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Abstract

The aim was to investigate outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use regarding need for assistance when moving around, frequency of mobility-related participation, easiness/difficulty in mobility during participation, and number of participation aspects performed in everyday life. The study was a prospective cohort study, using an instrument focusing on mobility-related participation outcomes of mobility device interventions (NOMO 1.0), at baseline, after 4-months and 1-year use. The results show that the outcomes in terms of participation frequency and easiness in mobility occur in a short time perspective, and that the effects remained stable at 1-year follow-up. The frequency of going for a walk increased most prominently (26%). Even though the majority of the participation aspects were not performed, more often they became easier to perform: 56-91% found that shopping, walking and visiting family/friends were easier. Moreover, independence outdoors and indoors increased. This small study provides knowledge about the outcomes of powered wheelchairs and scooters in terms of mobility and mobility-related participation in real-life situations. The study supports results from former studies, but even so, larger studies are required in order to provide evidence for the effectiveness of powered wheelchairs and scooters. [Box: see text].

Disability and Rehabilitation: Assistive Technology
2012
7
3
211
218
© 2012 Informa UK, Ltd.
10.3109/17483107.2011.619244
1748-3107
1748-3115
Disability and Rehabilitation: Assistive Technology, 2012; 7(3): 211–218
© 2012 Informa UK, Ltd.
ISSN 1748-3107 print/ISSN 1748-3115 online
DOI: 10.3109/17483107.2011.619244
Correspondence: Charlotte Löfqvist, Department of Health Sciences, Lund University, Sweden. Tel: +46 46 2221945.
E-mail: charlotte.lofqvist@med.lu.se
(Accepted August 2011)
Purpose: The aim was to investigate outcomes of powered
wheelchair and scooter interventions after 4-months and
1-year use regarding need for assistance when moving around,
frequency of mobility-related participation, easiness/difficulty
in mobility during participation, and number of participation
aspects performed in everyday life. Method: The study was a
prospective cohort study, using an instrument focusing on
mobility-related participation outcomes of mobility device
interventions (NOMO 1.0), at baseline, after 4-months and
1-year use. Results: The results show that the outcomes in
terms of participation frequency and easiness in mobility occur
in a short time perspective, and that the effects remained
stable at 1-year follow-up. The frequency of going for a walk
increased most prominently (26%). Even though the majority
of the participation aspects were not performed, more often
they became easier to perform: 56–91% found that shopping,
walking and visiting family/friends were easier. Moreover,
independence outdoors and indoors increased. Conclusions:
This small study provides knowledge about the outcomes of
powered wheelchairs and scooters in terms of mobility and
mobility-related participation in real-life situations. The study
supports results from former studies, but even so, larger studies
are required in order to provide evidence for the effectiveness
of powered wheelchairs and scooters.
Keywords: assistive devices, eect, electric wheelchairs,
mobility devices, NOMO 1.0, occupational therapy,
rehabilitation
INTRODUCTION
Powered wheelchairs (PWC) and powered scooters (PS) are
mobility devices (MD) that aim at improving mobility, activi-
ties and participation for persons with mobility limitations.
Provision of MD is generally considered to be an intervention
of great importance, and the United Nations [1] as well as the
World Health Organization [2] recommend assistive technol-
ogy (AT) interventions, such as MD, as an important tool for
creating equal opportunities for people with disabilities; to
increase the independence in daily life and to facilitate inclu-
sion and participation [3,4]. e importance of and need for
outcomes research of AT such as PWC/PS is stressed [5,6].
Research on eects of PWC and PS interventions in terms of
activities and participation is, however, limited.
Only two studies on outcomes of PWC and PS interven-
tions were identied in a systematic review from 2009 [7].
Hoenig et al investigated eects of PS interventions for per-
sons with osteoarthritis or rheumatoid arthritis by means of a
randomized controlled study, using no intervention as control
[8]. Using a study specic questionnaire they found no dier-
ence in the number of places visited, but there was a clear
increase in PS use, particularly when going to food shops or
the doctor. In the other study, Pettersson et al. investigated
participation outcomes of PWC interventions for older people
suering from stroke by means of a cohort study, using the In-
dividually Prioritised Problem Assessment (IPPA [9]) and the
World Health Organization Disability Assessment Schedule
(WHO-DAS II [10]) as outcome measurement instruments.
e study showed that nearly all participants’ activity-related
RESEARCH PAPER
Mobility and mobility-related participation outcomes of powered
wheelchair and scooter interventions after 4-months and 1-year use
C. Löfqvist1, C. Pettersson1, S. Iwarsson & A. Brandt2
1Department of Health Sciences, Lund University, Lund, Sweden and 2Department of Research & Development, Danish Centre
for Assistive Technology, Aarhus, Denmark
Powered wheelchair and scoter interventions in-•
creased independence in mobility and easiness in
mobility-related participation in everyday life.
Easiness in participation can be considered an im-•
portant follow-up dimension aer powered wheel-
chair and scooter interventions.
A 4-month follow-up time aer powered wheelchair •
and scooter intervention seems adequate.
Implications for Rehabilitation
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212 C. Löfqvist et al.
Disability and Rehabilitation: Assistive Technology
problems decreased, and that their independence in self-care,
domestic life, interpersonal interactions and relationships,
participation in community, social and civic life, and ability to
get around increased [11]. In 2010, Auger et al. (2010) found
that life space increased in relation to PWC interventions, i.e.
it was found that the participants went outdoors more oen,
even though still mostly around the home and neighbour-
hood. In addition, a few cross-sectional studies have been
carried out, all showing positive results aer a PWC or PS
intervention [12–15]. It can be summarized that high quality
research concerning outcomes of PWC and PS intervention
among community-living persons is scarce, and that more
research is required.
A considerable number of PWC and PS are taken into use
every year, and since each device costs from about € 200–2000,
PWC and PS intervention implies substantial societal costs.
According to available information, during 2005, 28 PWC/PS
per 10,000 inhabitants were delivered in Sweden [16]. A Dan-
ish study based on 33 municipalities showed that the number
of delivered PS had doubled from 2002 to 2006 and that the
number of delivered PWC also had increased. It was estimated
that 32.8 PS and 9.2 PWC per 10,000 inhabitants had been
delivered in 2006 [17]. e most recent Finnish study showed
that an average of 6.7 PWC/PS per 10,000 inhabitants was
delivered in 2001 [18]. According to the Norwegian national
register, 22.9 PS and 31.3 PWC per 10,000 inhabitants were
delivered in 2009 [19].
In the Nordic countries, AT interventions are mainly pub-
licly nanced. To persons with severe diculty or inability to
walk due to functional limitations, devices such as PWC and
PS are to some extent granted free, aiming at enhancing inde-
pendence, activity and participation. e decision on an AT
intervention is based on individual needs assessment [20–23].
Criteria for granting PWC or PS are that the devices should
increase independence in everyday life signicantly, and that
the person must be able to drive the PWC or PS independently
and safely. For this purpose, cognitive as well as practical skills
are being tested by driving in the actual environment. Knowl-
edge about outcomes of PWC/PS interventions is part of the
clinical reasoning process of the therapist involved in the in-
tervention, and knowledge about eects of PWC/PS regarding
activity and participation is therefore of utmost importance.
e purpose of this explorative study was to investigate the
outcomes of PWC and PS interventions over time, as part of the
MD solution for persons with mobility limitations regarding:
Extent of assistance from another person when moving •
around in dierent real-life environments.
Engagement in dierent kinds of everyday participation •
aspects; participation frequency; easiness/diculty in
mobility during participation; and number of participa-
tions aspects performed in everyday life.
Methods and materials
Study context
is study is part of a comprehensive cross-Nordic project,
running 2009–2013, aiming at providing national and Nordic
comparative knowledge about outcomes of PWC and PS to be
used for both research and clinical developmental purposes. In
all about 250 adults who receive a PWC or PS for the rst time
will be followed during one year. ey are interviewed about
mobility and mobility-related participation, i.e. participation
involving mobility by means of ‘e Nordic mobility-related
participation outcome evaluation of assistive device interven-
tions’ (NOMO 1.0), an instrument focusing on mobility-related
participation outcomes of MD interventions [24]. ey are also
asked about their quality of life, satisfaction with their PWC
or PS, and the delivered service. Besides, each service delivery
process is documented. e aim for the comprehensive cross-
Nordic project is also to perform further psychometric testing of
the NOMO 1.0. e present study is based on the rst Swedish
data on mobility and mobility-related participation outcomes
of PWC and PS collected by means of the NOMO 1.0.
Study design
e study was a prospective cohort study with data collection
by means of structured interviews at baseline, 4-months, and
at 1-year follow-up.
Study district and sample
e study district included ve municipalities in the south of
Sweden. Inclusion criteria were:
Persons, 20 years of age or more, living in private housing •
and not in any acute rehabilitation phase.
Persons granted a PWC or PS for the rst time for indoor •
and/or outdoor use, with the purpose to increase the per-
son’s mobility and participation.
Persons with cognitive capacity and verbal skills sucient •
for participation in personal interviews.
All eligible study participants during 2008 were enrolled
consecutively. e participants were asked to participate by
the therapist in connection with the selection and testing of
a PWC/PS. Written informed consent was given before the
interviews. Out of 48 person asked, 47 persons agreed to par-
ticipate and were interviewed at baseline. For the rst follow-
up interview 4 months later, it was possible to interview 42 of
them. Reasons for the dropout (three men and two women)
were not able to reach (n = 1), death (n = 1), return of the de-
vice (n = 3). One year aer baseline, the study sample consisted
of 34 persons, (n = 27 PS users; n = 7 PWC users). Reasons for
dropouts (seven men and one woman) were return of the de-
vice (n = 2), death (n = 1) and deteriorated health (n = 5). Drop
out analyses showed that there were no signicant dierences
between participants dropping out and the nal study sample
with respect to age, gender, number of functional limita-
tions, and general health. e participants were 23 men and
11 women (mean age = 69 years); half of them single-living.
e majority of the participants were living in urban or semi
urban areas (n = 27). e participants all had additional MD,
and the combinations of MD in use at baseline and over time
are presented in Table I. At one year follow-up, two persons
reported changes in the home environment (removed thresh-
olds and installation of a ramp). At baseline, 85% reported
that their dwelling was designed according to their mobility
capacity. Seventy-six percent (n = 26) were able to take at least
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Outcomes of powered wheelchair and scooter interventions 213
©  Informa UK Ltd.
one step without personal assistance. No changes were report-
ed concerning living situation, but the number of functional
limitations increased over time (mean number at baseline was
4.9 and 5.9 1 year later). Further sample characteristics are
presented in Table II.
The NOMO instrument
e NOMO 1.0 was developed in a Nordic context in or-
der to document outcomes of MD interventions [24].e
instrument focuses on outcomes concerning independence
in mobility in dierent environments and mobility-related
participation such as shopping, visiting friends/family or
going to a restaurant. e basic psychometric properties
of the instrument have been tested showing good content
validity, internal consistency, and test-retest reliability [24].
e instrument is available in four Nordic languages. It has
a structured format and a manual and is administered by
means of personal interviews. It consists of a baseline in-
terview to be administrated just before the person receives
a new MD or has a device replaced with another type, and
a follow-up interview to be accomplished aer the user
has used the device for at least 4 months. Participation
aspects were dened based on International Classication
of Functioning, Disability and Health (ICF [25]) and focus
on the actual performance of mobility and mobility-related
participation in the everyday environment. e objective of
the instrument is to assess outcomes of the total MD solu-
tion (not the single MD), and for this study, the outcome
of supplementing the users device solutions with PWC and
PS is in focus.
Table II. Description of the sample at baseline, at 4-months and 1-year follow-up, n = 34.
Baseline 4-months follow-up pa1-year follow-up pb
Age years, M (SD) 69 (13,3)
Age groups, n (%):
>80 5 (15)
61–79 21 (62)
<60 8 (23)
Gender, n (% women) 11 (32)
Perceived health, md (q1,q3) 4 (3.4) 4 (3,4) Ns 4 (3,4) Ns
Physical mobility, md (q1,q3) 4 (4.5) 4 (3,4) Ns 4 (3,5) Ns
Pain vital for mobility, n (%) 23 (68) 10 (29) 0.004 17 (50) Ns
Stairs; possible to take at least one step, n (%) 26 (76) 24 (71) 22 (65)
Number of FL, M (SD) 4.9 (1.9) 4.9 (2.0) Ns 5.9 (2.1) 0.001
Type of FL (n, %)
Back and legs 30 (88) 31 (91) 32 (94)
Tiredness 21 (62) 23 (68) 25 (73)
Stamina/breath 24 (70) 23 (68) 26 (78)
Balance/dizziness 21 (62) 20 (59) 29 (85)
Arms 20 (59) 13 (38) 22 (65)
Incontinence 12 (35) 10 (29) 13 (38)
Vision 8 (24) 10 (29) 11 (32)
Hearing 11 (32) 11 (32) 13 (38)
Moving head 5 (15) 6 (18) 8 (24)
Overall movements 6 (18) 5 (15) 8 (24)
Memor y 8 (24) 14 (31) 11 (32)
FL = functional limitations.
aDierence between baseline and 4-month follow-up.
bDierence between 4-months follow-up and 1-year follow-up.
Health was self-rated by SF-36 (37), 5-grade scale from excellent (1)–poor (5).
Physical mobility was self-rated by use of en 5-grade scale from excellent (1)–poor (5).
Pain was self-rated on a categorical scale: no/yes/don’t know.
Table I. Combination of mobility devices in use at baseline, at 4-month and 1-year follow-up, n = 34.
Mobility device
Baseline 4 months 1 year
Indoors n (%) Outdoors n (%) Indoors n (%) Outdoors n (%) Indoors n (%) Outdoors n (%)
Cane/crutches 13 (38,2) 19 (56) 14 (41) 15 (44) 9 (26) 16 (47)
Walk er 2 (6) 1 (3) 0 0 2 (6) 0
Rollator 14 (41) 19 (56) 15 (44) 17 (50) 18 (53) 17 (50)
Manual wheelchair 4 (12) 8 (24) 5 (15) 7 (21) 8 (24) 12 (35)
Transportation
wheelchair 1 (3) 4 (12) 1 (3) 2 (6) 0 0
Powered wheelchair 0 1 (3) 1 (3) 10 (29) 3 (9) 7 (21)
Powered scooter 0 0 0 24 (71) 4 (12) 27 (80)
It was possible to answer that one or more mobility devise was in use.
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214 C. Löfqvist et al.
Disability and Rehabilitation: Assistive Technology
e NOMO 1.0 consists of
1. Four items about dependence in mobility within four
dierent environments (indoors in the home, in and out
from the home, indoors in other places and outdoors in
general):
Extent of assistance in mobility scale oering response •
options on a 4-graded ordinal scale ranging from ‘no
assistance’ to ‘very much assistance’.
2. Twenty-two items about mobility-related participation:
Frequency of mobility-related participation scale of-•
fering response options on a 9-graded scale going
from ‘at least once a day’ to ‘never’.
Easiness/diculty in mobility during participation •
scale oering response options on a 5-graded ordinal
scale ranging from ‘very easy’ to ‘very dicult. e
alternative ‘don’t know’ was also possible.
Mobility-related participation repertoire index, i.e. a •
sum of the number of participation aspects performed,
based on the responses of the ‘frequency of mobility-
related participation scale.
In addition, the instrument includes a number of descriptive
items about MD use, housing, functional limitations, health,
etc. At baseline, one open-ended question about expectations
to the PWC/PS concerning participation was asked. At follow-
up two structured questions were asked about fulllment of
expectations, followed by an open-ended question about what
participation aspects the MD actually had been used for.
Procedure
e participants were interviewed at baseline by means of the
NOMO 1.0 [24] just aer they had been granted a PWC or
PS but had not yet received it. Two follow-up interviews fol-
lowed: aer 4–4.5 months use and when the MD had been
in use for at least 1 year (12–15 months). e majority of the
baseline interviews were performed during spring and sum-
mer time (n = 24), while the remaining ten were performed
in the autumn. Two experienced occupational therapists
carried out the interviews, one of whom was involved in the
provision process for ten of the participants. At baseline, 18
of the interviews were performed at a health center, 14 in
the respondents’ homes, and two at other locations. e two
follow-up interviews were in 95% of the cases performed in
the respondents’ homes.
Analysis
Dropout analysis was performed (n = 13 compared to the
nal sample n = 34) regarding age, gender, number of func-
tional limitations and overall health. e sign test was used
for analyzing changes over time in terms of dependence in
mobility, frequency of mobility-related participation aspects
and easiness/diculty in mobility during participation. In ad-
dition, changes in easiness/diculty over time were divided
into three groups: participation became easier, unchanged,
or more dicult, respectively. Since the frequency of ‘does
not know’ responses concerning easiness/diculty was low
(n = 5), these responses were excluded. In these analyses, due
to the high number of statistical tests performed, Bonferroni
corrections were made [26], considering p values <0.05 to be
signicant. e paired t-test was used to analyse the mobility-
related participation repertoire index. Descriptive statistics
were used to describe statements of expectations. Outcomes
given as responses to the open-ended questions were catego-
rized and utilized for illustrative purposes in the presentation
of the results.
Ethical issues
All principles in ethical guidelines for human research and
Swedish national legislation were followed meticulously. In
addition, approval of the Ethical Board within the Education
organization of the Faculty of Medicine was achieved.
Results
Extent of assistance in mobility
In the 4-month perspective, the need for assistance in mobil-
ity from other persons decreased signicantly when moving
around in general outdoor environments (p < 0.0001): ap-
proximately 50% became more independent, and indoors at
other places than in the home (p = 0.031) about 30% became
more independent. In the 1-year perspective, these changes
remained stable. No dierences in the extent of assistance
were seen as regards mobility indoors in the home or getting
in and out of the home, neither at the 4-month perspective
nor at the 1-year perspective.
Frequency of mobility-related participation and easiness/
difficulty in mobility
In the 4-month perspective, the frequency of how oen the
participants went for a walk/ride, performed shopping, vis-
ited restaurant and culture or sport events increased non-
signicantly by 12–26%, while not statistically signicant
(Table III). e results remained stable over the year. Turning
to easiness/diculty in mobility-related participation, half
of the participation aspects were rated as signicantly easier
to perform aer the PWC/PS had been in use for 4 months
(Table III). at is, mobility while shopping, going for a walk,
visiting friends, or the pharmacy, was experienced as sig-
nicantly easier (p = <0.0001–0.002). No other or additional
changes were seen at the 1-year follow-up.
Mobility-related participation repertoire
e number of participation aspects that the participants en-
gaged in did not increase signicantly over time. At baseline,
the mean number of participation aspects were 8.3 out of 22
SD 3.9; 4 months later it was 8.7 SD 3.1; and at the 1-year
follow-up 8.7 SD 2.9.
Expectations and fulfillments
At baseline, as response to the open-ended question about
expectations to the PWC/PS, the majority of the participants
stated that they wished to use the granted PWC/PS for getting
out doors, into the nature and the city-centre; i.e. to be able
to go to the church yard or a concert as well as to visit the
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Outcomes of powered wheelchair and scooter interventions 215
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sea-side or the forest. ey also expressed that they wished
to visit family and friends, and to socialize in, for example, a
café or the library. Half of the participants also said that they
expected that the PWC/PS would make it possible for them
to do the everyday shopping. At the 4-month follow-up, the
majority stated that they did use the PWC/PS to socialize and
perform everyday shopping. At the 1-year follow-up, the par-
ticipants reported involvement in the same types of partici-
pation aspects; they still went our-doors, into the city-center
and the nature, even though fewer persons performed each
participation aspect by that time.
Approximately, 80% had their expectations of the PWC/PS
fullled and judged the device much better or better than ex-
pected, according to the structured question. e participants
to a great extent did what they had intended to do with the
PWC/PS, and an increase in independence was expressed.
Discussion
Summing up on the results, this study provides some of the
rst user-based information about the outcomes of PWC/
PS in terms of mobility and mobility-related participation in
real-life situations, based on a small Swedish sample. e re-
sults indicate that participation frequency increases for some
aspects of participation aer a PWC/PS intervention, while
some become easier. e study also shows that the outcomes
occur in a short time perspective and remain relatively stable
in a 1-year perspective. In addition, the results show that the
device clearly increases independence in mobility outdoors
and indoors in other places than the home. PWC and PS in-
terventions thus seem to enhance mobility-related participa-
tion in everyday life.
Shopping, going for a walk and social and family events
were the participation aspects that were most prominently in-
uenced by a PWC/PS intervention. In terms of signicance,
without the Bonferroni correction, frequencies of shopping
and going for a walk were found to be signicant. As for how
easy the participation aspects were performed, besides go-
ing for a walk, shopping and visiting family/friends, kitchen
work, visiting restaurant, hairdresser, bank and gardening had
turned out to be signicantly easier to perform. However, we
have, for this small sample chosen a more rigorous approach
for the interpretation of the results. Further and more com-
prehensive studies are needed in order to increase this kind
of knowledge.
e fact that in our study PWC/PS facilitated indepen-
dence and made it possible to maintain important partici-
pation aspects such as shopping, socializing and going’ for
a walk has also been found in other pre-post design studies
[11,15]. ese social participation aspects are important for
health and quality of life, in particular in old age [27]. at
is, to be able to shop, go for a walk or on an excursion can
have great implications for wellbeing as well as independence,
and also presumably for ones role in the family situation, not
to mention the importance for the health in itself to be able
to go outdoors [28–30]. Aspects such as independence in
Table III. Changes in frequency of participation and in easiness/diculty of mobility-related participation at baseline, 4-month and 1-year follow-up; the
proportion of participants engaged in each participation aspect and the proportion of participants for whom easiness/diculty changed over time, N = 34.
Changes in participation frequency between baseline,
4-month and 1-year follow-up %
Changes in easiness/diculty between baseline and
4-month follow-up %d
Participation aspect baseline 4-month
Changes from
baseline to
4-month p valuea1-yearbncEasier Unchanged More dicult p valuee
Kitchen work 85 76 Ns 68 24 50 29 21 Ns
Washing up 44 38 Ns 38 15 53 40 7 Ns
Cleaning 44 41 Ns 35 24 64 0 36 Ns
Restaurant 53 68 Ns 65 23 61 35 4 Ns
Take care of children 12 9 Ns 12 0 0 0 0 Ns
Hairdresser 59 56 Ns 53 19 58 37 5 Ns
Shopping 65 79 Ns 76 27 74 22 4 0.001
Other shopping 56 68 Ns 71 23 87 9 4 <0.0001
Post 26 12 Ns 26 4 50 50 0 Ns
Bank 41 44 Ns 56 15 87 13 0 Ns
Pharmacy 50 53 Ns 50 18 44 22 34 0.001
Library 21 15 Ns 21 5 60 20 20 Ns
Union/church 32 32 Ns 41 11 72 14 14 Ns
Culture, sport 26 38 Ns 29 13 85 15 0 Ns
Hobby, exercise 29 29 Ns 29 10 83 17 0 Ns
Go for a walk/ride 71 97 Ns 91 33 91 8 1 <0.0001
Family, friends 85 82 Ns 82 27 56 22 4 0.002
Work/studies 6 9 Ns 18 3 66 33 1 -
Gardening 23 26 Ns 15 9 75 13 12 Ns
aSign test.
bNo additional signicant changes in participation frequency occurred between 4-month and 1-year follow-up and therefore no p value is reported.
cNumber of participants that answered the frequency-scale at both baseline and 4-month follow-up, utilized to calculate the changes in easiness. ose responding that they
never performed a certain participation aspect at baseline but had started doing it four month later are considered as gainers in easiness.
dNo other signicant changes in easiness/diculty occurred between 4-month and 1-year follow-up and therefore not presented.
ee sign test is based on data from the ordinal 5-step scale.
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216 C. Löfqvist et al.
Disability and Rehabilitation: Assistive Technology
mobility, the possibility to remain life-roles etc, can be as-
sumed to impact on life satisfaction and quality of life, which
imply that also these aspects should be assessed when study-
ing the outcome of PWS/PS.
e PWC/PS intervention did not, however, result in other
or additional participation aspects or changes in the par-
ticipants’ repertoire of participation aspects. One explanation
may be that that people’s life habits and routines tend to stay
stable [28] and may possibly reect the habits of this group
rather than lack of outcome of the device. is is also partly
supported by a study by Auger et al exploring life-space mo-
bility aer PS intervention [31], which also found stability in
going to specic locations, mostly around the home and in the
neighborhood.
e results also revealed that not all participation aspects
were maintained over the year and that some remained
unchanged or became more dicult to engage in for some
participants, for example, going to the pharmacy and post
oce. One reason could be that the participants received
the PWC/PS when the progress of disability and deteriorate
health already was prominent and worsened over time. Of
course, it could also be due to the ageing process as such,
since the mean age of the participants was 69 years, already
living/coping with a combination of functional limitations
increasing over the study period. Moreover, environmental
barriers in the outdoor environment such as kerbs most
likely add to increased diculty in participation as found in
other studies [12,32,33]. is is also supported theoretically
by the ecological model of aging by Lawton [34], in which
the person is seen as a set of competencies and the envi-
ronment constitute the environmental press. As a persons
competencies decline and adaptation capacity decrease, in
general, as people age, higher vulnerability to the environ-
mental demands arises.
It was not expected that mobility when performing partici-
pation aspects in the indoor environment would be improved,
because most PWS/PS were granted for outdoor use. Still,
some changes were seen as regards the easiness of mobility
indoors. Since signicantly less pain in relation to mobility
was reported at the 4-month follow-up, it could be that fa-
cilitating outdoor mobility impacted on the possibilities to
perform other everyday activities such as domestic work. is
unexpected outcome on participation aspects in the indoor
environment might therefore be of importance to study fur-
ther to fully understand the eects of the intervention.
Very few housing adaptations or other changes were made
in the participants’ homes during the study period and the
need for assistance when moving in and out of the home did
not decrease. at is, presumably environmental barriers
existed in terms of stairs and narrow doors, in and in close
connection to the home. While studying such aspects goes be-
yond the scope of the current study, for optimal eect of this
kind of MD one could argue that also other changes in the en-
vironment in order to facilitate mobility would be benecial.
Another reason for still having the need for assistance when
going in and out of home could be the need for help when
fetching or transferring to the PWS/PS, or for other practical
issues, such as putting on outdoor clothes. at is, there are
many challenges to overcome in order to get outdoors, which
has to be considered when providing a PWC/PS.
e users’ intention to use the PWC/PS is known to have
an impact on how and how far away from home the device is
being used [31]. In our study, PWC/PS were used for a variety
of participation aspects, most of them in congruence with the
user’s prior expectations. Even if the result of our open ques-
tion illustrates that this kind of MD makes a dierence in the
life of a person with mobility limitations, there is a need to
further explore the outcome on PWC/PS in order to grasp to
which extent the device assists the users. e overall outcome
constitutes a result from the interaction between the specic
device, also in relation to other MD in use, its user, the partici-
pation aspect carried out, and the environment − which is not
yet clearly described, understood or evaluated [35].
e study results should, however, is seen in the light of
some study limitations. For this rst study using the NOMO
1.0, a small sample was used implying reduced possibilities for
confounder control and causal analysis. Moreover, there are
dierences in use between PWC and PS presumably eecting
e.g. indoor and outdoor use, but due to the small sample size,
subgroups analyses were not feasible. Only few women took
part in this study, which presumably impact on the results,
since men are known to be more active in the use of PWC/PS
outdoors and the two genders engage in dierent participa-
tion aspects [12]. In addition, urban living relates to higher
use of MD by older adults [36], and age and gender impact
on the mobility-related participation repertoire, for example,
how oen and where one does the shopping. at is, the study
cannot be considered as representative for the study popula-
tion, hampering the generalizability of our results. In addi-
tion, the study was performed in south Sweden where weather
conditions are less severe concerning ice and snow compared
to e.g. Norway and north Sweden and Finland. Icy weather
conditions could have impacted on outcomes at 4-months
follow-up if baseline data had been collected in August and
follow-up in December. Hence, there is a need to further ex-
amine the eect of PWC/PS in larger studies, PWC and PS
as separate MD, in dierent age groups and from a gender
perspective.
Another limitation may seem to be the study design as no
control group was used to reduce bias. is was not, however,
possible for ethical and legal reasons, since in Sweden people
in need for have a legal right to receive at PWC or PS. In
such situations, a cohort study design following outcomes
over time is robust and is in reality the only possible study
design [7].
Even though the NOMO 1.0 instrument did identify chang-
es over time, the instrument is still under development and
further studies on psychometric properties of the instrument
are needed, e.g. responsiveness and ceiling/oor eects [24].
Conclusions
e overall conclusion regarding outcomes of PWC/PS inter-
ventions aer 4 and 12 months is that changes in the participa-
tion frequency and easiness in mobility-related participation
seem to occur in a short time perspective and stay relatively
Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Lund on 08/28/12
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Outcomes of powered wheelchair and scooter interventions 217
©  Informa UK Ltd.
stable over time. In turn, this implicates that the 4-month
follow-up time aer PWC/PS intervention is adequate in
areas with stable weather conditions. Going for a walk, shop-
ping, visiting restaurants and culture or sport events were the
participation aspects that most prominently increased aer
a PWC or PS intervention regarding frequency and going
for a walk, shopping and visiting family or friends regarding
easiness. Even though the results indicate that the PWC/PS
only lead to increased participation frequency for some of the
participation aspects, participation aspects became, to a great
extent, easier aer the intervention in spite of the fact that the
number of functional limitations increased during the 1 year-
study. Easiness in participation can therefore be considered as
an important outcome dimension of PWC/PS interventions.
In addition, the device clearly increased independence in mo-
bility, i.e. a prerequisite for mobility-related participation. e
study is, however, small with a non-representative sample,
and larger studies are required in order to provide evidence
for outcomes of PWC/PS. Even so, the study has generated
more knowledge about outcomes from PWC/PS, an area of
research that is decient, and this information so far can to
a certain extent assist policy makers, services providers and
users on service delivery criteria and the timing for follow-up
aer PWC/PS interventions.
Acknowledgement
e authors thank statistician V. Horstmann for statistical
advice.
Declaration of Interest: e authors report no declarations of
interest. is study was supported by funding from the Ribbing
Foundation, Lund Sweden and the Swedish Research Council
on Social Science and Working Life and accomplished in the
context of the Centre of Ageing and Supportive Environments
(CASE), Lund University.
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... Giesbrecht et al. or play without assistance from other people, particularly in relation to mobility. Independence as a theme was highlighted by 20 studies (Blach Rossen et al., 2012;Brandt et al., 2004;Carver et al., 2016;Edwards and McCluskey, 2010;Frank et al., 2010;Fredriksson et al., 2020;Korotchenko and Hurd Clarke, 2014;Labbé et al., 2020;Löfqvist et al., 2012;May and Rugg, 2010;Mortenson et al., 2015;Perr, 2014;Pettersson, 2014;Pettersson et al., 2015;Samuelsson and Wressle, 2014;Stenberg et al., 2016;Sund and Brandt, 2018;Sund et al., 2015;Widehammar et al., 2020) with the authors identifying how independence with PMDs had a positive impact, allowing study participants freedom to mobilise when and where they wanted to. Of these studies, five reported on findings that measured independence using a standardised tool, the Nordic mobility-related participation outcome evaluation (NOMO) (Löfqvist et al., 2012;Sund et al., 2015;Sund and Brandt, 2018), the Functional Mobility Assessment (FMA) (Carver et al., 2016) and the Canadian Occupational Performance Measure (COPM) (May and Rugg, 2010). ...
... Independence as a theme was highlighted by 20 studies (Blach Rossen et al., 2012;Brandt et al., 2004;Carver et al., 2016;Edwards and McCluskey, 2010;Frank et al., 2010;Fredriksson et al., 2020;Korotchenko and Hurd Clarke, 2014;Labbé et al., 2020;Löfqvist et al., 2012;May and Rugg, 2010;Mortenson et al., 2015;Perr, 2014;Pettersson, 2014;Pettersson et al., 2015;Samuelsson and Wressle, 2014;Stenberg et al., 2016;Sund and Brandt, 2018;Sund et al., 2015;Widehammar et al., 2020) with the authors identifying how independence with PMDs had a positive impact, allowing study participants freedom to mobilise when and where they wanted to. Of these studies, five reported on findings that measured independence using a standardised tool, the Nordic mobility-related participation outcome evaluation (NOMO) (Löfqvist et al., 2012;Sund et al., 2015;Sund and Brandt, 2018), the Functional Mobility Assessment (FMA) (Carver et al., 2016) and the Canadian Occupational Performance Measure (COPM) (May and Rugg, 2010). Participant's self-report of independence (n = 13) was the most common method of reporting on independence. ...
... Life-space assessment composite score Auger et al. (2010) x Mobility habits in 5 life-space levels. From a total of 20 items a composite score ranging from 0 to 120 is computed Nordic Mobility-related Participation Outcome Evaluation (NOMO) Löfqvist et al. (2012), Sund and Brandt (2018), Sund et al. (2015) x Assessment of mobility-related participation outcomes for mobility devices (Only validated for Nordic countries) ...
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Introduction The aim was to explore occupational participation and quality of life (QoL) for power mobility device users with chronic disease. Methods Arksey and O’Malley’s framework for scoping reviews was used. Six data bases were searched using keywords: wheelchair, scooter, QoL and participation. Data were extracted with coding and thematic analysis performed. Results Forty-one articles met the inclusion criteria. An overarching theme of enhanced QoL was identified with subthemes of (i) independence, (ii) enabling participation in instrumental activities of daily living, (iii) enhanced social participation and leisure, (iv) environmental barriers to occupational participation, (vi) power mobility device (PMD) performance concerns impacting occupational participation and (vii) overcoming risk of harm through PMD training. Conclusion The scoping review identified a heterogeneity of study designs and outcome measures, which makes comparison between studies difficult. For people with chronic diseases, PMDs improve independence in occupational participation, particularly in IADL, social participation and leisure. Unfortunately, improved QoL was often inferred, without the use of an outcome measure. Areas which impacted occupational participation for PMD users were environmental barriers and a lack of PMD training. Further research is needed to understand the impact of a PMD on QoL and occupational participation for those with chronic disease.
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Purpose: To evaluate and compare the perceived autonomy of people using wheeled mobility assistive devices (WMADs) in five community-based environments. To evaluate how personal, environmental, and assistive device-related factors impact the perceived autonomy of WMAD users. Method: A study-specific questionnaire was used to evaluate perceived satisfaction of WMAD users with their autonomy in five environments: the Home Environment, Buildings Outside of the Home Environment, Outdoor Built Environment, Outdoor Natural Environment, and Transportation. For each environment, participants rated their satisfaction with autonomy about 15 personal, environmental, and assistive device-related factors. Qualitative perceptions were also collected with open-ended questions. Results: Participants included 123 full- and part-time community-dwelling WMAD users. Participants' overall satisfaction with autonomy in the Outdoor Natural Environment was statistically significantly lower compared to the other four environments (p < 0.05). In all environments, the top factor respondents were most satisfied with was WMAD ease of use. Their least satisfaction was when negotiating stairs, curbs, or obstacles in the Home, Buildings Outside of the Home, and the Outdoor Built Environments. In the Outdoor Natural Environment, the most dissatisfaction was with manoeuvring on different terrains. Responses to open-ended questions supported the quantitative findings and highlighted the effects of various factors on autonomy (e.g., subject-environment familiarity). Conclusions: WMAD users reported the greatest restriction to their autonomy in outdoor environments. Different context-specific factors were found to impact autonomy in different environments. Understanding how environment-specific contextual factors contribute to overall perception of autonomy may inform the development of future strategies to overcome identified limitations and challenges.Implications for RehabilitationWheeled mobility assistive device (WMAD) users experienced the highest autonomy in their home environments, specifically, when having access to home modification services.WMAD users had the lowest autonomy in the outdoor natural environment, with manoeuvrability on different terrains being the main predictor of the overall satisfaction with autonomy in this environment.Environment-specific contextual factors with significant impacts on perceived autonomy were identified that can inform the design and development of future WMADs (e.g., distance travelled, safety).
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Individually Prioritised Problem Assessment (IPPA) is an instrument to assess the effectiveness of assistive technology provision. It is a generic instrument that can be used to assess the extent to which problems identified by an individual assistive technology user have been diminished. IPPA was developed because existing instruments in the field of Health Technology Assessment are not sufficient for assessing effectiveness of assistive technology. IPPA assesses effectiveness in relation to those activities that the individual respondent considers relevant. At the start of the service delivery process, the client is asked to identify and rate the activities that he or she has problems with in everyday life. The same activities are rated again, a few months after receiving a new assistive technology. IPPA has been used in several studies and has proven to be a usable and valid instrument.
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