Changes in Functional Mobility Outcomes of Individuals Receiving a New Seating/Mobility Device

Transcription

1 Changes in Functional Mobility Outcomes of Individuals Receiving a New Seating/Mobility Device Virginia Fly Miranda Law Stacey Lindsley Lacey Little Spence Tomlinson Penny Powers, PT, ATP Renee Brown, PT, PhD

2 Use of Wheeled Mobility 3.3 million individuals 15 or older use a wheelchair or similar device (1.8 million over 65 yo) With advances in health care and obesity, there are more individuals living with disabilities that require mobility assistance There is a growing need to validate the fit and functionality of users with their prescribed devices

3 Background Personal adverse effects of long term wheelchair use include dysthymia, malnutrition, reduced social and leisure activities, lower life satisfaction, and increased use of home health care services (Hoenig, Landerman, Shipp, & George, 2003) Individuals have reported a sense of helplessness during wheelchair use (Evans, Frank, Neophytou, and Souza, 2007) Lack of mobility, functionality or inappropriate wheeled mobility can lead to physical issues such as pressure ulcers, pulmonary complications, and cardiovascular deconditioning, overuse injuries, Cardiovascular deconditioning can result in a cascade of negative events including orthostatic hypotension, increased heart rate, blood pooling in peripheral tissues, decreased lung perfusion, thrombophlebitis, and reduced kidney function (Volicer, 2007)

4 Wheelchair Use Personal adverse affects of long term wheel chairs use Over use, repetitive injury Reduced social interaction Increased use of HH Sense of helplessness Inappropriate fit Pressure ulcers Cardiopulmonary compromise Communication/ swallowing difficulties

5 Evaluating Functional Mobility in Wheelchair Users Need to assess an individual s functioning with their seating system to validate the prescription and to evaluate new seating and mobility technology Technical Brief 9 Wheeled Mobility (wheelchair) Service Delivery (2012) emphasized the needs for evidence of outcomes for wheelchair prescription A number of tools have been developed to assess different aspects of functionality. QUEST WcS-DAT WUFA FEW FMA**

6 Functional Mobility Assessment The FMA is a self-report outcome tool designed to determine an individual s ability to function in their mobility device The FMA is a ten-question assessment that asks individuals about their ability to use their mobility device for functional tasks Daily routine, comfort, health needs, mobility, reach, transfer, indoor and outdoor mobility, transportation The FMA is a questionnaire using a seven-point response scale ranging from completely agree to completely disagree with an option for does not apply

7 FMA The FMA is applicable to individuals who use manual wheelchairs, power wheelchairs, scooters, walkers, canes, or crutches This allows for a broader use of the tool to determine how individuals are functioning with their adaptive equipment The FMA has been shown to be a valid and reliable tool for wheelchair users (Kumar 2012) Test-Retest Reliability ICC=.87 for all ten questions

8 Purpose To examine the functional outcomes of patients receiving a new wheelchair or seating system The difference in patients reported function between their previous assistive device and their new system indicates whether the prescription the individual received is meeting his or her needs by improving their function and potentially minimizing adverse long term effects.

9 Who is Eligible? 18 years of age or older and after receiving a physical therapy evaluation were prescribed and received a new wheelchair and/or seating system through the Vanderbilt Adult Seating and Mobility Clinic Subjects were excluded if they met any of the following criteria: a progressive disorder under the age of 18 unable to provide consent and legal representative was not able to provide consent not able to communicate via the phone.

10 Subjects Caregivers could provide the information via phone if appropriate consent was provided The subjects were provided with a copy of the FMA at the time of their initial evaluation when consent was obtained.

11 Participants 53 subjects consented to participate 42 subjects completed the pre-fit FMA 23 subjects completed the post-fit FMA 22 subjects completed both the pre-fit and post-fit FMA

12 Methods The subject was contacted by phone within 7 days of their initial evaluation, and the FMA was administered. The subject was contacted again 10 to 20 days after receiving their new seating or mobility system, and the FMA was re-administered. The subject s responses were documented, and additional comments they provided were noted for further qualitative analysis.

13 Results Average FMA score for each question Average FMA scores for each question and for the average total score for both pre- and post-fit for all responses (averages were calculated based on number of responses other than does not apply)

14 Results Average FMA score for each question The largest difference between pre and post FMA score was in question 2 My current means of mobility meets my comforts needs: (e.g. heat/moisture, sitting tolerance, pain, stability) The smallest change between pre and post FMA score was seen in question 10 My current means of mobility allows me to use personal or public transportation as independently, safely and efficiently as possible (e.g. secure, stow and ride)

15 Results: Changes in response for each question FMA Question Number Subject Average denotes that change score was not calculated because one of the scores was a 0 ( Does Not Apply ) response

16 Results: Changes in response for each question FMA Question Number Subject Average denotes that change score was not calculated because one of the scores was a 0 ( Does Not Apply ) response

17 Results: Changes in response for each question FMA Question Number Subject Average denotes that change score was not calculated because one of the scores was a 0 ( Does Not Apply ) response

18 Results: Changes in response for each question Greatest change between pre and post Question 2 - comfort Least change between pre and post Question 6 My current means of mobility allows me to transfer from one surface to another (e.g. bed, toilet, chair) Question 10 transportation

19 Discussion Obtaining post-fit responses was a challenge due to the length of time between the evaluation and obtaining the new seating system (avg 105 days) Intervening illness Changes in location Denial of the device Not being informed of the final fit when delivered directly to the home

20 Conclusions Subjects reported a higher level of functioning with their new seating system The greatest improvement was reported in meeting their comfort needs Access to public and private transportation for wheelchair users is an issue in this community Future studies are needed to examine type of device prescribed and transition from one device to another

21 References Centers for Disease Control and Prevention (CDC). (2009) million U.S. adults report a disability; arthritis remains most common cause. In Center for Disease Control and Prevention. Retrieved November 18, 2010, from Crane, B., Holm, M., Hobson, D., Cooper, R., Reed, M., Stadelmeier, S. (2004). Development of a consumer- driven Wheelchair Seating Discomfort Assessment Tool (WcS-DAT). International Journal of Rehabilitation Research, 27(1), Davies, A., De Souza, L., Frank, A. (2003). Changes in the quality of life in severely disabled people following provision of powered indoor/outdoor chairs. Disability and Research, 25, Evans S, Frank A, Neophytou C, Souza L. (2007). Older adults' use of, and satisfaction with, electric powered indoor/outdoor wheelchairs. Age and Ageing, 36, Hoenig, Helen, Landerman, L., Shipp, K., George, L. (2003). Activity restriction among wheelchair users. Journal of the American Geriatrics Society, 51, Kumar, A., Schmeler, M., Karmarkar,A., Collins, D., et al.(2012). Test-retest reliability of functional mobility assessment (FMA): a pilot study. Disability and Rehabilitation: Assistive Technology. Early Online:1-7. Mao, H., Chen, W., Yao, G., Huang, S., Lin, C., Haung, W. (2010). Cross-cultural adaptation and validation of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0): the development of the Taiwanese version. Clinical Rehabilitation, 24, Mills, T., Holm, M.B., Trefler, E., Schmeler, M., Fitzgerald, S., Boninger, M. (2002) Development and consumer validation of the Functional Evaluation in a Wheelchair (FEW) instrument. Disability and Rehabilitation, 24(1/2/3), Mills, T., Holm, M., Schmeler, M. (2007). Test-retest reliability and cross validation of the Functioning Everyday with a Wheelchair instrument. Assistive Technology, 19, Samuelsson K, Wressle E. (2008). User satisfaction with mobility assistive devices: An important element in the rehabilitation process. Disability and Rehabilitation, 30(7), Stanley, R., Stanfford, D., Rach, E., Rodger, M. (2003). Development of a functional assessment measure for manual wheelchair users. Journal of Rehabilitation Research and Development, 40(4), Volicer, L. (2007). Does wheelchair use improve ambulation and quality of life? Alzheimer's Care Today, 8(3),

22 Thank you Patients Vendors Penny Powers, PT, ATP Vanderbilt Seating and Mobility Clinic Dr. Brown, PT, PhD