attributed to
related to wheelchair use and related to service the wheelchair weight difference between the light-
delivery of the wheelchairs between the three groups. weight and the depot style wheelchairs – approxi-
For manual wheelchair group satisfaction related to mately 25 pounds. There was no significant
wheelchairs were highest for the community dwelling difference between the satisfaction levels among the
cohort and lowest for the Private NH cohort. Some VA NH group, which was using mostly lightweight
Wheelchair use in older adults 341
Satisfaction-related to wheelchair
Dimensions 4.2 + 0.7 4.2 + 0.9 4.2 + 0.9
Weight 4 + 0.8 2.5 + 0.7 4.1 + 1.2
Adjustment 4.2 + 0.8 3.2 + 1.7 4.1 + 0.9
Safety 4.5 + 0.6 3.7 + 0.9 4.3 + 0.9
Durability 4.5 + 1.2 3.1 + 1.9 4.1 + 0.9
Ease of use 4.5 + 0.6 4.4 + 1.3 4.5 + 0.9
Comfort 3.4 + 1.4 3.6 + 1.7 4.1 + 0.9
Effectiveness 3.9 + 1.5 3.8 + 0.8 4.3 + 0.9
Satisfaction-related to wheelchair service delivery
Service delivery 3.5 + 1.8 3.5 + 0.7 4.1 + 0.8
Repairs and services 3.4 + 1.8 2.3 + 1.5 4.1 + 1.2
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wheelchairs (92%), and the community dwelling notable for repairs, professional services, and follow-
group. The ultra light and lightweight wheelchairs up services delivery. Since all the participants from the
have a marginal difference in their weights. This is community dwelling cohort were veterans, the results
reflected by the fact that no significant difference indicate greater access to specialized professional care
exists between the reported satisfaction scores related related to wheelchairs and AT services compared, to
to weight for the two types of wheelchairs. Another those available to the participants living in private NH
major difference was observed for ease of use, with facilities. The Veterans Health Administration (VHA)
participants from the community dwelling group has established Wheelchair and Seating Clinics within
reported highest satisfaction ratings, compared to VA Pittsburgh Healthcare System (VAPHS). These
those for the VA NH group and the private NH clinics provide specialized services related to wheel-
group. However, the difference was only significant chair provision, and also provide routine wheelchair
between the community dwelling group and the repairs/maintenance services. These clinics are held
private NH group. A previously conducted study by twice a month in the participating VA NH facilities.
Trefler et al. indicated a positive impact of newly However, lack of permanent presence of these speci-
prescribed wheelchairs on improving propulsion alty clinics at the VA NH facilities could have resulted
efficiency of older adults in NH facilities [22]. In in lower satisfaction levels with respect to wheelchair
our study, as the community dwelling participants service delivery between the VA NH group when
were using better quality wheelchairs, with adjustable compared with the community dwelling cohort. A
axle positions to improve set up and propulsion, previous report suggested low rates of wheelchair
compared to those from the private NH group, the repairs in their population and a positive relationship
results were similar to the findings of the study by between wheelchair repairs and maintenance to
Trefler et al. [22]. Another factor was comfort satisfaction related to wheelchair use [24]. This is
related to wheelchair use, our results confirmed represented in our study, which identified overall low
previous study results, indicating a positive relation- satisfaction related to this aspect of wheelchair service
ship between quality of wheelchairs and satisfaction delivery in all three cohorts.
related to comfort or perceived comfort [22,23]. With respect to powered wheelchair user, levels of
Despite differences in the types of MWC used, no satisfaction were higher for both the community
significant differences in comfort were found be- dwelling cohort and the VA NH cohort as compared
tween the community dwelling and the VA NH to the Private NH, without significant differences. The
group. This finding contradicts the one reported by differences were notable regarding the service delivery
DiGiovine, who reported a higher level of riding for repairs, professional services, and follow-up
comfort for ultra lightweight wheelchairs users as services. Access to specialized wheelchairs and seating
compared to lightweight wheelchair users [23]. clinics is limited in the private NH setting. The
Satisfaction related to manual wheelchair service majority of the PWC used by the residents in private
delivery was highest for the community dwelling NH settings were also personally owned, with an
cohort followed by the VA NH cohort, and lowest outside Durable Medical Equipment (DME) supplier
for the Private NH cohort. The differences were as a point of contact for all wheelchair-related services.
342 A. M. Karmarkar et al.
Better access to these specialized clinics could be a by the VA Centre for Excellence in Wheelchairs
possible explanation for greater satisfaction with all and Associated Rehabilitation Engineering (Grant
service related areas for veterans in both the NH No. B3142C), Human Engineering Research
setting and those living in the community. Laboratories Competitive Pilot Project Fund (Grant
Because of the small sample size for (especially for No. H0001).
the PWC users) in both the VA and private NH
facilities, generalization of the results may not be
applicable to a broader population. Also, the study References
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