The provision of seating and wheeled mobility devices is a complex process that requires trained professionals and multiple appointments throughout the service delivery process. However, this can be ...inconvenient and burdensome for individuals with mobility limitations or for individuals who live in rural areas. Rural areas often present unique difficulties regarding the provision of healthcare services including lengthy travel times to medical facilities and lack of specialized providers and medical technology. The purpose of this article is to provide a comprehensive overview of the development and implementation of a service delivery protocol for a home-based telerehabilitation assessment for wheelchair seating and mobility.
The telerehabilitation team consists of a trained wheelchair seating and mobility therapist and a telehealth clinical technician (TCT). In order to determine veterans that are appropriate for a home-based telerehabilitation assessment, a three-phase pre-assessment screening process was conducted by the therapist and TCT, including consult, chart, and phone review. Veterans that met all of the predetermined eligibility criteria were recommended for a telerehabilitation wheelchair assessment. The TCT traveled to the veteran's residence with necessary evaluation and safety equipment and connected with the therapist remotely using the VA Video Connect platform. Assessment and veteran data were collected during the initial evaluation and then during a 21-day follow-up.
Forty-three veterans were successfully seen via telerehabilitation for a seating and wheeled mobility assessment between November, 2017 and July, 2018. The average travel distance between the veteran's residence and the clinic was 34.1 miles. The total telerehabilitation encounter times ranged from 45 min to 145 min.
The implementation of this service delivery protocol for wheelchair seating and mobility assessments demonstrated the benefits of using telehealth services including reaching rural veterans, reducing distance traveled, maximizing efficiency of provider schedules, and conducting realistic assessments in veterans' home environments. Success can be attributed to being able to deliver best practice remotely and to the rapport of the TCT with the providers. Cultivating provider buy-in, selecting appropriate outcome measures, and restructuring workflows were additional lessons learned. The VA Video Connect platform is an accessible tool that can be easily learned by both veterans and providers and used beyond initial wheelchair seating evaluations for improved access to follow-up healthcare services.
A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The need for advancements in mobility-assistive technologies is continually growing due to advances in medicine and ...rehabilitation that preserve and prolong the lives of people with disabilities, increases in the senior population, and increases in the number of veterans and civilians involved in conflict situations. The purpose of this study is to survey a large sample of veterans and other consumers with disabilities who use mobility-assistive technologies to identify priorities for future research and development.
This survey asked participants to provide opinions on the importance of developing various mobility-assistive technologies and to rank the importance of certain technologies. Participants were also asked to provide open-ended comments and suggestions.
A total of 1,022 individuals, including 500 veterans, from 49 states within the USA and Puerto Rico completed the survey. The average age of respondents was 54.3 yr, and they represented both new and experienced users of mobility-assistive technologies. The largest diagnostic group was spinal cord injury (SCI) (N = 491, 48.0%). Several themes on critical areas of research emerged from the open-ended questions, which generated a total of 1,199 comments.
This survey revealed several themes for future research and development. Advanced wheelchair design, smart device applications, human-machine interfaces, and assistive robotics and intelligent systems emerged as priorities. Survey results also demonstrated the importance for researchers to understand the effects of policy and cost on translational research and to be involved in educating both consumers and providers.
To describe the development of a patient registry related to wheeled mobility and seating (WMS) device interventions to accumulate large datasets for clinical quality assurance and research purposes.
...Accepted guidelines for registry development were applied and anchored around the Functional Mobility Assessment (FMA) questionnaire and a uniform dataset (UDS).
The FMA and UDS were developed under a corporate research agreement between clinical researchers and commercial providers. The questionnaires are administered in rehabilitation clinics to patients at the time of assessment for new device interventions (baseline) and readministered by telephone or other remote strategies periodically thereafter (follow-up).
The FMA and UDS can be administered to any patient with a mobility impairment in need of a WMS device.
WMS interventions include manual wheelchairs, power wheelchairs, scooters, seating, and other accessories.
The FMA is a validated 10-item patient-centered outcome measure that investigates satisfaction in performing common mobility-related activities of daily living. The UDS includes variables related to age, diagnosis, and type of device used, as well as health, participation, and environmental factors.
Currently there are over 1500 complete FMA and UDS cases at baseline and more than 600 follow-up datasets from 45 providers nationwide. Feedback indicates use of the FMA and UDS does not add burden to the clinical routine.
A registry in the field of WMS has been developed and shown to be feasible in a clinical setting. This has created an opportunity to collect large datasets to increase sample sizes for future analyses to more scientifically evaluate what types of WMS devices work best for what types of patients under varying circumstances to promote health and participation.
It is documented that wheelchair failures occur frequently, repair times are lengthy, and users often experience adverse consequences. This study aims to gather evidence on efficiency of current ...wheelchair repair processes from the perspective of complex rehabilitation technology (CRT) suppliers who perform repairs within the United States.
A 20 statement survey was developed to identify barriers and facilitators related to wheelchair repairs across the domains of administrative and operational factors as well as to identify future opportunities for improvement. Key statements in these areas included time to perform a repair, documentation requirements, tracking repair progress, reimbursement, technician competency, emerging strategies and preventative maintenance. The online survey was broadly disseminated to a nationwide network of CRT suppliers for data collection.
A total of 127 responses were received. Results showed that administrative statements received the lowest scores while those statements dealing with future opportunities received the highest scores. Areas of the industry that suppliers were in most disagreement with included wait time for insurance approval, reimbursement for parts, reimbursement for technician travel time and lack of coverage for preventative maintenance. Telehealth system usage, preventative maintenance coverage, tracking repairs and repair scheduling were future opportunities that suppliers were in most agreement with.
Administrative issues exist in the CRT industry due to restrictive insurance policies associated with repairs and maintenance. Future opportunities to improve the process exist including payment models and the application of telehealth, device monitoring and service-based performance incentives to reduce adverse consequences to the user.
Implications for rehabilitation
Highlights the direct importance and barriers faced within the wheelchair repair industry by CRT suppliers.
In a sample of CRT suppliers, there is agreement there exists many administrative and operational issues related to wheelchair repairs.
There is agreement among survey respondents of opportunities to investigate further telehealth and remote strategies, preventative maintenance coverage and online tracking for wheelchair repairs.
The purpose of this study was to: (1) estimate battery lifespan in power wheelchairs (PWCs) as measured by the length of time until battery replacement occurs and (2) identify factors associated with ...variability in battery lifespan after device distribution.
PWCs distributed between 1 January 2016 and 31 December 2018 were retrieved from the Wheelchair Repair Registry (WRR) and included into this retrospective cohort study. Factors associated with battery lifespan were examined with the stratified Cox proportional hazard model.
A data set of 1268 PWCs from four different manufacturers was analysed. Five hundred and ten PWCs (40.2%) had one battery replacement with median battery lifespan of 22.3 months. The overall cumulative incidences of battery replacement were 14.5%, 56.2% and 88.2% at the end of the first, second and third year after device distribution, respectively. Among PWC manufacturers, manufacturer C (hazard ratio (HR), 2.63; 95% confidence interval (CI), 1.35-5.12; p = 0.004) and manufacturer D (HR, 3.02; 95% CI, 1.51-6.01; p = 0.002) were associated with shorter battery lifespan. PWCs operated in warmer states (65-75 °F annual temperature averages) were associated with longer battery lifespan.
Results showed that the median battery lifespan was 22 months. PWC manufacturer and operating climate temperature were associated with variability in battery lifespan. This research has implications to better inform users, providers, manufacturers and payers to be more aware of battery lifespan across PWC types and manufactures to anticipate replacement timelines and avoid adverse situations associated with battery failures.
Implications for rehabilitation
There are differences in battery lifespan across different power wheelchair (PWC) manufactures.
Power wheelchair batteries last longer in warmer operating climates.
Future attention needs to be sought towards the types of batteries manufacturers are using for PWC group classifications.
These types of studies could be useful to justify reasonable timelines and the costs associated with battery replacements.
Currently, no self-report instruments exist for assessing satisfaction with performing instrumental activities of daily living and occupations for people with disabilities using internet-connected ...assistive devices like accessible smartphones, tablets, laptops, and apps.
To assess the test-retest reliability and internal consistency of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) self-report outcome tool.
Repeated-measures cohort study with a time frame of 7 to 21 days.
Multicity online recruitment at assistive technology clinics, nongovernmental organizations, advocacy and peer support groups for people with disabilities, and higher education institutions.
Eighty-four participants with disabilities, age 18 yr or older, with a mean age of 43.3 yr (range = 19-75 yr), and 57% female.
Not applicable.
The a priori study hypotheses were that the EISA test-retest reliability scores would be above the minimum acceptable level (Rs > .80) and that internal consistency would be good (Cronbach's α = .70-.90).
On the basis of the study data, the EISA, Version 1.0, demonstrated good test-retest reliability (Rs = .81) and excellent internal consistency (Cronbach's α = .88).
The results of the test-retest reliability and internal consistency analyses provide good support for the EISA to be used in clinical settings. What This Article Adds: This article documents the reliability and internal consistency of, to our knowledge, the first-ever self-report instrument for assessing satisfaction with performance of everyday occupations for people with disabilities using internet-connected assistive devices such as smartphones, tablets, laptops, and apps.
Wheeled mobility and seating (WMS) devices allow users to achieve greater mobility independence. Previous studies determined that 53% of wheelchair users required one or more repairs over a 6-month ...period; however, there are a limited number of studies that have evaluated types of repairs. The purpose of this study was to describe the types of manual wheelchair, power wheelchair, and scooter repairs within the Wheelchair Repair Registry (WRR) and examine the association between WMS devices and the frequency of repairs. A dataset of 4,645 devices distributed in the United States was collected from equipment suppliers who performed and logged community-based wheelchair repair services. The results demonstrated common repairs found across devices were within the wheels/tires/forks and batteries/cables categories. Device type was the most significant predictor of variance in the number of repairs. Customizable manual wheelchairs, tilt-in-space, Groups 2 & 3 power wheelchairs, and scooters were associated with higher number of repairs compared to non-customizable manual wheelchairs, pediatric, heavy-duty manual wheelchairs, and Group 4 power wheelchairs. The higher failure rate found in specific devices may be associated with a population of more active users, environment/conditions where equipment is used, time spent in equipment, additional features on device, or lower durability.
A problem in the Complex Rehabilitation Technology industry is the lack of standardization in the assessment for wheeled mobility and seating (WMS). The aim of this paper was to identify assessment ...tools commonly used by clinicians during WMS evaluations. After the tools were identified by a panel of 12 subject matter experts, a presentation at the 2018 International Seating Symposium in Vancouver, Canada and the 2018 European Seating Symposium in Dublin, Ireland polled attendees via the Sli.do polling application to determine professional opinions of each tool, resulting in face validity for use in wheelchair evaluations. The Lawshe Content Validity Ratio was used to convert this anecdotal data into numerical data, indicating which tools were most and least used by attendees. Finally, a literature search was conducted to determine the reliability, validity, and International Classification of Functioning, Disability, & Health domain for each measure. The findings indicate that while there are many standardized and reliable assessment tools available for wheeled mobility and seating evaluations, most clinicians use only a few standardized assessment tools during WMS evaluations.
The purpose of this study was to examine factors associated with variability in time from assessment to device delivery (cycle time). Our hypothesis was that device type and type of insurance would ...be the strongest predictor of cycle time.
Data were extracted from the Functional Mobility Assessment/Uniform Dataset (FMA/UDS) Registry that at the time of analysis contained a sample of 2588 people with disabilities (PWD) who were provided with a wheeled mobility device (WMD) between 21 March 2016 and 29 June 2021. To examine the effect of individual factors on the variability in cycle time, a robust linear regression analysis was conducted.
The average national cycle time was 101.5 (SD = 59.9) d. Geographic area (Capital Metro p < .001, Great Lakes p = .016, and Northeast area p < .001), higher years since onset of disability (p < .001) and customizable devices (p = .021) were associated with higher cycle time. Non-customizable devices (p = .005), scooters (p < .001), Group 2 power wheelchairs (PWCs; p < .001), and funding source (Medicaid managed care (p < .001) and "other" (p = .028)) were associated with lower cycle time.
Longer cycle time is likely related to variations in clinical practice, insurance coverage criteria and the level of customizability of the device needed for a particular diagnosis, especially long-term disabilities.
Implications for rehabilitation
The national average number of days between initial evaluation and device delivery (cycle time) to deliver a wheeled mobility device (WMD) varies based on specific variables such as type of WMD, diagnosis and payer source.
Geographic area, years since onset of disability, device type, primary diagnosis and funding source significantly impact cycle times.
Increased complexity of the WMD, both manual and power wheelchairs (PWCs), was associated with longer cycle times.
As more service delivery models emerge, specific benefits and challenges need to be reported on how they impact cycle time.
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