The Importance of Comfort to Wheelchair Users: A Preliminary Study

Barbara Crane, MA, PT, ATP
University of Pittsburgh
RERC on Wheelchairs and Related Technology

Slide 1
The Importance of Comfort to Wheelchair Users: A Preliminary Study

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Barbara Crane, MA, PT, ATP
University of Pittsburgh
RERC on Wheelchairs and Related Technology

This preliminary study was conducted as the first phase of a multi-phase study of wheelchair seat comfort issues and the potential of a new dynamic seat technology in improvement of wheelchair seat comfort.

This study is being conducted as a part of the RERC on Wheelchairs and related technology at the University of Pittsburgh.

Slide 2
Statement of the problem

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Individuals who use wheelchairs because of severe mobility impairment and have sensation are at high risk of comfort related problems

Comfort and discomfort have not been extensively investigated in the wheelchair seating industry

There are two basic problems that are the impetus for this phase:

People who use wheelchairs, cannot move, but have intact sensation are perceived as having many problems related to comfort. Clinically we know that this can be a very difficult problem to resolve.

The second issue is that this topic has had very little research directed towards it. Greg Shaw investigated discomfort in a population of nursing home residents and several others have done some preliminary study, but overall it has not been the focus of a great deal of seating research up to this point.

Slide 3
Affected populations

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Discomfort may occur in any wheelchair using population

Most common in sensate populations with inability to move -- i.e. multiple sclerosis, amyotrophic lateral sclerosis, muscular dystrophy, post polio, frail elders with arthritis and debility, Guillian Barre syndrome

Notes:
Discomfort may occur in any wheelchair using population.

Populations of wheelchair users with relatively intact sensation and severe motor impairment seem to be particularly affected.

These include: MS, ALS, MD, PPS, GBS, frail elders, arthritic, debility, some instances of CVA

Individuals with cerebral palsy may also be affected, but they seem to be spared this complication in many cases -- possibly because of spared motor function and the ability to use spasticity and abnormal movement patterns to their benefit. Clinically, this does not seem to be a population of individuals with a great deal of discomfort. (it could be that they are not asked about discomfort and do not report it)

This study will focus on a subset of these populations -- MS, MD, ALS, and polio. These populations were selected because of their propensity toward discomfort and related functioning problems.

Slide 4
Size of affected population

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Multiple sclerosis

  • third leading cause of wheelchair use
  • first in population 18 - 64 years old
  • 82,000 wheelchair users

MS, ALS and MD combined account for 150,000 wheelchair users in the US

The primary cause of wheelchair use in all age groups is CVA, followed by arthritis -- tend to be frail elder population

Note:
IN contrast, the population of individuals who use wheelchairs because of quadriplegia or paraplegia (the focus of the majority of seating research) is around 90,000 (NIDDR report)

This does not even include institutionalized populations -- which Shaw determined also had a high prevalence of comfort problems

Slide 5
Specific aims of this preliminary phase

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Determine the prevalence of discomfort as a problem in this population

Investigate the importance of comfort to this population

Determine strategies or equipment that might mitigate discomfort

Note:
Three separate but related aims of this research.

Slide 6
Methods

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Questionnaire based descriptive study

Nine individuals: MS, MD, ALS

All full time wheelchair users

All had intact sensation and difficulty weight shifting

All had experienced some problems with discomfort

Note:
This was just a preliminary study, a questionnaire was developed in order to find out some specific information regarding discomfort and it's role in the lives of the participants.

Slide 7
Questionnaire-based interview

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Four parts

Part I - general/demographic info

Part II - functional information

Part III - current level of comfort

Part IV - suggestions for improving comfort

Notes:
The questionniare had four major parts, each with approximately 10 - 15 questions. Some questions were closed ended, some were more open ended and investigatory.

Slide 8
Results

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Demographic information:

Age range 18 - 66, mean age 41
2 female, 7 male
2 - ALS, 2 - MS, 5 - MD
7 - power mobility, 2 - manual mobility
5 - tilt in space, 3 - reclining back,
1 - neither

Slide 9
Results

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Average time spent in wheelchair -- 15 hours per day (range 8 - 24 hours)

All 9 reported routinely ignoring discomfort in order to function

5 reported experiencing discomfort on a daily basis

Most common site - low back (7), next most common - buttocks(6)

Slide 10
Res
hted Rank Orders

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Most important aspect of wheelchair:
Comfort - 1
Mobility - 1
Adjustability - 3
Independent use - 4
Self care allowance - 5
Safety - 6
Care-giver adjustability - 7

Importance of adjustability:
Control mechanism - 1
Leg rests - 2
Seat temperature - 3
Arm rests - 4
Head support - 5
Lateral supports - 6
Seat belt - 7

Notes:
We completed two weighted rank orders based on questions in the questionnaire.

The first was related to the most important aspect of the wheelchair itself. The other related to the importance of having various features of the wheelchair be adjustable. This information was targeted specifically to gather suggestions as to what needed to be included in our test chair.

Slide 11
Discussion

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All participants indicated that comfort is very important to them

All indicated that discomfort is a significant problem associated with wheelchair use

3 reported getting out of their chairs in order to manage discomfort

5 indicated problems with skin breakdown

Notes:
These are the major points in summary from the questionnaire data.

All participants indicated that comfort was very important and that discomfort was a significant problem in their lives.

Three of the nine individuals reported that they had to get out of their chairs in order to relieve discomfort.

Five of these individuals had experienced at least one episode of skin breakdown -- in spite of the fact that this is considered a low risk group. (another individual was excluded from the study because of a current skin breakdown episode)

Slide 12
Acknowledgements

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National Institute on Disability Rehabilitation and Research -- Rehabilitation engineering and research center on wheelchairs and related technology Grant #H133E990001

Technical assistance in questionnaire development provided by Shirley Fitzgerald, PhD, University of Pittsburgh

Slide 13
Contact Information

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Barbara Crane, MA, PT, ATP

RERC on Wheelchairs and Related Technology
5051 Forbes Tower, University of Pittsburgh
Pittsburgh, PA, 15260
412-383-6583

Bacst62@pitt.edu

Slide 14
Thank you for your attention

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Return to Slide Series

Updated: March 22, 2002

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Please note: This information is provided a archival information from the Rehabilitation Engineering Research Center on Wheeled Mobility from 1993 to 2002.

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