Emergency evacuation readiness of full-time wheelchair users with spinal cord injury

McClure LA, Boninger ML, Oyster ML, Roach MJ, Nagy J, Nemunaitis G. Emergency evacuation readiness of full-time wheelchair users with spinal cord injury.

Objectives

To determine the percentage of full-time wheelchair users with spinal cord injuries who felt they could evacuate from various locations, and the percentage who have a plan for evacuation. Study results will help clinicians and emergency officials understand needs related to evacuation preparedness.

Design

Convenience sample survey.

Setting

Six Spinal Cord Injury Model System centers, part of the national database funded through the Department of Education, National Institute on Disability and Rehabilitation Research.

Participants

People (N=487) with spinal cord injuries who use a wheelchair more than 40 hours a week.

Interventions

Not applicable.

Main Outcome Measures

The percentage of wheelchair users who felt they would be able to safely evacuate, had a plan for safe evacuation, or reported a need for assistive technology and human assistance to evacuate from various locations in the event of an emergency.

Results

The highest percentage of participants felt they would be able to safely evacuate and had a plan for work evacuation. The lowest percentage of participants reported they could evacuate from their city/town in the event of an emergency and had a plan to evacuate their city/town in the event of a natural disaster. A large difference exists between the percentage of participants who felt they could evacuate and those who have a plan for evacuation.

Conclusions

A large discrepancy exists between the perception that one can evacuate and actually having a plan. The perception that one can evacuate without a plan or the use of assistive technology is an area of concern that must be further addressed by educators. Education must emphasize the need to have a defined evacuation plan and effective utilization of assistive technology.     

Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury

Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, Dyson-Hudson TA. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury.

Objectives

To investigate the presence of ultrasound (US) abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight.

Design

Case series.

Setting

National Veterans' Wheelchair Games 2005 and 2006.

Participants

Volunteer sample of manual wheelchair users with SCI participating in the National Veterans' Wheelchair Games.

Interventions

Not applicable.

Main Outcome Measures

Presence of relationships between US findings, PE findings, pain, and subject characteristics.

Results

The USPRS correlated with age, duration of SCI, and weight (all P<.01), and showed a positive trend with the total Wheelchair User's Shoulder Pain Index (WUSPI) score (r=.258, P=.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI (r=.679, P<.001) and duration of SCI (P<.05). The presence of untreated shoulder pain that curtailed activity was noted in 24.5% of subjects, and this was related to increased WUSPI scores (P=.002).

Conclusions

PE and US abnormalities are common in manual wheelchair users with SCI. The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is indicated.     

Investigation of factors associated with manual wheelchair mobility in persons with spinal cord injury

Oyster ML, Karmarkar AM, Patrick M, Read MS, Nicolini L, Boninger ML. Investigation of factors associated with manual wheelchair mobility in persons with spinal cord injury.

Objective

To quantify wheelchair mobility of persons with a spinal cord injury (SCI), and to assess the relationship between wheelchair mobility and demographics, type of manual wheelchair, and participation.

Design

Cross-sectional study.

Setting

Six Model Spinal Cord Injury Systems.

Participants

People (N=132) with SCI who use a manual wheelchair as their primary means of mobility.

Interventions

Not applicable.

Main Outcome Measures

Wheelchair-related mobility characteristics measured by a data-logging device, and community participation measured by the short form of the Craig Handicap Assessment Recording Technique (CHART).

Results

Age was found to be significantly (r=–.225, P<.01) related to average speed traveled per day. Whites were found to travel significantly further (P<.01) and accumulate more minutes per day (P<.01) compared with minorities. Participants who were employed traveled significantly further (P<.01), faster (P<.01), and for more minutes per day (P<.01) compared with those who were not employed. A moderate relationship (r=.245–.390) was found between wheelchair mobility data and CHART total score.

Conclusions

Results suggest a need for future investigation of the factors that influence wheelchair mobility and community participation of persons with SCI. Findings indicate the efficacy of a quantitative method to track wheelchair mobility in community settings, which could serve as a way of identifying community participation for persons with SCI and possibly uncovering additional aspects of participation.     

Subject- and injury-related factors influencing the course of manual wheelchair skill performance during initial inpatient rehabilitation of persons with spinal cord injury

OBJECTIVES: To study changes in wheelchair skills in subjects with spinal cord injury (SCI) during rehabilitation; to determine whether changes in wheelchair skill performance are related to the subject, lesion characteristics, secondary complications, and upper extremity pain; and to investigate if wheelchair skill performance at discharge can be predicted from these features. DESIGN: Longitudinal. Subjects performed the Wheelchair Circuit 3 times during rehabilitation: at admission (t1), 3 months later (t2), and at discharge (t3). SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: One hundred twenty-one subjects with SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. RESULTS: All the scores of the Wheelchair Circuit improved significantly between t1 and t2, and between t2 and t3. The scores were related to age and lesion level, whereas changes in scores were related to age, sex, lesion level, and secondary complications. The variables age, body mass index, sex, lesion level, motor completeness, and secondary complications contributed significantly to the prediction of the scores at t3. CONCLUSIONS: Wheelchair skill performance improved during rehabilitation. Personal and lesion characteristics are most important for improving wheelchair skill performance and predicting wheelchair skill performance.     

The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury

OBJECTIVE: To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury (SCI) during rehabilitation. DESIGN: Observational prospective cohort study. Measurements were taken 3 times during subjects' rehabilitation. SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: Ninety-seven subjects with SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Parameters of physical capacity were upper-extremity muscle strength (manual muscle test [MMT] sum score), peak oxygen uptake, and peak power output (POpeak). The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. RESULTS: POpeak was related to all 3 scores of the Wheelchair Circuit, and the MMT sum score was related to the ability score and the performance time score. The results indicate that (1) subjects with higher values of POpeak and/or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and (2) when a subject increased his/her POpeak and/or MMT sum score, this was associated with better wheelchair skill scores. CONCLUSIONS: There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI. To optimize wheelchair skill performance, attention should be directed toward manual wheelchair exercise training and strength training of the upper body.     

The Wheelchair Circuit: Construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury

OBJECTIVE: To assess the validity and responsiveness of the Wheelchair Circuit, a test to assess manual wheelchair mobility in persons with spinal cord injury (SCI). DESIGN: Longitudinal. Subjects performed the Wheelchair Circuit at the start (T1) and at the end (T3) of inpatient functional rehabilitation. Construct validity and responsiveness were assessed. SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: Seventy-four subjects with SCI admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. The construct validity of the Wheelchair Circuit was assessed by testing whether the test scores were significantly related to the subjects' functional status, physical capacity, lesion level, motor completeness of the lesion, and age. To prove the test's responsiveness, it was assessed whether the test scores had significantly improved between T1 and T3. RESULTS: For construct validity, 4 of the 5 hypotheses were confirmed. For test responsiveness, all 3 test scores had significantly improved during rehabilitation, and the standardized response mean values ranged from 0.6 to 0.9. CONCLUSIONS: The Wheelchair Circuit is a valid and responsive instrument with which to measure manual wheelchair mobility in subjects with SCI.     

Course of gross mechanical efficiency in handrim wheelchair propulsion during rehabilitation of people with spinal cord injury: a prospective cohort study

OBJECTIVE: To investigate the course of mechanical efficiency of handrim wheelchair propulsion during rehabilitation of subjects with (in)complete paraplegia and tetraplegia. DESIGN: Subjects were tested at the start of active rehabilitation (t1), 3 months later (t2), and when discharged from inpatient rehabilitation (t3). They performed two 3-minute submaximal treadmill exercise blocks in a wheelchair. SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: Ninety-two people with (in)complete paraplegia and tetraplegia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mechanical efficiency values were calculated for each block. The course of mechanical efficiency was investigated using test occasions (t1 -t3), completeness and level (paraplegia or tetraplegia) of the lesion, and power output as independent variables in a multilevel regression analysis. RESULTS: Mechanical efficiency significantly increased between t1 and t2 only. After adding level and completeness of the lesion and their interactions with time to the model, block 2 showed that subjects with paraplegia had a significantly higher mechanical efficiency than subjects with tetraplegia. Subjects with tetraplegia improved more between t1 and t2 . Differences in mechanical efficiency between subjects with paraplegia and tetraplegia could not be explained by differences in absolute and relative power output levels. CONCLUSIONS: Results showed a significant improvement in mechanical efficiency during the first 3 months of active rehabilitation. Subjects with paraplegia showed a higher mechanical efficiency than did subjects with tetraplegia, whereas the latter showed more improvement between t1 and t2 .     

Cardiorespiratory demand and rate of perceived exertion during overground walking with a robotic exoskeleton in long-term manual wheelchair users with chronic spinal cord injury: A cross-sectional study

Background

Many wheelchair users adopt a sedentary lifestyle, which results in progressive physical deconditioning with increased risk of musculoskeletal, cardiovascular and endocrine/metabolic morbidity and mortality. Engaging in a walking program with an overground robotic exoskeleton may be an effective strategy for mitigating these potential negative health consequences and optimizing fitness in this population. However, additional research is warranted to inform the development of adapted physical activity programs incorporating this technology.

Pelvic movement and interface pressure distribution during manual wheelchair propulsion

OBJECTIVE: To investigate the movement of the ischial tuberosities and the redistribution of interface pressure during manual wheelchair propulsion. DESIGN: Measurement of ischial tuberosity positions and comparison with corresponding position of the zones of peak pressure by using independent samples t tests. Analysis of variance was used to compare peak and average pressures under static and dynamic conditions. SETTING: Human locomotion laboratory. PARTICIPANTS: Ten subjects with spinal cord injury (SCI) and 10 individuals with no disabilities. INTERVENTIONS: Manual wheelchair propulsion on a stationary wheelchair ergometer at the subject's maximum propulsion speed. MAIN OUTCOME MEASURES: Seat interface pressure and the 3-dimensional position of the pelvis were measured with a pressure mat and an optical motion analysis system. RESULTS: During wheelchair sprinting, the ischia were located at 19.2+/-11.7 mm behind the corresponding peak pressure locations. The anteroposterior rocking of the pelvis was 11.2 degrees and 5.2 degrees for the normal and SCI group, respectively. The average interface pressure over the ischial tuberosity area was lower under dynamic conditions. It was also observed in the SCI group that there was a concentration of high-pressure gradients around the peak pressure areas of the buttock during dynamic propulsion. CONCLUSION: Peak pressure locations did not concur exactly with the ischial tuberosities during propulsion. The movements of the ischial bone and the cyclic loading imposed on the tissue underneath the ischial tuberosities during dynamic conditions may have implications for the etiology of decubitus ulcers.     

Internal consistency, stability, and validity of the spinal cord injury version of the multidimensional pain inventory

OBJECTIVE: To evaluate the internal consistency, stability, and construct validity of a spinal cord injury (SCI) version of the Multidimensional Pain Inventory (MPI-SCI). DESIGN: Interview. SETTING: Veterans Affairs medical center and university-based institute. PARTICIPANTS: Community sample of persons with SCI and chronic pain (N=161). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The MPI-SCI. RESULTS: The internal consistency of the MPI-SCI subscales ranged from fair (.60) for affective distress to substantial (.94) for pain interference with activities. The subscales of the MPI-SCI (ie, life interference [r=.81], affective distress [r=.71], solicitous responses [r=.86], distracting responses [r=.85], general activity [r=.69], pain interference with activities [r=.78], pain severity [r=.69], negative responses [r=.69]) showed adequate stability. In contrast, the stability of the support (r=.59) and the life control subscales (r=.31) was unacceptably low. All MPI-SCI subscales with the exception of the perceived responses by significant others subscales showed good convergent, discriminant, and concurrent validity. CONCLUSIONS: The MPI-SCI appears to be a reasonable measure for evaluating chronic pain impact after SCI. In clinical trials, however, supplementary instruments should be included to assess changes in affect, social support, and perceptions of life control.     

Effect of wheelchair tilt-in-space and recline angles on skin perfusion over the ischial tuberosity in people with spinal cord injury

Jan Y-K, Jones MA, Rabadi MH, Foreman RD, Thiessen A. Effect of wheelchair tilt-in-space and recline angles on skin perfusion over the ischial tuberosity in people with spinal cord injury.

Objective

To investigate the efficacy of wheelchair tilt-in-space and recline on enhancing skin perfusion over the ischial tuberosity in wheelchair users with spinal cord injury (SCI).

Design

Repeated-measures, intervention, and outcomes-measure design.

Setting

A university research laboratory.

Participants

Wheelchair users with SCI (N=11; 9 men, 2 women; mean ± SD age, 37.7±14.2y; body mass index, 24.7±2.6kg/m²; duration of injury, 8.1±7.5y).

Interventions

Protocols (N=6) of various wheelchair tilt-in-space and recline angles were randomly assigned to participants. Each protocol consisted of a 5-minute sitting-induced ischemic period and a 5-minute wheelchair tilt-in-space and recline pressure-relieving period. Participants sat in a position without tilt or recline for 5 minutes and then sat in 1 of 6 wheelchair tilted and reclined positions, including (1) 15° tilt-in-space and 100° recline, (2) 25° tilt-in-space and 100° recline, (3) 35° tilt-in-space and 100° recline, (4) 15° tilt-in-space and 120° recline, (5) 25° tilt-in-space and 120° recline, and (6) 35° tilt-in-space and 120° recline. A 5-minute washout period (at 35° tilt-in-space and 120° recline) was allowed between protocols.

Main Outcome Measures

Laser Doppler flowmetry was used to measure skin perfusion over the ischial tuberosity in response to changes in body positions caused by performing wheelchair tilt-in-space and recline. Skin perfusion response to wheelchair tilt-in-space and recline was normalized to skin perfusion of the upright seated position (no tilt/recline).

Results

Combined with 100° recline, wheelchair tilt-in-space at 35° resulted in a significant increase in skin perfusion compared with the upright seated position (no tilt/recline; P<.05), whereas there was no significant increase in skin perfusion at 15° and 25° tilt-in-space (not significant). Combined with 120° recline, wheelchair tilt-in-space at 15°, 25°, and 35° showed a significant increase in skin perfusion compared with the upright seated position (P<.05).

Conclusions

Our results indicate that wheelchair tilt-in-space should be at least 35° for enhancing skin perfusion over the ischial tuberosity when combined with recline at 100° and should be at least 25° when combined with recline at 120°. Although smaller angles of wheelchair tilt-in-space and recline are preferred by wheelchair users for functional purposes, wheelchair tilt-in-space less than 25° and recline less than 100° may not be sufficient for effective pressure reduction for enhancing skin perfusion over the ischial tuberosity in people with SCI.     

Psychometric Properties of the Brief Fatigue Inventory in Community-Dwelling Older Adults

Objective

To investigate the psychometric properties of the Brief Fatigue Inventory (BFI) in community-dwelling older adults.

Design

Cross-sectional validation study.

Setting

Community based.

Participants

Subjects (N=302) were nondemented older adults (mean age, 76.44y; 54% women).

Interventions

Not applicable.

Main Outcome Measures

BFI total, severity, and interference summation scores.

Results

A principal component analysis (PCA) yielded 2 factors, fatigue severity and interference, explaining 65.94% of the variance. Both factors had good reliability, with Cronbach alpha values of .867 for fatigue interference and .818 for fatigue severity. Higher fatigue scores were associated with older age and worse physical and cognitive functions.

Conclusions

Fatigue is a common and debilitating symptom in the aging population. The current study provides novel findings in validating and establishing a bidimensional factor structure for the BFI in older adults. Severity and interference were differentially related to important health outcomes; therefore, using these subscales in addition to the total BFI score is recommended with older adults. Because of its relatively short administration time and established psychometric properties, the BFI can be successfully incorporated into longitudinal studies and clinical trials.     

Ventilation efficiency and pulmonary function after a wheelchair interval-training program in subjects with recent spinal cord injury

OBJECTIVE: To study the effect of a wheelchair interval-training program on the ventilatory function of subjects with recent spinal cord injury (SCI). DESIGN: Evaluation trial before and after a training program. SETTING: Center of reeducation and university hospital. PARTICIPANTS: Six subjects (5 men, 1 woman) hospitalized after a recent SCI. INTERVENTION: On a wheelchair ergometer, subjects with SCI performed 30 minutes of interval training 3 times a week for 6 weeks. The training program was part of their reeducation program. MAIN OUTCOME MEASURES: Spirometric values at rest and dynamic ventilatory responses were studied before and after this training program with a spirometric test, a maximal exercise test that increased by 5W every 2 minutes, and a submaximal test. RESULTS: Spirometric values at rest did not change after training. At maximal exercise, peak ventilation (Vepeak, 7.5%), peak breathing frequency (f peak) (-13.4%), peak tidal volume (Vtpeak +28.9%), and the ventilatory reserve (12.9%) improved after training. The oxygen cost of Ve decreased significantly (-20%) after training. We observed for the wheelchair tests that, at the same workload after training, Ve and f decreased and Vt increased. CONCLUSIONS: After 6 weeks of our interval-training program in subjects with recent SCI, the increase of Vt and the decrease of oxygen cost of Ve indicated better ventilatory efficiency.     

Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury

OBJECTIVES: To determine if a standard of care for wheelchair provision exists within the participating centers and if there is disparity in wheelchair customizability among the study sample. DESIGN: Convenience sample survey. SETTING: Thirteen Model Spinal Cord Injury Systems that provide comprehensive rehabilitation for people with traumatic spinal cord injury (SCI) and that are part of the national database funded through the US Department of Education. PARTICIPANTS: A total of 412 people with SCI who use wheelchairs over 40 hours a week. INTERVENTION: Survey information was obtained from subjects via telephone and in-person interviews and from the national database. Collected information included age, race, education, level of injury, and wheelchair funding source. MAIN OUTCOME MEASURES: Number and type (manual or power) of wheelchairs. Wheelchair customizability as defined by design features (eg, adjustable axle position, programmable controls). RESULTS: Ninety-seven percent of manual wheelchair users and 54% of power wheelchair users had customizable wheelchairs. No power wheelchair user received a wheelchair without programmable controls. Minorities with low socioeconomic backgrounds (low income, Medicaid/Medicare recipients, less educated) were more likely to have standard manual and standard programmable power wheelchairs. Older subjects were also more likely to have standard programmable power wheelchairs. CONCLUSIONS: The standard of care for manual wheelchair users with SCI is a lightweight and customizable wheelchair. The standard of care for power wheelchairs users has programmable controls. Unfortunately, socioeconomically disadvantaged people were less likely to receive customizable wheelchairs.     

Effects of spinal cord injury level on the activity of shoulder muscles during wheelchair propulsion: an electromyographic study

OBJECTIVE: To determine the influence of spinal cord injury (SCI) level on shoulder muscle function during wheelchair propulsion. DESIGN: Fine-wire electromyographic activity of 11 muscles was recorded during wheelchair propulsion. SETTING: Biomechanics research laboratory. PARTICIPANTS: Convenience sample of 69 men, in 4 groups by SCI level (low paraplegia, n=17; high paraplegia, n=19; C7-8 tetraplegia, n=16; C6 tetraplegia, n=17). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Timing of muscle activity onset, cessation, and duration, and time of peak intensity for each functional group were compared with 1-way analysis of variance. Median electromyographic intensity was also compared. RESULTS: Two functional synergies were observed: push (anterior deltoid, pectoralis major, supraspinatus, infraspinatus, serratus anterior, biceps) and recovery (middle and posterior deltoid, supraspinatus, subscapularis, middle trapezius, triceps). Push phase activity began in late recovery and ceased in early to late push. Recovery phase muscles functioned from late push to late recovery. Recruitment patterns for the groups with paraplegia were remarkably similar. For subjects with tetraplegia, pectoralis major activity was significantly prolonged compared with subjects with paraplegia (P<.05). Subscapularis activity shifted from a recovery pattern in subjects with paraplegia to a push pattern in persons with tetraplegia. CONCLUSIONS: Level of SCI significantly affected the shoulder muscle recruitment patterns during wheelchair propulsion. Differences in rotator cuff and pectoralis major function require specific considerations in rehabilitation program design.     

The timed manual wheelchair slalom test: a reliable and accurate performance-based outcome measure for individuals with spinal cord injury

Gagnon D, Décary S, Charbonneau M-F. The timed manual wheelchair slalom test: a reliable and accurate performance-based outcome measure for individuals with spinal cord injury.

Objectives

To describe the timed manual wheelchair slalom test (MWST) and to quantify its test-retest reliability, standard error of measurement, and minimum detectable change (MDC).

Design

Repeated-measures design.

Setting

Pathokinesiology laboratory.

Participants

Manual wheelchair users (N=15) with spinal cord injury (SCI) (vertebral levels, C6 to T12; American Spinal Injury Association Impairment Scale: A, B, or C) participated in this study. Participants were 40.7±12.6 years of age, measured 1.77±.08m in height, weighed 79.6±23.9kg, and had been using a manual wheelchair as their primary mode of mobility for 5.9±7.5 years.

Interventions

Participants propelled their own wheelchair at a self-selected maximum velocity along a slalom trajectory (linear length, 18m) defined by 7 cones aligned in a straight line and set 3m, 2m, and 1m apart from one another. Three trials (T=3) of the MWST were performed on 2 separate visits (V=2) 6.3±5.4 days apart. The generalizability theory was used to determine the reliability, standard error of measurement, and MDC and to propose testing protocols for the MWST.

Main Outcome Measure

The time needed to complete the MWST expressed in seconds.

Results

All participants successfully completed the MWST. No adverse effect was reported. The time required to complete the MWST at visits 1 and 2 was 16.8±4.4 and 16.5±4.3 seconds, respectively. The reliability coefficient (φ=.981) and accuracy (standard error of measurement=3.47%, MDC=8.097%) were high when the time required for a participant to perform 3 MWST trials during a single visit (T=3, V=1) was averaged.

Conclusions

The timed MWST is a safe, reliable, and accurate performance-based outcome measure that can be administered easily and quickly in individuals with SCI who rely on a manually propelled wheelchair for mobility.     

Assessing the influence of wheelchair technology on perception of participation in spinal cord injury

OBJECTIVE: To investigate factors related to the wheelchair, impairment, and environment that affect perception of participation of persons with spinal cord injury (SCI) in activities performed in 3 settings: in the home, in the community, and during transportation. DESIGN: Cross-sectional study. SETTING: Research centers and a specialized assistive technology (AT) clinic in Pittsburgh (Pitt). Research centers and community-based rehabilitation technology suppliers in Saint Louis (SL). PARTICIPANTS: Seventy wheelchair users with SCI. INTERVENTIONS: Subjects from Pitt and SL completed a written survey of AT usage in daily activities. MAIN OUTCOME MEASURES: Subjects were asked 5 questions within each setting (home, community, transportation) related to their perceived reason for functional limitations. RESULTS: The wheelchair was the most commonly cited factor limiting participation, followed by physical impairment and physical environment. Twenty-one percent of subjects with paraplegia reported pain as a limiting factor for their transportation use, significantly more (P=.047) than subjects with tetraplegia (3%). A trend (P=.099) was seen toward a higher percentage of subjects with tetraplegia (tetraplegia, 7%; paraplegia, 3%) reporting lack of equipment as a limiting factor for use of transportation. Differences were also seen across sites. CONCLUSIONS: The wheelchair was the most commonly cited limiting factor, followed by physical impairment and physical environment. The wheelchair is the most important mobility device used by persons with SCI and the one that users most associate with barriers.     

Tracking Functional Status Across the Spinal Cord Injury Lifespan: Linking Pediatric and Adult Patient-Reported Outcome Scores

Objective

To use item response theory (IRT) methods to link scores from 2 recently developed contemporary functional outcome measures, the adult Spinal Cord Injury–Functional Index (SCI-FI) and the Pedi SCI (both the parent version and the child version).

Design

Secondary data analysis of the physical functioning items of the adult SCI-FI and the Pedi SCI instruments. We used a nonequivalent group design with items common to both instruments and the Stocking-Lord method for the linking. Linking was conducted so that the adult SCI-FI and Pedi SCI scaled scores could be compared.

Setting

Community.

Participants

This study included a total sample of 1558 participants. Pedi SCI items were administered to a sample of children (n=381) with SCI aged 8 to 21 years, and of parents/caregivers (n=322) of children with SCI aged 4 to 21 years. Adult SCI-FI items were administered to a sample of adults (n=855) with SCI aged 18 to 92 years.

Interventions

Not applicable.

Main Outcome Measures

Five scales common to both instruments were included in the analysis: Wheelchair, Daily Routine/Self-care, Daily Routine/Fine Motor, Ambulation, and General Mobility functioning.

Results

Confirmatory factor analysis and exploratory factor analysis results indicated that the 5 scales are unidimensional. A graded response model was used to calibrate the items. Misfitting items were identified and removed from the item banks. Items that function differently between the adult and child samples (ie, exhibit differential item functioning) were identified and removed from the common items used for linking. Domain scores from the Pedi SCI instruments were transformed onto the adult SCI-FI metric.

Conclusions

This IRT linking allowed estimation of adult SCI-FI scale scores based on Pedi SCI scale scores and vice versa; therefore, it provides clinicians with a means of tracking long-term functional data for children with an SCI across their entire lifespan.