Predictors of Mobility Among Wheelchair Using Residents in Long-Term Care

Mortenson, W. Ben; Miller, William C.; Oliffe, John L.

doi:10.1016/j.apmr.2011.03.032

Cited by 26 publications

(18 citation statements)

References 34 publications

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“…Secondary data analyses were employed with results of a crosssectional study exploring predictors of resident mobility in LTC, for which ethics approval was obtained from the University of British Columbia Ethics Board [16] . All LTC facilities with a minimum of 100 wheelchair users within a prescribed area of the lower mainland of British Columbia were invited to participate in the study; 11 out of 13 potential facilities agreed.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Facility Level Correlates of Need for Wheelchair Seating Assessment among Long-Term Care Residents

2012

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Background: Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care. Objective: To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors. Methods: Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy. Results: The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6–64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (r_p = –0.684, CI –0.143 to –0.910) was found. Conclusion: Prevalence of need for seating assessment in long-term care is high overall but it varies considerably between facilities. Increasing access to occupational therapy services appears to mediate this need.

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Section: Methodsmentioning

confidence: 99%

Prevalence and Facility Level Correlates of Need for Wheelchair Seating Assessment among Long-Term Care Residents

2012

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“…Wheelchairs improve mobility and participation, reduce caregiver burden and reduce the likelihood of placement in a long-term-care facility [2–7]. However, there are a number of problems associated with their use.…”

Section: Introductionmentioning

confidence: 99%

“…There are a growing number of randomized controlled trials (RCTs) that provide evidence for the safety and effectiveness of the WSTP in a variety of settings [27–32] as well as other evidence about the benefits of wheelchair-skills training [33–35]. There is also growing evidence for a relationship between wheelchair skills and other important outcomes such as confidence and participation [2,3,4,21,22,31,36–39]. …”

Section: Introductionmentioning

confidence: 99%

Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial

et al. 2016

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ObjectivesTo test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group.MethodsWe carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30–45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores.ResultsParticipants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021).ConclusionsIndividualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.

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“…We anticipated enrolling 34 residents from eight facilities to meet our target sample size of 264. 8 …”

Section: Recruitmentmentioning

confidence: 99%

Association Between Mobility, Participation, and Wheelchair‐Related Factors in Long‐Term Care Residents Who Use Wheelchairs as Their Primary Means of Mobility

Mortenson

Miller

Backman

et al. 2012

J American Geriatrics Society

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OBJECTIVES-To explore how wheelchair-related factors, mobility, and participation are associated in a sample of long-term care residents who use wheelchairs as their primary means of mobility. DESIGN-Cross-sectional survey SETTINGS-Eleven residential care facilities in the Lower Mainland of British Columbia CanadaPARTICIPANTS-146 self-responding residents and 118 proxy respondents: mean age 84 years (range 60-103). Most were women (69%), and a small proportion (9%) drove a power wheelchair. Author Contributions: Dr. Mortenson was involved in conceptualizing the research, recruitment of sites and participants, supervising data collection, performing data analysis and interpretation, and preparation of the manuscript. Dr. Miller was involved in conceptualizing the research, supervising data collection, data analysis, and writing up the study findings. Dr. Backman was involved in conceptualizing the research, data analysis and manuscript preparation. Dr. Oliffe was involved in conceptualizing the research, data analysis, and interpretation and writing up the study findings. RESULTS-Path analysis indicated that wheelchair-related factors were associated with participation frequency directly and indirectly through their relationship with mobility. The final model explained 46% of the variance in resident's mobility and 53% of the variance in resident's participation frequency. Wheelchair skills, which include the ability to transfer in and out of and propel a wheelchair, were important predictors of life-space mobility and frequency of participation, and life space mobility was a significant predictor of frequency of participation. Depression was associated with decreased wheelchair skills, mobility and participation frequency. Counter intuitively, perceived environmental barriers were positively associated with frequency of participation.CONCLUSION-The findings suggest that by addressing wheelchair-related factors resident's mobility and participation may be improved, but the efficacy of this approach needs to be confirmed experimentally. Keywordswheelchair; mobility; participation; nursing homeProblems with ambulation mean that most long-term care residents use wheelchairs as their primary means of mobility. 1 However, facility-related problems including inadequate selection and maintenance of wheelchairs and limited availability of staff to assist residents who are unable to self-propel their wheelchairs may negatively affect their participation in daily activities. 2,3 To facilitate positive outcomes of wheelchair prescription, the Matching Person to Technology (MPT) model posits that personal, environmental and assistive technology factors need careful consideration. 4 To date, most research investigating predictors of resident's participation has focused on personal factors. 5,6 Earlier studies have not investigated how wheelchair-related factors contribute to residents' activity and participation.Based on the MPT and a preliminary qualitative study 7 we developed a model to explain the association amon...

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Predictors of Mobility Among Wheelchair Using Residents in Long-Term Care

Cited by 26 publications

References 34 publications

Prevalence and Facility Level Correlates of Need for Wheelchair Seating Assessment among Long-Term Care Residents

Prevalence and Facility Level Correlates of Need for Wheelchair Seating Assessment among Long-Term Care Residents

Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial

Association Between Mobility, Participation, and Wheelchair‐Related Factors in Long‐Term Care Residents Who Use Wheelchairs as Their Primary Means of Mobility

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