Assistive devices for personal mobility
Which ones do Swiss people with SCI have – and which ones do they miss?
Author of summary: Rebecca Jaks (Swiss Paraplegic Research)
Original article: Florio, J., Arnet, U., Gemperli, A., Hinrichs, T. & for the SwiSCI study group. Need and use of assistive devices for personal mobility by individuals with spinal cord injury. The Journal of Spinal Cord Medicine. 2016;39(4):461-70.
Optimal mobility is crucial for participation in many aspects of life. Manual wheelchairs and adapted vehicles are the assistive devices that people with SCI in Switzerland use most to improve their mobility. However, this study also showed that there are still gaps in the provision of certain assistive devices.
What was the aim of the study?
Nearly all individuals with spinal cord injury (SCI) depend on mobility devices of some sort such as crutches, manual wheelchairs or power wheelchairs. Until now, however, little is known about the needs of specific devices for individuals who do not have currently access to them. The objectives of this study were to evaluate the provision and the frequency of use of mobility devices in Switzerland and to identify the perceived need of assistive equipment that people with SCI are not provided with.
How did the researchers proceed?
The researchers used the data collected from the 2012 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). It included individuals aged 16 or older living in Switzerland with SCI.
Of the 1549 people who returned the survey, 580 were randomly selected to compile a specific module with questions regarding the use and need of assistive devices. 492 returned the questionnaire and were thus included in this study.
The eleven mobility devices investigated were: crutches, walking frame, manual wheelchair, power wheelchair, power assisted wheelchair, wheelchair tractor, sport wheelchair, handbike, arm brace, leg brace, and adapted vehicle within family. The questions were related to the provision, frequency of use and unmet needs of individuals with SCI.
What did the researchers discover?
The most common mobility devices among the participants were adapted family vehicles (78.2%), manual wheelchairs (69.9%) and wheelchair tractors (32.7%). The most frequent combinations of two devices were manual wheelchair/adapted vehicle (59.4%), followed by manual wheelchair/wheelchair tractor (29.4%).
The most frequently used device was the manual wheelchair: of the individuals who had one, 83.8% used it on a daily basis. The second place went to crutches, that 61.3% used every day.
The devices used mostly for 1-6 times per week were sport wheelchairs (47.2%) and handbikes (40.2%), which are the devices used for engaging in sports.
Table 1 provides a broader picture of the frequency of use of each mobility device (except the adapted vehicle).
Arm brace was the mobility device individuals reported most often as unmet need: 53.2% of the people with a need didn’t have one. Other widely unavailable devices were power assisted wheelchairs (47.3%) and sport wheelchairs (36.3%).
In accordance with the above results concerning the provision, the manual wheelchair and the adaptive vehicle occupied the last ranks for unmet needs: 4.8% respectively 8.1% declared needing but not having one.
What do these findings mean?
The results of the study give an insight on the situation in Switzerland and show that there are some gaps in the provision of assistive devices. For basic devices such as manual wheelchairs or crutches the provision seems to be satisfying. However, when it comes to less common devices such as power assisted and sports wheelchairs there is still a considerable number of people who report unmet needs.
There might be two reasons for this. The missing devices could all be considered as additional devices which are not absolutely necessary to perform basic mobility tasks. Therefore, healthcare professionals might not focus on these devices when making their prescriptions.
A second aspect is the financial coverage of assistive devices. Institutions like insurances usually provide devices only if they are economical and strictly needed. Consequently, patients must pay part of the costs of supplementary devices such as sport wheelchairs by themselves. This, however, is difficult in a situation where they already have many other costs related to their injury.
Who conducted and financed the study?
This study has been conducted and financed by Swiss Paraplegic Research in Nottwil, Switzerland, within the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI).