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Wheelchair mobility is a prerequisite to being able to carry out important activities and to participate in social life. Level of satisfaction with the wheelchair and overall quality of life were found to be positively associated. The aim of this study was to determine the level of satisfaction of French manual wheelchair (MW) users and caregivers with MW characteristics. A total of 132 users and 76 caregivers completed a questionnaire about their level of satisfaction with their MW characteristics. Satisfaction scores were independent of age, sex, reason for MW use, and time of use. As a whole, MW users are satisfied. However, a few parameters such as MW weight and difficulties propelling outdoors demonstrate a low level of satisfaction among users. MW weight, brakes, and height of pushing handles are the less satisfying elements among caregivers. In conclusion, the majority of French MW users are satisfied, but some characteristics, such as weight, must be optimized. Considering caregiver needs is paramount when aiming to improve MW parameters such as brakes or pushing handles. Improvement in some MW parameters seems to be important in achieving improved level of satisfaction and increased participation and active lifestyle among MW users and caregivers.
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Volume 52, Number 2, 2015
Pages 181–192
Manual wheelchair satisfaction among long-term users and caregivers:
A French study
Claire Marchiori;
Djamel Bensmail, MD;
Dany Gagnon, PhD;
Didier Pradon, PhD
Raymond Poincaré Hospital, Garches, France;
Pathokinesiology Laboratory, Centre for Interdisciplinary Research
in Rehabilitation of Greater Montreal, Institut de Réadaptation Gingras-Lindsay-de-Montréal, Montreal, Canada
Abstract—Wheelchair mobility is a prerequisite to being able
to carry out important activities and to participate in social life.
Level of satisfaction with the wheelchair and overall quality of
life were found to be positively associated. The aim of this
study was to determine the level of satisfaction of French man-
ual wheelchair (MW) users and caregivers with MW character-
istics. A total of 132 users and 76 caregivers
completed a
questionnaire about their level of satisfaction with their MW
characteristics. Satisfaction scores were independent of age,
sex, reason for MW use, and time of use. As a whole, MW
users are satisfied. However, a few parameters such as MW
weight and difficulties propelling outdoors demonstrate a low
level of satisfaction among users. MW weight, brakes, and
height of pushing handles are the less satisfying elements
among caregivers. In conclusion, the majority of French MW
users are satisfied, but some characteristics, such as weight,
must be optimized. Considering caregiver needs is paramount
when aiming to improve MW parameters such as brakes or
pushing handles. Improvement in some MW parameters seems
to be important in achieving improved level of satisfaction and
increased participation and active lifestyle among MW users
and caregivers.
Key words: accessories, caregivers, French, French
chair, manual wheelchair, parameters, satisfaction, users,
wheelchair characteristics, wheelchair satisfaction.
Mobility is an essential component of activities of
daily living and is neces
sary for participation in social
activities [1]. Impaired body functions leading to limited
walking ability may restrict activity and participation [2].
Mobility assistive technology can be a means to improve
activity and participation [3]. Among mobility assistive
devices currently available, canes are used the most for
improving mobility among persons with motor impair-
ments and functional disabilities, whereas
rank second; 1 percent of the world population requires a
wheelchair, but only 0.3 percent are wheelchair users [4].
In France, 62 persons per 10,000 (i.e., 360,000 people)
use a wheelchair [5]. This figure includes 59 persons per
10,000 who use a manual wheelchair (MW), which may
be foldable, rigid, sporty, or designed specifically for
comfort [5]. These people use an
MW for various rea-
sons: neurological disorders, genetic disorders, cognitive
deficits, p
athology of the lower limb and trunk, or age-
related changes. The age-related changes category
includes participants more than 60 yr old who have a
Abbreviations: GH = geriatric hospital, MW = manual wheel-
chair, MWU = manual wheelchair user, PAPAW = pushrim-
activated power-assisted wheelchair, QUEST = Quebec User
Evaluation of Satisfaction with Assistive Technology, RH =
retirement home, SCI = spinal cord injury, UH = university
hospital, UL = upper limb.
Address all correspondence to Claire Marchiori, UVSQ,
EA 4497, CIC-IT 805, Raymond Poincaré Hospital 92380,
Garches, France; +33 1 71 14 49 21.
JRRD, Volume 52, Number 2, 2015
reduced level of independence and safety during ambula-
tion due to various age-related changes (e.g., balance
problems, muscle
weakness) and risk of falls. The major-
ity of MW users (MWUs) live at home (57%), but this
d reverses with age and elderly MWUs mainly live in
institutions [5]. With a revenue of €133.8 million ($141.2
million) in 2007, the wheelchair industry is large and still
growing (8% growth between 1996 and 2001) [6].
The provision of an MW aims to improve the mobil-
ity of the MWU despite his or her impairments and dis-
abilities. Caregivers, mainly family members and health
s who play an important role in the person’s
daily life, also help to improve mobility and promote
social integration.
Improved mobility among people with disabilities is
a prerequisite for int
egrating into the community and
gaining access to education, employment, and socializa-
tion, as well as preventing additional secondary compli-
cations (e.g., pressure sores). MW settings are also
important in
optimizing mobility. Dalyan et al. showed
that the use of a poorly configured MW may cause upper-
limb (UL) pathologies and actually decrease autonomy
[7]. Hence, a well-designed and -adapted MW may allow
MWUs to access the same opportunities as other mem-
bers of their community and improve their level of sati
faction. The choice in the type of MW as well as
justments must be individualized to enhance satisfac-
tion and usability [8].
MWU satisfaction is an important variable for
rchers in the field of mobility [9–11]. Samuelsson
and Wressle demonstrated that users used their assistive
device (MWs and wheeled walkers) for more years when
the level of satisfaction was high [12]. One cause of dis-
continued use is user dissatisfaction. Moreover, studies
have shown that level of satisfaction with the wheelchair
and overall quality of life of persons with spinal cord
injury (SCI) were positively related in China and the
Netherlands [12]. de Groot et al. highlighted key aspects
of the wheelchair (i.e., dimensions and simplicity of use)
that are important for optimizing an active lifestyle and
social participation [10]. The importance of good wheel-
chair adjustments has been previously described in
wheelchair ergonomics
literature [13].
In some countries, assistive technology is free of
arge, but in other countries, the provision of assistive
technology depends on insurance conditions. Further-
more, regulations and assistive technology service sys-
tems differ between countries [14]. In
the few studies
carried out in China, Denmark, the Netherlands, and Can-
ada, MWUs were found to be satisfied with their MWs
2]. However, this question has not been investigated
in France. The French healthcare system is different and
covers only a few parts of the wheelchair by insurance.
The remainder of the cost must be paid by the user. To the
best of our knowledge, a few studies have evaluated the
level of satisfaction of wheelchair users with specific
types of wheelchairs (i.e., power wheelchairs) but not for
MWs. Based on a PubMed search using the key words
“satisfaction” and “wheelchair,” 224 results were found,
but when the key words “French” and “manual” were
added, only 2 results were found. One study evaluated
satisfaction with a lever-propelled wheelchair prototype
but not for MWs with traditional propulsion [15], and the
other study evaluated technological equipment in general
[16]. When the key word “caregivers” was added, no
results were found. Given the important role of caregiv-
ers in the mobility of MWUs, i
seems important to also
evaluate their level of satisfaction with the technical
aspects of MWs.
The aim of this study was to determine the satisfac-
tion of French MWUs and caregivers of MWUs with
MW characteristics, partic
ularly the wheels, brakes,
accessories, and MW dimensions and weight. We
believed that increasing our understanding of the satis-
faction of MWUs and caregivers would help to improve
the de
sign of MWs (dimensions, weight, etc.). MWUs
and caregivers each completed a different questionnaire
(Appendix, available online only) about their level of
satisfaction with the MW parameters. We hypothesized
that the level of satisfaction would not vary with age, sex,
cause of disability, or MW type and that MWUs would be
satisfied on the whole with their MW but that they might
not be satisfied with all the specific parameters. Particu-
larly, we hypothesized that they might be dissatisfied
with the MW weight.
e also hypothesized that full-time
MWUs would be less satisfied than occasional MWUs
and that the caregivers would be largely less satisfied
with the MW parameters than the MWUs.
The study started in December 2011 and finished in
ne 2012. A convenience sample of MWUs and their
caregivers was recruited from various sources, including
a geriatric hospital (GH), a retirement home (RH), and a
MARCHIORI et al. Manual wheelchair satisfaction
university hospital (UH). The questionnaire was also posted
on the Garches Foundation Web site (
These different locations were chosen in order to target a
wide po
pulation. A total of 654 questionnaires was dis-
tributed. Individuals over 18 yr old who used a MW were
eligible to
participate. Participants who were unable to
understand and answer the questionnaire were excluded.
Caregivers included family members and health profes-
sionals of the MWU. They were defined as people who
ed a dependent person in activities of daily living
[17]. Caregivers over 18 yr old were eligible to partici-
pate. The study was approved by a local ethics commit-
tee. It was registered as a national multicenter
study of
MWs. Subjects were not paid for their participation in the
A questionnaire was developed for the purpose of the
study in collaborati
on with clinicians who prescribe
wheelchairs and by a physiotherapist with 20 yr of expe-
rience specialized in assisting pe
rsons choose and adjust
their wheelchairs. The items on the questionnaire
included the mechanical characteristics of wheelchairs
described by Cooper [18]. Table 1 describes the ques-
tions asked in each category.
Manual Wheelchair Users
Participants first provided demog
raphic information,
including age, sex, height, weight, profession, diagnosis,
etiology, and number of years of wheelchair use. They
then reported the characteristics of their wheelchair,
including type, model, and make. Participants were also
asked to report the total number of wheelchairs they had
used since their first wheelchair and whether they had a
pushrim-activated power-assisted wheelchair (PAPAW).
The main part of the questionnaire was related to satis-
faction with the MW and its parts, including the brakes
wheels, and accessories (i.e., armrest, head support). A 4-
point scale was used to rate global MW satisfaction. The
final part of the questionnaire related to participants’
needs. Participants were asked to choose their three main
criteria when selecting a new MW from a list and an
open-ended question was asked about aspects that should
be improved.
The caregiver questionnaire foc
used on age and sex
and the characteristics of the MW, including type, model,
make, and satisfaction related to parts of the MW that the
person whom they cared for used. It also asked whether
the MWU had a PAPAW. At the end, there was an open-
ended question relating to aspects that they felt should be
Data Analysis
Descriptive statistics (mean ± standa
rd deviation for
continuous variables and frequencies for categorical vari-
ables) were used to describe the study sample, MW char-
acteristics, satisfaction levels, and selection criteri
a if
they needed to buy a new MW. Differences between
groups (old/young, male/female, accident/disease, type
of MW) regarding global satisfaction score were ana-
lyzed with independent Student t-tests
. Theses compari-
sons were carried out to evaluate whether or not the
of satisfaction varied with age, sex, cause of disability, or
MW type. The 4-point satisfaction scale was divided into
two categories: “quite satisfied and very satisfied” and
“not very satisfied and not satisfied at all.” A McNemar
test was used to analyze global satisfaction and satisfac-
tion with each parameter. A chi-squa
re test was used to
analyze satisfaction with each parameter between full-
time MWUs and occasional MWUs and to compare satis-
faction among caregivers and MWUs. A Bonferroni cor-
rection was applied to an adjusted p-v
alue of 0.004,
which was used for all tests. Data were analyzed with
Statistica 10 software (Stat Soft Inc; Tulsa, Oklahoma).
A total of 132 MWUs and 76 caregivers completed
the questionnaire (re
sponse rate: MWUs: 35%; caregiv-
ers: 27%). Out of the 132 MWUs, 107 (81.1%) were
cruited from GHs, RHs, and UHs and 25 were recruited
from other sources (Internet).
Characteristics of Manual Wheelchair Users
Most participants reported that they spent all day in
their wheelchairs (69
.7%). The diagnosis and/or disabili-
ties reported included sensorimotor impairments of the
lower limbs and
trunk (43.2%), neurological diseases
(31.8%), genetic diseases (5.3%), and aging (17.4%). The
diagnoses were as follows: SCI, amputation, multiple
sclerosis, and cerebral palsy. The main cause of MW
among males was trauma (59.7%), while trauma
Information Category How Obtained
Sex Category (men, women).
Age Number of years.
Height and Weight Open-ended question.
Profession Open-ended question.
Years of Use in General Open-ended question.
Diagnosis Category (neurological disease, genetic disease, weight problem, sensory
ficit, mental deficit, lower-limb deficit, system deficit, old age with
motor impairment, other). Several categories can be chosen. Category
(birth, accident, disease, old age).
Wheelchair Characteristics
Number of Wheelchairs Owned Open-ended question.
Type Category (foldable, rigid, sport,
power). Make and model.
Frequency of Use Category (sometimes [for particular activi
ties], often, always [for daily
Place of Use Category (indoors, outdoors, indoors and outdoors).
Difficulty Using Category (can be realized alone, very di
fficult, difficult, easy, very easy).
About propulsion, transfer, loading of wheelchair into car, folding of
wheelchair, crossing obstacles.
Satisfaction with Wheelchair Category (not at all satisfied, not very satisfied, q
uite satisfied, very satis-
fied). About wheelchair (dimensions, weight, ease of
indoors and out-
doors propulsion, ease of pivot), brakes, wheels, and accessories
rests, support head).
Improvements Open-ended question about points to improve on wheelchair.
Criteria Choose 3 from list of 11 criteria.
Sex Category (men, women).
Age Number of years.
Wheelchair Characteristics: Type Category (foldable, rigid, sport,
power). Make and model.
Satisfaction with Wheelchair Category (not at all satisfied, not very satisfied, q
uite satisfied, very satis-
fied). About wheelchair, brakes, wheels, and acces
Improvements Open-ended question about points to improve on wheelchair.
JRRD, Volume 52, Number 2, 2015
represented only 25 percent of causes for females, with
diseases (36.8%) and aging (29.4%) accounting for the
largest distribution of causes (Figure 1).
In terms of wheelchair skills, most MWUs were able
to propel (52.2%) and transfer (45%) easily, i.e., they
could perform these tasks independently without diffi-
culty regardless of the surface, slope, or height of the
sfer surface. Some reported difficulties in loading
their MW into the car (27.2%), folding it (20.4%), and
crossing obstacles (39.4%). Many MWUs were unable to
load MW (58.3%), fold MW (48.5%), or cross obstacles
independently (43.2%)
Wheelchair Characteristics
Table 2 lists the characteristics of the MWs and the
. Of the pa
rticipants, 100 (75.7%) used a foldable
MW, 22 used a rigid MW (16.7%), 8 used a comfort MW
(allows for movement, prolonged sitti
ng, and napping
Table 1.
Description of questionnaire.
Sport wheelchairs are designed for athletes with disabilities who are competing in sports that require agility and speed such as basketball, tennis, rugby, or racing.
Comfort wheelchairs are self-propelled and allow patients to displace themselves and sit for long periods of time, as well as to nap in chair without increasing num-
ber of transfers.
Figure 1.
Etiology of wheelchair use for (a) men and (b) women.
MARCHIORI et al. Manual wheelchair satisfaction
without an increased number of transfers) (6.1%), and
only 2 used a sport MW (1.5%). The average duration of
MW use was 12.5 ± 13.7 yr. Each patient had used an
average of 3.1 ± 3.3 wheelchairs and had changed their
wheelchair every 4.0 yr on average. Only 15 participants
(11.4%) owned a PAPAW. Most participants used the fol
lowing MW brands: Invacare (Elyria, Ohio) (n = 37;
28.0%) and Kuschall
(Witterswil, Switzerland) (n = 31;
Satisfaction Ratings
No differences were found between age groups (p =
sex (p = 0.93), or cause of MW use (p = 0.69)
regarding global satisfaction scores and satisfaction with
each parameter. Moreover, no differences were found
between the types of MW (p = 0.39). The majority of
MWUs was satisfied (71 MWUs gave a rating of 3 [satis-
fied] and 26 MWUs gave a rating of 4 [very satisfied]).
13 and 22 of 132 MWUs were not satisfied, with
ratings of 1 (not satisfied at all) and 2 (not very satisfied),
respectively. Only five differences were found between
global satisfaction and satisfaction with each parameter
(Table 3). MWUs were satisfied with all items (Figure 2)
except for two: the MW weight (p < 0.001, 38%) and out-
door propulsion (p < 0.001, 39%). As
for acc
few MWUs had a head support (13.6%) or lateral trunk
supports (10.6%). MWUs were particularly satisfied with
the weight of the wheels (p = 0.001, 86%), MWU friend-
liness of the brakes (p = 0.
002, 81%), and indoor propul-
sion (p = 0.00
1, 82%). Concerning the differences among
full-time versus occasional MWUs, it appears that there
are no differences in mean
Characteristic n (%)
Users 132
Mean Age, yr (range) 55.4 (18–97)
Male 62 (47)
Female 70 (53)
Mean Time in Use, yr (range) 13.3 (0–52)
Caregivers 76
Mean Age, yr (range) 45.3 (16–81)
Male 26 (34)
Female 50 (66)
Family Member 55 (72)
Health Professional 21 (28)
Accident 54 (40.9)
Disease 42 (31.8)
Old Age 23 (17.4)
Birth 11 (8.3)
Other 2 (1.5)
Foldable 100 (75.7)
Rigid 22 (16.7)
Comfort 8 (6.1)
Sport 2 (1.6)
Frequency of Use
Sometimes 22 (16.7)
Often 18 (13.6)
Always 92 (69.7)
Place Used
Indoors 27 (20.4)
Outdoors 27 (20.4)
Indoors and Outdoors 78 (59.2)
age (p = 0.8) and global satis-
faction (p = 0.5). F
ull-time and occasional MWU satis-
faction for MW parameters were similar (p > 0.99).
For MWUs, the most important
criterion was weight
(26.5%), followed by comfort (19%), durabilit
y (19%),
and maneuverability (16%).
Characteristics of Caregivers
Caregivers were recruited from GHs, RHs,
and UHs
(62, 81%) and other sources (Internet) (14, 19%). Out of
those, 55 (72%) were family members and 21 (28%) were
health professionals. Caregivers were mostly women (50,
65%) with a mean age of 46.0 ± 17.5 yr. Distribution of
MW type was the same as that of MWUs with a majority
having foldable MWs (64
.5%) followed by comfort MWs
Tabl e 2.
Characteristics of study population.
Subjects “Quite Satisfied or
Very Sa
tisfied” (%)
Dimensions 78
Weight 62
Propulsion Indoors 82
Propulsion Outdoors 61
Ease of Pivot 78
Brake Position 80
Ease of Brakes 81
Clothes-Guards 65
Pushing Handles 80
Braking Quality 73
Ease of Handrim 73
Wheels Weight 86
Maintenance of Wheels 75
Armrests 73
Foot Rest 81
Support Head 78
Trunk Support 71
Global Satisfaction 73
JRRD, Volume 52, Number 2, 2015
(19.7%) and rigid MWs (14.5%). The task of loading the
MW into the car and crossing obstacles was more diffi
cult for caregivers than pushing, folding, and other activ-
ities. Indeed, 65.8 and 59.2 percent of caregivers ha
difficulty in carrying out these activities, respectively.
Figure 3 depicts MW satisfaction
among caregivers.
Overall, they were satisfied with the MW (10/12 items
satisfied). However, 40 percent were dissatisfied with the
push handle, especially its adjustment (p = 0.001). Table 4
shows the comparison of satisfaction with each item
between MWUs and caregivers. Caregivers were less sat-
isfied with MW weight (p < 0.001
, 63% dissatisfaction)
and brake position (p < 0.001). The results of the open-
ended question revealed that the most important criterion
of an MW for caregivers was that they were lightweight,
designed for comfort, and durable (reported 22, 15, and
13 times, respectively). Other aspects also frequently
mentioned were compactness (10 times), ease of folding
(9 times), and aesthetic qualities (9 times).
The aim of this study was to evaluate the satisfaction
of French
MWUs and caregivers with MW characteris-
tics. To our knowledge, this has hardly bee
n evaluated
around the world and no studies have specifically been
conducted in France on MWUs and caregivers. We
believe that measuring satisfaction with an MW is an
important aspect of assessing the quality of an MW. The
major findings of this study are that French MWUs are
generally satisfied with their MW and its technical char-
acteristics, although some improvements do
seem nece
sary. The results of this study sho
wed that weight and
outside propulsion were the main reasons of dissatisfac-
tion among MWUs. Caregivers were unsatisfied with
MW dimensions and the bra
es and were most unsatis-
fied with MW weight.
de Groot et al. showed a relationship between partici-
pation and simplicity of use and between an active life-
style and MW dimensions [10]. They showed that some
aspects of
the MW should
be optimized because they are
related to an active lifestyle and participation. MWUs
considered the wheelchair to have a positive influence on
their opportunity to work and have an active leisure life
[12]. Other studies have also shown that participants who
were more satisfied with MW dimensions or who were
satisfied overall had a more active lifestyle [9–11]. The
results of our study showed that MWUs are satisfied with
their MWs (73.5% satisfied, mean score of 2.8/4). The
global satisfaction scores and level of satisfaction for
each item did not depend on age, sex, or etiology. These
results are similar to those reported by de Groot et al.,
who did not find any differences between age or sex
groups [10]. Satisfaction with MW dimensions and sim-
plicity of use indoors was above 80
similar to the
previous study. The most important aspects perceived by
the MWUs were that the MW was lightweight, designed
for comfort, durable, and easy to maneuver. The same
items were found to be important in a study by Samuels-
son and Wressle [12].
As we hypothesized, despite the fact tha
the persons
were globally satisfied, they had many criticisms. MW
weight and outdoor propulsion were the aspects with the
most mixed responses for MWUs. Unlike MWUs, the
most mixed responses among caregivers concerned the
MW’s weight, dimensions, position, and ease of use of
the brakes and push handles. In the previously mentioned
studies, the authors reported lower levels of satisfaction
with MW weight [10–12]. The results of the study by
Samuelsson and Wressle showed that MW weight and
type of surface have an effect on propulsion [12].
Cowan et al. indeed showed that surface type substantially
Table 3.
Comparison of manual wheelchair user parameter satisfaction and global
satisfaction (n = 132).
p < 0.004.
Figure 2.
Percentage of answers given by manual wheelchair users to item of satisfaction questionnaire.
MARCHIORI et al. Manual wheelchair satisfaction
affects self-selected velocity, peak resultant force, and
peak tangential force and that the addition of 9 kg
reduces self-selected velocity and increases peak forces
on each surface [19]. Cowan et al. concluded that the
greatest reductions in the resultant peak force would be
obtained with the lightest possible wheelchair [19]. To
our knowledge, no studies have been carried out on satis
faction with wheelchair accessories. Caregivers are less
satisfied than MWUs in te
rms of push handles and
It is interesting to note that despite the fact that
MWUs and c
aregivers were dissatisfied with several
aspects of the MWs, they expressed overall satisfaction.
It therefore appears that they are resigned to the fact that
they have to live with this reality. This is known as
accommodation. Accommodation is an effect of the envi-
ronment on the MWU that alters his or her way of seeing,
, and thinking. It reflects the action of the environ-
ment on the cognitive activity of the subject, reor
knowledge, and changing his or her way of seeing things.
Thus, to accommodate to the MW, the person must
accept its faults and qualities. In other words, the person
learns to put up with it whatever happens [20].
The caregivers in this study were family members
d health professionals with a majority of women (65%)
aged 46 yr on average. This is similar to a previous study
in which the caregivers were found to be generally
women (68%) with a mean age of 47 yr [21]. The main
sources of dissatisfaction among caregivers were MW
weight, dimensions, brakes, and push handles. This is
likely related to the fact that these elements can cause
discomfort or pain (such as low back pain) and limit the
caregivers actions. If the MW is too heavy, it is difficult
to move, especially for tasks such as loading it into a car.
Similarly, if the push handles are improperly adjusted or
not adjustable, this can cause back pain. A study by van
Figure 3.
Percentage of answers given by caregivers to item of satisfac-
tion questionnaire.
JRRD, Volume 52, Number 2, 2015
der Woude et al. showed that the biomechanical load
when pushing a wheelchair is partly influenced by push
handle height [22]. In general, higher push handles
appear to offer some advantages. Low push handles cre
ate greater net moments of force, compression forces,
d shear forces on lumbar 5 to sacral 1 and greater lift-
ing forces in comparison with higher push handles. van
der W
oude et al. determined that the push handles should
be positioned at 86.5 percent of shoulder height and
should therefore be adjustable. Moreover, caregivers
have a high-risk of developing low back pain [23]. This
can interfere with the caregivers own life as well as with
the mobility of the MWU. The brakes are also a problem
because of their low position on the MW.
The elements of satisfaction and dissatisfaction high-
lighted here and in other studies must be taken into
nt in the design and modification of MWs since a
well-designed, well-adjusted MW can enhance the
mobility and community participation of individuals with
reduced mobility [4]. Moreover, a poorly adjusted or
adapted MW may cause secondary UL pathologies and
decreased independence [7]. The importance of a well-
adjusted wheelchair has been previously described in the
literature. For example, seat height has an effect on phys-
ical strain; a low, backward position of the seat allows
ter efficiency of propulsion, but if the seat is too low
and the wheels too far back, this increases joint angles
and could increase the risk of UL injuries [24].
One major problem is that MWUs often have diffi-
culty in obtaining improved MW models,
such as lighter,
more compact MWs, because of the cost. In France, the
level of reimbursement from the state depends on the
type of wheelchair, e.g., €558 ($589) for a rigid and fold-
able wheelchair and €948 ($1,001) for a comfort wheel-
chair. These sums do not correspond with the price of
icated wheelchairs, which can be over €4,000
($4,224). If users do not have a complementary health
insurance plan to help them pay for their wheelchair, they
are often unable to access the one best suited to their MW
needs. In this study, MWUs and caregivers were unani-
mous in their belief that the price of wheelch
airs is too
high. A study of the France Paralyzed Association on
wheelchair funding showed that reimbursement is insuf-
ficient compared with the price and that it does not allow
persons wi
th disabilities to acquire a wheelchair that
reflects their needs [25]. MWUs hesitate to choose a
Subjects “Quite Satisfied or Very Satisfied” (%)
Manual Wheelchair Users (n =
2) Caregivers (n = 76)
Dimensions 78 64
Weight 62
Propulsion Indoors 82 85
Propulsion Outdoors 61 63
Ease of Pivot 78 75
Brake Position 80
Ease of Brakes 81 68
Clothes-Guards 65 74
Pushing Handles 80
Table 4.
Comparison of parameter satisfaction of manual wheelchair users and caregivers.
p < 0.004.
MARCHIORI et al. Manual wheelchair satisfaction
expensive MW based on the amount of reimbursement
since most of them cannot cover the difference. Decreas
ing the cost, changing insurance regulations, or improv-
ing global insurance coverage should be a priori
ty in
order to allow access for all. Mobility should not be a
luxury, and rehabilitation professionals should lobby for
this alongside MWUs and caregivers.
This study excluded MWUs who were unable to
nd and answer the questionnaire. Vignier et al.
showed that half of this population has cognitive impair-
ments and two-thirds have some communication difficul-
ties and memory disorders [5]. The population studied
s an average age of 55.4 ± 19.8 yr, with 70 women and
62 men. In comparison with the study by Vignier et al.
[5], our population is younger. This is likely related to the
recruitment method. The majority of MWUs who partici-
pated were recruited from Raymond Poincare Hospital
lived at home, whereas in the study by Vignier et al.,
the majority lived in institutions [5]. Vignier et al. deter-
mined five types of MWUs [5], but in our study only
three were
represented: elderly with physical impair-
ments, dependant elderly living in instit
utions, and active
MWUs with motor impairments. As for the type of
wheelchairs, most MWs were foldable and a few were
comfort wheelchairs. Since they are often used both
inside and outside, the MW is an essential tool for mobil-
ity. Nevertheless, it appears that a large number of
MWUs stay in the
ir room or their residence. This is par-
ticularly true for those who live in institutions and are
above the age of 60 [5]. This
is confirmed by the results
of our study, since all the MWUs who lived in institutions
used their MWs inside only. The younger subjects in our
sample used the MW both inside and outside. These
results cannot therefore be generalized to the entire popu-
lation of MWUs. Also, we did not use the Quebec User
on of Satisfaction with Assistive Technology
(QUEST) 2.0 questionnaire, which is a standardized
evaluation tool especially developed to measure user sat-
isfaction with assistive devices [26]. QUEST 2.0 has
been us
ed in several studies and is used in several coun-
tries. Using this index could be
interesting to compare
satisfaction with MWs in France and other countries
based on the same items.
The results of this study show that the majority of
French MWU
s express a good level of satisfaction with
their MWs. They also show that the global satisfaction
scores and satisfaction with MW-specific items do not
depend on age, sex, or etiology or the type of MW. The
results showed that some aspects of the MW (lightweight
design, comfort, durability, and maneuverability) and
MW parameters (dimensions and push handles) should
be optimized because they are related to an active life-
style and participation. It is also important to consider
ers by improving parameters such as the push
handles, brakes, and MW weight. Improving these
aspects of the MW should decrease the risk of musculo-
skeletal injuries for both MWUs and caregivers, thus pos-
sibly improving mobility and satisfaction.
Author Contributions:
Study concept and design: C. Marchiori, D. Pradon.
Acquisition of data: C. Marchiori.
Analysis and interpretation of data: C. Marchiori.
Drafting of manuscript: C. Marchiori, D. Bensmail.
Critical revision of manuscript for important intellectual content:
D. Pradon, D. Gagnon.
Final approval: D. Pradon.
Financial Disclosures: The authors have declared that no competing
interests exist.
Funding/Support: This material was based on work supported by the
Safran Foundation and the Garches Foundation.
Additional Contributions: We would like to thank Carolyn Bastable
Laidman for revising this article.
Institutional Review: All participants were informed of the objec-
tives and nature of the study, which was approved by the Researcher
Ethics Committee of the Raymond Poincaré Hospital.
Participant Follow-Up: The authors do not plan to inform partici-
pants of the publication of this study because contact information is
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Submitted for publication April 2, 2014. Accepted in
revised form January 23, 2015.
This article and any supplementary material should be
cited as follows:
Marchiori C, Bensmail D, Gagnon D, Pradon D. Manual
wheelchair satisfaction among long-term users and care-
givers: A French study. J Rehabil Res Dev. 2015;52(2):
ORCID: Claire Marchiori: 0000-0002-4906-1387; Dany
Gagnon, PhD: 0000-0003-3464-4667
... We found high satisfaction perceptions among all WMAD users. This could be associated with the general benefits of WMADs, such as promoting or maintaining independence, supporting connection with the community, and enhancing wellbeing (Marchiori et al., 2015;May et al., 2010). In general, this survey showed that among all WMAD users and on average, MWC+AO users had higher overall autonomy satisfaction across all environments. ...
... Regarding the accessibility of challenging environments (e.g., Outdoor Built and Natural), MWC+AOs appeared to provide more autonomy than MWCs. This is in line with findings of previous research discussing difficulties and reporting low satisfaction when propelling MWCs outdoors (Marchiori et al., 2015). In general, we believe high autonomy satisfaction among MWC+AO users could be due to the fact that add-ons can transform a MWC to a modular WMAD, enabling users to interact with their environments more flexibly. ...
We evaluated perceived autonomy among users of different types of wheeled mobility assistive devices (WMADs) across five environments and identified the effect on user autonomy due to specific device characteristics. A study-specific questionnaire was used to assess satisfaction with autonomy of WMAD users in the Home, Buildings Outside of the Home, Outdoor Built, Outdoor Natural Environment, and Transportation. For each environment, 15 contextual factors were rated for their impact on participants’ autonomy. Our results revealed that manual wheelchair with add-on (MWC+AO) users had higher overall satisfaction with their autonomy compared to other WMAD users. MWC+AO users reported higher satisfaction with autonomy due to their health conditions compared to other WMAD users across all environments. In Outdoor Natural Environments, MWC+AO users had the highest satisfaction with autonomy across all factors except for negotiating hills. When performing activities in Buildings, MWC users with and without add-ons reported higher satisfaction for all factors compared to power wheelchair users, except for maneuverability on different surfaces. Satisfaction with autonomy regarding contextual factors varied among WMAD users, however, MWC+AO(s) appeared to provide a more balanced sense of autonomy across most factors and environments. More in-depth investigations are required to evaluate impacts of add-on use on autonomy.
... Relevantly, wheelchair users attach great importance to their satisfaction with assistive devices. The previous research has shown that people with disabilities using wheelchairs are generally satisfied with them save for few parameters, such as excessive wheelchair weight and propulsion difficulties while outdoors [13]. ...
... Depending on funding and personnel availability, an average AR camp lasts for a period of 5-10 days. In Morocco, all participants with physical disabilities participated in a 6-day program (8)(9)(10)(11)(12)(13)(14) September 2019) that included 9 training sessions (with a total of 29 h). The camp took place at a wheelchair-accessible venue (Kenzi Club Agdal Medina, Marrakech, Morocco). ...
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Purpose The aim of this study was to assess wheelchair skills of persons with physical disabilities who attended the first Wheelchair Skills and Empowerment Camp in Morocco and their satisfaction with manual wheelchairs provided for the camp activities. Materials and methods 19 persons (13 male and 6 female) with physical disabilities took part in the project. The average time since injury or illness was 24 years. To assess wheelchair skills/user satisfaction, the researchers used the Queensland Evaluation of Wheelchair Skills test and the Quebec User Evaluation of Satisfaction with assistive Technology. Results Study participants improved their overall wheelchair mobility skills (p = 0.002; d = 0.20), especially their ability to ascend and descend a ramp (p = 0.012; d = 0.67). The participants reported significantly greater satisfaction with the new provided wheelchairs in comparison to their own wheelchairs in regard to five satisfaction items; i.e., ease in adjusting (p = 0.011; d = 0.96), safety and security (p = 0.014; d = 0.97), durability (p = 0.037; d = 0.81), ease to use (p = 0.045; d = 0.87), and comfort (p = 0.006; d = 1.03). Conclusions Findings of this study indicate that persons with physical disabilities in Morocco need structured training in wheelchair skills and better-quality wheelchairs. The study also confirmed that community peer-based programmes in low-resource countries can play a significant role in rehabilitation of persons with physical disabilities, even many years after their injury or illness. • IMPLICATIONS FOR REHABILITATION • The One World project educated local persons with disabilities and government officials about the need for buying appropriate wheelchairs and for providing them according to the World Health Organization guidelines. • 19 persons who use wheelchairs participated in 6-days of wheelchair skills training sessions, which were led by three peer mentors who use a wheelchair: two with spinal cord injury, and one with polio complications. • The 19 participants, who had lived with their disabilities on average for 24 years, advanced their general wheelchair mobility skills, which was assessed through a practical test. • The results confirmed that community peer-based programmes in low-resource countries are important for improving wheelchair skills not only when beginning rehabilitation but even after individuals live many years with a disability.
... or displacement using manual wheelchair in people with physical disabilities [3,4]. Walking is reported as the first form of locomotion in which people engage worldwide [5]. ...
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Background Wearable activity monitors such as ActiGraph monitoring devices are widely used, especially in research settings. Various research studies have assessed the criterion validity of ActiGraph devices for step counting and distance estimation in adults and older adults. Although several studies have used the ActiGraph devices as a reference system for activity monitoring, there is no summarized evidence of the psychometric properties. The main objective of this systematic review was to summarize evidence related to the criterion validity of ActiGraph monitoring devices for step counting and distance estimation in adults and/or older adults. Methods Literature searches were conducted in six databases (Medline (OVID), Embase, IEEExplore, CINAHL, Engineering Village and Web of Science). Two reviewers independently conducted selection, a quality analysis of articles (using COSMIN and MacDermid’s grids) and data extraction. Results This review included 21 studies involving 637 participants (age 30.3 ± 7.5 years (for adults) and 82.7 ± 3.3 years (for older adults)). Five ActiGraph devices (7164, GT1M, wGTX +, GT3X +/wGT3X + and wGT3X − BT) were used to collect data at the hip, wrist and ankle to assess various walking and running speeds (ranging from 0.2 m/s to 4.44 m/s) over durations of 2 min to 3 days (13 h 30 mins per day) for step counting and distance estimation. The ActiGraph GT3X +/wGT3X + and wGT3X − BT had better criterion validity than the ActiGraph 7164, wGTX + and GT1M according to walking and running speeds for step counting. Validity of ActiGraph wGT3X + was good for distance estimation. Conclusion The ActiGraph wGT3X − BT and GT3X +/wGT3X + have good criterion validity for step counting, under certain conditions related to walking speeds, positioning and data processing.
... A French study tried to check the satisfaction levels of 132 manual wheelchair users and their 76 caregivers, good satisfaction with their wheelchair was reported. The majority (69.7 %) of the users reported to spend all day using their wheelchairs similar to this study where 80.36 % of manual and 72.22 % of electric wheelchair users reported using their device regularly [34]. It was also seen that some aspects like maneuverability, lightweight design, durability and comfort along with parameters like push handles and dimensions were associated with an active lifestyle and participation. ...
Background Spinal cord injury (SCI) survivors rely greatly on assistive devices, spending around 9–11 hours daily in a wheelchair. It can act both as a barrier and facilitator, positively impacting their mobility, community participation, quality of life (QOL) and functional independence provided the device is satisfactory. However, there is a paucity of information on the level of user satisfication and its impact on the mobility and well being. Keeping in view the present study was conducted to determine the level of wheelchair user’s satisfaction and its impact on physical activity and QOL in SCI. Methods A cross sectional study with a sample of 130 was conducted at Paraplegic Center, Peshawar using “Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)” for wheelchair user’s satisfaction, “Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) for physical activity and World Health Organization Quality of Life (WHOQOL-BREF) for QOL. Results Mean age of the study participants was 32.48±11.96 years. The majority of the participants were males, with most of them being manual wheelchair users. Nearly 80% were regular users. The calculated mean for the QUEST was 3.23±0.51 while 24.49±27.66 for the PASIPD. For the WHOQOL-BREF the calculated median (IQR) in the environmental 56.00 (19.00) and psychological 56.00 (12.00) domain was highest followed by physical domain 50.00(19.00). No significant correlation between participant’s satisfaction level (for wheelchair), and PASIPD (rs=0.054, p=0.541) was observed. On the other hand significant positive correlation was found between physical (rs=0.394, p<0.001), social (rs=0.303, p<0.001) and environmental domain (rs=0.425, p<0.001) except psychological domain (rs=0.156, p=0.076) of QOL. Conclusion The majority of the participants showed moderate levels of satisfication and the impact was observed on the physical, social and environmental domains of QOL. Appropriate wheelchairs enhancing the QOL therefore special measures should be taken to customize the device to the body structure and needs of the customers as anything that can improve their lives even to a minor extent can prove very helpful.
... WC users experience many difficulties in society, at home or in other participatory activities in daily living and this affects life satisfaction. 15 Those who had difficulties at home and could not do housework were in the great majority (>90%), with a lower number reporting difficulties in outdoor activities and social life. This may indicate that patients are more likely to spend time at home or unfortunately, could not leave home. ...
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ABS TRACTObjective: To investigate the difficulties experienced by wheelchair users and to determine the relative impact of environmental barriers compared with demographic data and disability. Material and Methods: The study included 92 individuals who had received initial rehabilitation between January 2015 and January 2017 at Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey for wheelchair use because of multiple sclerosis, spastic paraparesis, cerebral palsy and transverse myelitis diagnoses. Face-to-face interviews were conducted and the extent of the disability was measured using the Craig Handicap Assessment and Reporting TechniqueShort Form, functional independence was assessed with the Functional Independence Measurement and the Beck Depression Inventory was completed by all participants. Results: Age, gender, marital status and presence of social support did not seem to be associated with functional independence, handicap and depression scores. The type of wheelchair and duration of wheelchair use were found to be associated with handicap scores. In the comparison of two groups who had difficulty at home or not, a significant difference was determined in the functional independence scores, and in wheelchair use outside the home, a significant difference was determined between the groups in respect of functional independence, depression and handicap scores. Conclusion: Most of the difficulties experienced were related to handicap and functional independence scores and the vast majority of the participants reported that there was a need for architectural changes in the place where they lived. Further efforts to eliminate environmental barriers will help to make life easier for wheelchair users.
... Previous research has shown that people with disabilities using wheelchairs are generally satis ed with this assistive device. However, a few parameters such as weight and di culties propelling outdoors demonstrate a low level of satisfaction among users (13). ...
Full-text available
Background. Access to health services was found to be a major problem for over half of persons with disabilities in Morocco. This has created the need to increase opportunities for community-based rehabilitation activities in this country.The aim of this study was to assess wheelchairs skills of persons with physical disabilities attending the first Wheelchair Skills and Empowerment Camp in Morocco, and their satisfaction with the manual wheelchairs available during the camp activities. Methods. 19 persons (13 male and 6 female) with physical disabilities took part in the project. Mean years since injury or illness was 24 years. The following measures have been used: the Queensland Evaluation of Wheelchair Skills test, and the Quebec User Evaluation of Satisfaction with assistive Technology. Results. Study participants improved their overall wheelchair mobility skills (p=0.002; d=0.20), especially the ability to ascend and descend a ramp (p=0.012; d=0.67). The participants were significantly larger satisfied with the new provided wheelchairs in comparison to their own wheelchairs with regard to five of the satisfaction items i.e. ease in adjusting (p=0.011; d=0.96), safety and security (p=0.014; d=0.97), durability (p=0.037; d=0.81), ease to use (p=0.045; d=0.87), and comfort (p=0.006; d=1.03). Conclusions. Findings of this study suggest that there is a need for structured wheelchair skills training and better-quality wheelchairs for persons with physical disabilities in Morocco. The study also confirmed that community peer-based programmes in low-resource countries can play an important role in rehabilitation in persons with physical disabilities, even many years since their injury or illness.
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Importance: Several diseases and conditions, such as cerebrovascular disease, arthritis, previous fractures, neurological diseases, or amputation, can result in severe immobility justifying wheelchair use for increased mobility. Immobility results in disuse osteoporosis and is considered a risk factor for fracture, although there are no large cohort studies that have investigated fracture risk in patients who use wheelchairs compared with an ambulatory control group. Objective: To investigate whether immobilized adults who used wheelchairs had a different risk of fracture and injurious falls compared with matched ambulatory controls. Design, setting, and participants: This retrospective cohort study compared patients who used wheelchairs and controls (propensity score matched 1:1 using 22 variables relating to anthropometrics, general condition, comorbidity, and fall and fracture risk), identified through a national database of adults 65 years or older who underwent a health evaluation (baseline) at Swedish health care facilities. Patients were followed up from January 1, 2007, to December 31, 2017, and data analysis was performed between June 1 and 30, 2022. Main outcomes and measures: Incident fracture, injurious falls without fracture, and deaths. Results: A total of 55 442 adults using wheelchairs were included in the analysis (mean [SD] age, 83.2 [8.3] years; 60.5% women). Those who used wheelchairs and the 55 442 matched controls were followed up for a median of 2.0 (IQR, 0.5-3.2) and 2.3 (IQR, 0.8-3.6) years, respectively. Patients who used wheelchairs had a lower risk of any fracture (hazard ratio [HR], 0.43 [95% CI, 0.41-0.44]), major osteoporotic fracture (HR, 0.32 [95% CI, 0.31-0.33]), and hip fracture (HR, 0.30 [95% CI, 0.28-0.32]) compared with the ambulatory controls, associations that were only marginally affected by multivariable (same as the matching variables) adjustment. The risk of fall injury was lower among those who used wheelchairs than among ambulatory controls (unadjusted HR for Cox proportional hazards models, 0.48 [95% CI, 0.47-0.50]) and remained highly similar after adjustments. Patients who used wheelchairs had a significantly increased risk of death (HR, 1.35 [95% CI, 1.33-1.36]) compared with controls. Association between wheelchair use and fracture outcomes and injurious falls, calculated using a Fine and Gray model with death as a competing risk, was similar to associations obtained using Cox proportional hazards regression for all fracture outcomes. Conclusions and relevance: In this retrospective cohort study of older adults, wheelchair use was associated with a lower risk of fracture than observed in ambulatory controls. These findings suggest that immobility associated with wheelchair use should not be considered a risk factor for fracture.
Purpose: This study aimed to understand Bangladeshi users' satisfaction with their assistive devices, including (a) device characteristics, e.g., size, weight, safety, ease of use, comfort, and effectiveness, and (b) availability of parts and repair services. We also described how frequently individuals with disabilities living in the community used assistive devices in their daily activities and how the use of assistive devices promoted individuals' wellbeing. Method: We conducted a cross-sectional survey with assistive device users or their guardians (if under 18) in Bangladesh about their experience and satisfaction with their assistive device 6 months after receiving it. The research team developed a survey questionnaire consisting of both closed and open-ended questions. All data were collected via telephone interviews. We employed descriptive statistics to analyse quantitative data and inductive analysis for the qualitative data. Results: We found that out of the 376 participants, nearly 95% used assistive devices on a regular basis, and their satisfaction with the devices was high. Participants reported that assistive devices improved mobility, independence, and wellbeing of persons with disabilities. A few participants (6.4%) reported that their devices were damaged. Some participants identified concerns with their assistive devices, including (i) inappropriate size of ankle-foot orthoses, manual self-propelled wheelchairs, and prostheses, (ii) back slabs (a type of brace) being too short, and (iii) walking frames being too large. Several participants noted pain and discomfort when they used their assistive device. Additionally, some participants stated that environmental factors (e.g., muddy roads) contributed to the disrepair of their assistive devices. Finally, participants recounted that repair services were limited in rural areas of Bangladesh. Conclusion: These findings indicate that the provision of assistive devices requires accommodating individuals' needs and ensuring appropriate environments in which to function. The results support the need for follow-up services after distributing assistive devices. Further research could explore the impact of assistive devices on the family quality of life of persons with disabilities.IMPLICATIONS FOR REHABILITATIONIt is essential for rehabilitation professionals to conduct follow-up services after distributing assistive devices among persons with disabilities.There is a need for the government of Bangladesh to revisit the Rights and Protection of Persons with Disability Act of 2013 and provide further clarity about their commitment to the provision of assistive devices and associated services (e.g., repair services) and its subsequent implementation.Policymakers in Bangladesh must be proactive to translate policy commitments into practice, as it relates to building an accessible environment for people using assistive devices. Further, government efforts are needed to educate policy implementers in all relevant ministries so that all responsible bodies are fully familiar with their national and international commitments regarding the rights of persons with disabilities.Future research could (i) include user's satisfaction with the service delivery process and (ii) measure the impact of assistive devices on family quality of life of persons with disabilities.
Purpose To evaluate patient satisfaction with their wheelchairs among Jewish and Arab older adults. Materials and method A cross-sectional study based on personal interviews. Participants were confined to a wheelchair (WC) Level 3. The Quebec User Evaluation of Satisfaction (scales 1–5) evaluated patient satisfaction. T test evaluated differences between continuous variables and χ 2 or a Fisher’s exact test between categorical variables. The contribution of background variables to the overall satisfaction with the wheelchair and related service was evaluated by multivariate regression. Results A total of 74 Jewish and 24 Arab (mean age 78.4 ± 14.1), participated in the study. The overall satisfaction score was moderate/high (3.97 ± 0.8) with no difference between the groups. The most important items for all participants were WC safety, comfort and weight. Participants from the Arab sector were less educated, had higher BMI and were less satisfied with the chair dimensions. Conclusions A WC Level 3 may be effective and meets most of the basic needs of both Jewish and Arab patients at older ages. Higher BMI may result in difficulty to adopt to WC dimensions and can explain the less satisfaction of Arab patients with this component. A routine initial phone call follow-up is recommended to all patients after receiving a wheelchair. Those with problems will be scheduled for home visit. It is recommended to perform a study that will include more types of assistive devices and other groups of patients. • Implication For Rehabilitation • Apparently, despite lack of home visit follow-up, overall satisfaction with wheelchaires is relatively high. Therefore, initial phone calls may be monitored to all patients and home visits may be scheduled only for those unsatisfied with their chair. • Converting a home visit to phone call can reduce the costs associated with routine home visits for all patients as is currently the case in some counties. This counts for both Jewish and Arab patients.
A cadeira de rodas proporciona aos seus usuários uma necessidade humana fundamental: a mobilidade. Este dispositivo pode ser visto como uma interface de suporte corporal essencial para o desempenho de diversas atividades de vida diária. Objetivo: Avaliar a satisfação de cadeirantes sobre o conforto, a mobilidade e a segurança na cadeira de rodas. Métodos: Estudo observacional do tipo transversal. O instrumento utilizado para a coleta de dados foi um questionário elaborado pelos próprios autores, contendo oito questões. Para cada questão, os participantes da pesquisa responderam às perguntas com base em quatro níveis de satisfação, incluindo "insatisfeito", "pouco satisfeito", "satisfeito" e "plenamente satisfeito". Resultados: Participaram 25 cadeirantes, com idade média de 38,3 ± 20,5 anos e diagnóstico de lesão medular. Pode-se observar que 72% dos participantes estão plenamente satisfeitos com a independência funcional proporcionada pela cadeira de rodas. De modo geral, 33,3% dos usuários estiveram plenamente satisfeitos com sua cadeira de rodas. Os aspectos posicionamento (20%), eficiência em embientes externos (12%) e conforto (8%) apresentaram o maior percentual de insatisfação dos participantes. Conclusões: Sugere-se que questões relacionadas ao posicionamento corporal, à eficiência e ao conforto devam ser consideradas pelo usuário e pelo profissional de saúde durante a escolha da cadeira de rodas, otimizando o uso deste dispositivo para a mobilidade e a inclusão social dos usuários. Palavras-chave: Cadeiras de rodas, conforto do paciente, limitação da mobilidade, locomoção.
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Mobility in Wheelchair: Bodily Adjustment and Practical Arrangements within the Social and Physical Space The author uses wheelchair mobility to examine the distinction (based on the historical opposition of two models of disability – an individual model and a social model) between the individual experience and the social experience of disability. In looking at the interaction between the person and the wheelchair, she demonstrates that there is continuity in people’s experiences: their mobility (its form and extent) is the result of a process of reciprocal adaptation with their wheelchairs and their environment, which involves their bodies. In this process, the status of the wheelchair (as an incorporated or outside object) and of a person’s space for movement (both social and physical) are correlatively and gradually defined. Analysis of these co-definition processes is important, because it allows us to identify the diversity of the resources – other people, objects, urban planning, services – upon which people rely in order to be able to move around and act in wheelchairs and in different public and private spaces.
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To examine the impact of surface type, wheelchair weight, and rear axle position on older adult propulsion biomechanics. Crossover trial. Biomechanics laboratory. Convenience sample of 53 ambulatory older adults with minimal wheelchair experience (65-87y); men, n=20; women, n=33. Participants propelled 4 different wheelchair configurations over 4 surfaces: tile, low carpet, high carpet, and an 8% grade ramp (surface, chair order randomized). Chair configurations included (1) unweighted chair with an anterior axle position, (2) 9.05 kg weighted chair with an anterior axle position, (3) unweighted chair with a posterior axle position (Delta0.08 m), and (4) 9.05 kg weighted chair with a posterior axle position (Delta0.08 m). Weight was added to a titanium folding chair, simulating the weight difference between very light and depot wheelchairs. Instrumented wheels measured propulsion kinetics. Average self-selected velocity, push frequency, stroke length, peak resultant and tangential force. Velocity decreased as surface rolling resistance or chair weight increased. Peak resultant and tangential forces increased as chair weight increased, as surface resistance increased, and with a posterior axle position. The effect of a posterior axle position was greater on high carpet and the ramp. The effect of weight was constant, but was more easily observed on high carpet and ramp. The effects of axle position and weight were independent of one another. Increased surface resistance decreases self-selected velocity and increases peak forces. Increased weight decreases self-selected velocity and increases forces. Anterior axle positions decrease forces, more so on high carpet. The effects of weight and axle position are independent. The greatest reductions in peak forces occur in lighter chairs with anterior axle positions.
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The purpose of this study was to evaluate pushrim-activated, power-assisted wheelchair (PPW) performance among dual-users in their natural environment to determine whether the PPW would serve as a satisfactory alternative to a power wheelchair for community-based activities. A concurrent mixed methods research design using a cross-over trial was used. The outcome measures used were number of hours reported using the different wheelchairs, Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), Functioning Everyday with a Wheelchair (FEW), Psychosocial Impact of Assistive Devices Scale (PIADS) and Canadian Occupational Performance Measure (COPM). The number of hours spent participating in self-identified activities was not significantly different. Only the Self-Esteem subscale of the PIADS identified a statistically significant difference between the PPW and power wheelchair conditions (p = 0.016). A clinically important difference for Performance and Satisfaction was suggested by the COPM, in favour of the power wheelchair. Additional knowledge was gained about the benefits of PPW technology. Participants were able to continue participating independently in their self-identified community activities using the PPW, and identified comparable ratings of satisfaction and performance with the PPW and the power wheelchair. For some individuals requiring power mobility, the PPW may provide an alternative to the power wheelchair.
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To evaluate the effects of wheelchair seat height on wheeling efficiency and technique during rehabilitation in subjects with a spinal cord injury. Laboratory-based study. Twelve persons with spinal cord injury (age range 19-77 years, lesion level: C5/C6-L2; 7 men; 8 incomplete). Subjects conducted 8 submaximal hand rim wheelchair exercise tests (4 min) on a computerized ergometer at 8 seat heights (elbow angle: 70-140 degrees , full extension = 180 degrees) in a counter-balanced order (individualized fixed power output (5.4-13.9 W) and speed). Last-minute physiological and technique parameters were evaluated using repeated measures analysis of variance (ANOVA) and multilevel regression analysis (p < 0.05). Physical strain and mechanical efficiency changed significantly (p < 0.05) with seat height, with optimal values at 100-130 degrees . Lower seat heights were clearly detrimental. Forces on the hand rims were affected by seat height, showing lower forces with increasing seat height. Lesion level was not a confounder of seat height with respect to mechanical efficiency, oxygen uptake or fraction effective force. Mean physiological data indicate a tendency to optimize at 100-130 degrees seat height. This does not relate to the trends seen in force and technique data. Optimization of seat height during spinal cord injury rehabilitation may lead to more efficient and less straining conditions for manual wheeling.
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The aim of this investigation was to analyze the external forces and biomechanical loading on the musculoskeletal system during wheelchair pushing, in relation to different push handle heights. In addition, recommendations for wheelchair pushing in accordance with push handle height are made. Eight young, female subjects carried out three different wheelchair transport tasks at five different push handle heights in a standardized laboratory setting. Five pushing heights were selected as a percentage of the subjects shoulder height (61, 69.5, 78, 86.5 and 95%). All three wheelchair transport tasks investigated required higher pushing handles in order to minimise net shoulder moments and external vertical forces on the hands. When pushing a wheelchair on to a pavement, net moments around wrists, elbows, shoulders compression and shear forces at L5-S1 and external vertical forces were lower using higher pushing heights. When low pushing handles are used, elderly female attendants are at risk of L5-S1 low back pain when lifting and pushing the wheelchair on to a pavement. A recommendation is made to reconsider height and position of the pushing handles of attendant propelled wheelchairs. For the investigated tasks, a pushing height of 86.5% (1.191 +/- 0.034 m) was most favourable.
Objective To measure the acquisition, use and satisfaction with high technology equipment by spinal cord injured tetraplegic subjects.
Biomechanical studies have linked the handrim wheelchair propulsion with a prevalence of upper limb musculoskeletal disorders. The purpose of this study was to examine the influence of the wheelchair settings on upper limb kinematics during wheelchair propulsion. Recordings were made under various wheelchair configuration conditions to understand the effect of wheelchair settings on kinematics parameters such shoulder, elbow and wrist angles. Ten experts and ten beginners' subjects propelled an experimental wheelchair on a roller ergometer system at a comfortable speed. Twelve wheelchair configurations were tested. Kinematics were recorded for each configuration. Based on the hand position relatively to the handrim, the main kinematic parameters of wheelchair propulsion were investigated on the whole propulsion cycle and a key event such as handrim contact and release. Compared to the beginner subjects, all the experts' subjects generally present higher joint amplitude and propulsion speeds. Seat height and antero-posterior axle position influence usage of the hand-rim, timing parameters and configurations of upper limb joints. Results seem to confirm that low and backward seat position allow a greater efficiency. Nevertheless, according that proximity of joint limit is a well known factor of musculoskeletal disorders, our results let us think that too low and backward seat position, increasing joints positions and amplitudes, could increase the risk of upper limb injuries in relation with manual wheelchair propulsion. Kinematic differences highlight that future studies on wheelchair propulsion should only be done with impaired experienced subjects. Furthermore, this study provides indications on how wheelchair settings can be used for upper limb injury prevention.
Cross-sectional study. To describe the satisfaction of the manual wheelchair user with hand rim wheelchair-related aspects (for example, dimensions, weight and comfort) and wheelchair service-related aspects and to determine the relationship between wheelchair users' satisfaction, personal and lesion characteristics, and active lifestyle and participation in persons with a spinal cord injury (SCI). Eight Dutch rehabilitation centers with a specialized SCI unit. The Dutch version of the Quebec user evaluation of satisfaction with assistive technology (D-QUEST) was filled out by 109 participants 1 year after discharge from inpatient SCI rehabilitation. Relationships between the D-QUEST scores and personal and lesion characteristics, and active lifestyle and participation (physical activity scale for individuals with physical disabilities (PASIPD), Utrecht activity list (UAL), mobility range and social behavior subscales of the SIP68 (SIPSOC)) were determined. A high level of satisfaction was found with wheelchair-related aspects. The participants were less satisfied with the service-related aspects. Participants with an incomplete lesion were slightly more satisfied regarding both aspects than those with a complete lesion. A higher satisfaction regarding wheelchair dimensions and a higher overall satisfaction were related to a more active lifestyle. Persons who were more satisfied with the simplicity of use of the wheelchair had a better participation score. Dutch persons with SCI are in general quite satisfied with their hand rim wheelchair. Some aspects of the wheelchair (dimensions and simplicity of use) are important to optimize as these are related to an active lifestyle and participation.
To evaluate the results of a user satisfaction questionnaire on a new type of lever-propelled wheelchair designed to avoid the discomfort and potential repetitive strain injuries related to conventional hand-rim propulsion. Seventeen participants filled out a questionnaire to rate their conventional wheelchair and the prototype (after 2 days' use) in terms of comfort, adjustability, steering/ride, manoeuvrability, stability when crossing obstacles, safety, weight, size, portability and appearance. Overall satisfaction was also scored. According to the user questionnaire results, the lever-propelled prototype chair was rated as significantly superior than conventional wheelchairs in terms of comfort, safety and overall satisfaction. The prototype was rated significantly inferior in terms of size, adaptability, appearance and crossing obstacles. We conclude that the prototype wheelchair is highly acceptable and comfortable and can be recommended to disabled sportspersons. The prototype's weak points are mainly related to ergonomic aspects, which could be improved in future models.