Measuring self–perceived satisfaction and independence of wheelchair users

Abstract

The wheelchair is viewed as one of the most important assistive technology devices used in rehabilitation.1 Wheelchairs, both manual and powered, are enablers of community participation, are used to enhance function, to improve independence, and to enable a person to successfully live at home and in the community.2 Wheelchair evaluation is a continuous process requiring re-assessment of wheelchair fit as users age and their functional conditions change.3 Research has shown that during this process, clinicians need to take factors into consideration that are associated with functional performance, such as wheelchair characteristics and client demographics. It is the dynamic interactions between these factors that pose the challenge for clinicians and wheelchair users as they decide on the best wheeled mobility interventions.4 Although clients seeking a wheeled mobility device are assessed before a device is prescribed, research has not focused on the everyday functional performance of the clients with their wheelchairs. Rather, instead of focusing on the ability of the device to enable activities and participation, research has focused on wheelchair skills, propulsion, abandonment, cost, policy, and wheelchair design.5 Following receipt of a wheeled mobility device, outcomes can be measured using subjective (self/proxy report) or objective (performance-based observation at clinic and home) methods. These assessment methods do not always yield equivalent results with clinical samples, and therefore the level of association among functional subjective and objective methods among clients being assessed for, and receiving, wheeled mobility devices is unclear.6 There is currently a lack of comprehensive outcome measures that focus on everyday functioning with a wheelchair. The Wheelchair Physical Functional Performance (WC-PFP), the Wheelchair Skills Test (WST), and the Wheelchair Users Functional Assessment (WUFA) are valid and reliable performance measures used to assess client’s skills or function while using a manual wheelchair.7,8 None of these measures address the quality of functional performance or provide individual scores for independence and safety for both manual and power wheelchair users. Furthermore, these measures do not fully represent all the important tasks wheelchair users identified as important to perform in a seatingmobility device, such as Comfort Needs, Reach for multiple levels, Transfers to/from multiple levels, and Transportation.6,9 In response to the need for more comprehensive outcome measures to document function for third-party payers, and evaluate the efficacy of wheeled mobility interventions, a team of researchers at the University of Pittsburgh developed the FEW (a self-report measure), the FEWCapacity (FEW-C, a performance-based measure for the clinic), and the FEW-Performance (FEW-P, a performance-based measure for the home) outcome measurement instruments. The trio of FEW tools has been used in research and proved to be reliable, valid, and useful.6,9–11 A study of 25 subjects showed that both the self-report FEW and FEW-C were able to detect significant changes in function over time following the provision of a new wheeled mobility and seating device. However, the FEW often significantly underestimated function compared to the FEW-C, and therefore documented greater changes in function over time6. Underestimation may have occurred because it is not unusual for individuals who are seeking interventions to underestimate their capabilities to obtain services or products.12 The FEW tools have been used in tele rehabilitation studies and also proved to be reliable and effective in that venue.11 Although there are several assessments of wheelchair skills, none address independence, safety and adequacy of performance of everyday tasks with a wheelchair. The FEW, FEW-C and FEW-P were developed to address the need for a more comprehensive assessment and outcomes tool for clients seeking and receiving wheeled mobility devices. Only a handful of research studies focused on measuring level of satisfaction and functional independence for wheelchair users using their current wheelchairs at everyday functional performance.13 Therefore, the FEW instrument was selected in this study to measure self-perceived satisfaction and functional independence of wheelchair users. The objectives of this study were to measure self-perceived satisfaction and independence in performing functional activities of individuals who use wheelchair as their primary mobility and seating device, to enable wheelchair users to identify the degree of problems they