Test-Retest Reliability of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA): A Cohort Study.

IMPORTANCE: Currently, no self-report instruments exist for assessing satisfaction with performing instrumental activities of daily living and occupations for people with disabilities using internet-connected assistive devices like accessible smartphones, tablets, laptops, and apps. OBJECTIVE: To assess the test-retest reliability and internal consistency of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) self-report outcome tool. DESIGN: Repeated-measures cohort study with a time frame of 7 to 21 days. SETTING: Multicity online recruitment at assistive technology clinics, nongovernmental organizations, advocacy and peer support groups for people with disabilities, and higher education institutions. PARTICIPANTS: Eighty-four participants with disabilities, age 18 yr or older, with a mean age of 43.3 yr (range = 19-75 yr), and 57% female. INTERVENTION: Not applicable. OUTCOMES AND MEASURES: The a priori study hypotheses were that the EISA test-retest reliability scores would be above the minimum acceptable level (Rs > .80) and that internal consistency would be good (Cronbach's α = .70-.90). RESULTS: On the basis of the study data, the EISA, Version 1.0, demonstrated good test-retest reliability (Rs = .81) and excellent internal consistency (Cronbach's α = .88). CONCLUSIONS AND RELEVANCE: The results of the test-retest reliability and internal consistency analyses provide good support for the EISA to be used in clinical settings. What This Article Adds: This article documents the reliability and internal consistency of, to our knowledge, the first-ever self-report instrument for assessing satisfaction with performance of everyday occupations for people with disabilities using internet-connected assistive devices such as smartphones, tablets, laptops, and apps.

Effect of the Assistive Technology Professional on the Provision of Mobility Assistive Equipment.

OBJECTIVE: The purpose of this study was to examine factors associated with variability in satisfaction with functional mobility (as measured by the Functional Mobility Assessment [FMA]) in users of mobility devices. Our primary hypothesis was that device type and Assistive Technology Professional (ATP) involvement will be the most significant predictors of FMA score. Our secondary hypothesis was that ATP involvement is associated with use of more custom-fitted manual wheelchairs and group 3 and 4 power wheelchairs. DESIGN: Retrospective cohort study. SETTING: Data were collected from equipment suppliers who collaborate with clinicians to administer the FMA and associated Uniform Data Set within various settings (ie, rehabilitation clinic, school, supplier place of business). PARTICIPANTS: A data set of 4743 cases was included in the analysis (N=4743). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FMA questionnaire collected at baseline, client age, gender, primary diagnosis, years since disability onset, device type, device age, living situation, ATP involvement, and geographic area. RESULTS: Ordinal logistic regression modeling showed that geographic area, device type, ATP involvement, primary diagnosis, gender, age, device age, and years since onset of disability significantly predicted the variance in FMA scores at P<.05. Device type was the most significant predictor of variance in FMA score. Involvement of an ATP had a significant effect on the type of device that participants used (χ220=1739.18, P<.001; odds ratio, 0.589; 95% confidence interval, 0.49-0.708). If an ATP was involved, there were significantly higher proportions (all P<.05) of individuals using custom-fitted manual wheelchair and high-end groups 3 and 4 power wheelchairs prescribed compared with when no ATP was involved or when involvement was uncertain. CONCLUSIONS: The relationship between ATP involvement and functional outcome supports the concept that ATP certification recognizes demonstrated competence in analyzing the needs of consumers with disabilities and selection of appropriate mobility assistive equipment with improved functional outcomes.

Development and Implementation of a Wheelchair Outcomes Registry.

OBJECTIVE: To describe the development of a patient registry related to wheeled mobility and seating (WMS) device interventions to accumulate large datasets for clinical quality assurance and research purposes. DESIGN: Accepted guidelines for registry development were applied and anchored around the Functional Mobility Assessment (FMA) questionnaire and a uniform dataset (UDS). SETTING: The FMA and UDS were developed under a corporate research agreement between clinical researchers and commercial providers. The questionnaires are administered in rehabilitation clinics to patients at the time of assessment for new device interventions (baseline) and readministered by telephone or other remote strategies periodically thereafter (follow-up). PARTICIPANTS: The FMA and UDS can be administered to any patient with a mobility impairment in need of a WMS device. INTERVENTIONS: WMS interventions include manual wheelchairs, power wheelchairs, scooters, seating, and other accessories. MAIN OUTCOME MEASURES: The FMA is a validated 10-item patient-centered outcome measure that investigates satisfaction in performing common mobility-related activities of daily living. The UDS includes variables related to age, diagnosis, and type of device used, as well as health, participation, and environmental factors. RESULTS: Currently there are over 1500 complete FMA and UDS cases at baseline and more than 600 follow-up datasets from 45 providers nationwide. Feedback indicates use of the FMA and UDS does not add burden to the clinical routine. CONCLUSIONS: A registry in the field of WMS has been developed and shown to be feasible in a clinical setting. This has created an opportunity to collect large datasets to increase sample sizes for future analyses to more scientifically evaluate what types of WMS devices work best for what types of patients under varying circumstances to promote health and participation.

Telerehabilitation for New Wheelchair Evaluations: A Retrospective Study of Patient Characteristics.

The purpose of this paper was to describe the clinical and personal factors of persons with disabilities (PwD) seeking a new wheelchair evaluation via telerehabilitation compared to in-person appointments. This retrospective cohort analysis used the Functional Mobility Assessment and Uniform Dataset, which is a nationwide registry with ongoing enrollment at 31 clinical sites of PwD seeking a new wheelchair evaluation. PwD were stratified into either a Telerehabilitation Group or In-Person Group. There were 1,669 PwD in the Telerehabilitation Group and 10,284 in the In-Person Group. The Telerehabilitation Group had a higher mean age and higher percentage of Progressively Acquired Disabilities than the In-Person Group. This project lays the groundwork for future comparative effectiveness studies, which may influence telerehabilitation reimbursement policies for wheelchair services.

Estimating power wheelchair battery lifespan based on real-world data.

PURPOSE: The purpose of this study was to: (1) estimate battery lifespan in power wheelchairs (PWCs) as measured by the length of time until battery replacement occurs and (2) identify factors associated with variability in battery lifespan after device distribution. MATERIALS AND METHODS: PWCs distributed between 1 January 2016 and 31 December 2018 were retrieved from the Wheelchair Repair Registry (WRR) and included into this retrospective cohort study. Factors associated with battery lifespan were examined with the stratified Cox proportional hazard model. RESULTS: A data set of 1268 PWCs from four different manufacturers was analysed. Five hundred and ten PWCs (40.2%) had one battery replacement with median battery lifespan of 22.3 months. The overall cumulative incidences of battery replacement were 14.5%, 56.2% and 88.2% at the end of the first, second and third year after device distribution, respectively. Among PWC manufacturers, manufacturer C (hazard ratio (HR), 2.63; 95% confidence interval (CI), 1.35-5.12; p = 0.004) and manufacturer D (HR, 3.02; 95% CI, 1.51-6.01; p = 0.002) were associated with shorter battery lifespan. PWCs operated in warmer states (65-75 °F annual temperature averages) were associated with longer battery lifespan. CONCLUSIONS: Results showed that the median battery lifespan was 22 months. PWC manufacturer and operating climate temperature were associated with variability in battery lifespan. This research has implications to better inform users, providers, manufacturers and payers to be more aware of battery lifespan across PWC types and manufactures to anticipate replacement timelines and avoid adverse situations associated with battery failures. Implications for rehabilitationThere are differences in battery lifespan across different power wheelchair (PWC) manufactures.Power wheelchair batteries last longer in warmer operating climates.Future attention needs to be sought towards the types of batteries manufacturers are using for PWC group classifications.These types of studies could be useful to justify reasonable timelines and the costs associated with battery replacements.

Investigation of factors from assistive technology professionals that impact timeliness of wheelchair service delivery: a cross-sectional study.

PURPOSE: The purpose of this study was to examine factors associated with variability in time from assessment to device delivery (cycle time). Our hypothesis was that device type and type of insurance would be the strongest predictor of cycle time. MATERIALS AND METHODS: Data were extracted from the Functional Mobility Assessment/Uniform Dataset (FMA/UDS) Registry that at the time of analysis contained a sample of 2588 people with disabilities (PWD) who were provided with a wheeled mobility device (WMD) between 21 March 2016 and 29 June 2021. To examine the effect of individual factors on the variability in cycle time, a robust linear regression analysis was conducted. RESULTS: The average national cycle time was 101.5 (SD = 59.9) d. Geographic area (Capital Metro [p < .001], Great Lakes [p = .016], and Northeast area [p < .001]), higher years since onset of disability (p < .001) and customizable devices (p = .021) were associated with higher cycle time. Non-customizable devices (p = .005), scooters (p < .001), Group 2 power wheelchairs (PWCs; p < .001), and funding source (Medicaid managed care (p < .001) and "other" (p = .028)) were associated with lower cycle time. CONCLUSIONS: Longer cycle time is likely related to variations in clinical practice, insurance coverage criteria and the level of customizability of the device needed for a particular diagnosis, especially long-term disabilities.Implications for rehabilitationThe national average number of days between initial evaluation and device delivery (cycle time) to deliver a wheeled mobility device (WMD) varies based on specific variables such as type of WMD, diagnosis and payer source.Geographic area, years since onset of disability, device type, primary diagnosis and funding source significantly impact cycle times.Increased complexity of the WMD, both manual and power wheelchairs (PWCs), was associated with longer cycle times.As more service delivery models emerge, specific benefits and challenges need to be reported on how they impact cycle time.

A descriptive analysis of wheelchair repair registry data.

Wheeled mobility and seating (WMS) devices allow users to achieve greater mobility independence. Previous studies determined that 53% of wheelchair users required one or more repairs over a 6-month period; however, there are a limited number of studies that have evaluated types of repairs. The purpose of this study was to describe the types of manual wheelchair, power wheelchair, and scooter repairs within the Wheelchair Repair Registry (WRR) and examine the association between WMS devices and the frequency of repairs. A dataset of 4,645 devices distributed in the United States was collected from equipment suppliers who performed and logged community-based wheelchair repair services. The results demonstrated common repairs found across devices were within the wheels/tires/forks and batteries/cables categories. Device type was the most significant predictor of variance in the number of repairs. Customizable manual wheelchairs, tilt-in-space, Groups 2 & 3 power wheelchairs, and scooters were associated with higher number of repairs compared to non-customizable manual wheelchairs, pediatric, heavy-duty manual wheelchairs, and Group 4 power wheelchairs. The higher failure rate found in specific devices may be associated with a population of more active users, environment/conditions where equipment is used, time spent in equipment, additional features on device, or lower durability.

Functional mobility, employment and safety benefits of seat elevating devices.

STATUS OF RESEARCH PROCESS: Study completed. INVOLVEMENT OF ASSISTIVE TECHNOLOGY USERS: Participants were power wheelchair users.

A cross-sectional descriptive analysis of complex rehabilitation technology (CRT) supplier opinions on the current state of wheelchair repair services.

PURPOSE: It is documented that wheelchair failures occur frequently, repair times are lengthy, and users often experience adverse consequences. This study aims to gather evidence on efficiency of current wheelchair repair processes from the perspective of complex rehabilitation technology (CRT) suppliers who perform repairs within the United States. MATERIALS AND METHODS: A 20 statement survey was developed to identify barriers and facilitators related to wheelchair repairs across the domains of administrative and operational factors as well as to identify future opportunities for improvement. Key statements in these areas included time to perform a repair, documentation requirements, tracking repair progress, reimbursement, technician competency, emerging strategies and preventative maintenance. The online survey was broadly disseminated to a nationwide network of CRT suppliers for data collection. RESULTS: A total of 127 responses were received. Results showed that administrative statements received the lowest scores while those statements dealing with future opportunities received the highest scores. Areas of the industry that suppliers were in most disagreement with included wait time for insurance approval, reimbursement for parts, reimbursement for technician travel time and lack of coverage for preventative maintenance. Telehealth system usage, preventative maintenance coverage, tracking repairs and repair scheduling were future opportunities that suppliers were in most agreement with. CONCLUSIONS: Administrative issues exist in the CRT industry due to restrictive insurance policies associated with repairs and maintenance. Future opportunities to improve the process exist including payment models and the application of telehealth, device monitoring and service-based performance incentives to reduce adverse consequences to the user. Implications for rehabilitationHighlights the direct importance and barriers faced within the wheelchair repair industry by CRT suppliers.In a sample of CRT suppliers, there is agreement there exists many administrative and operational issues related to wheelchair repairs.There is agreement among survey respondents of opportunities to investigate further telehealth and remote strategies, preventative maintenance coverage and online tracking for wheelchair repairs.

Common reasons for non-participation during the outcome measurement process: wheeled mobility service delivery quality improvement reporting.

OBJECTIVE: The purpose of this paper is to describe non-participation during the outcome measurement step of the wheeled mobility service delivery process (WMSDP) based on the Functional Mobility Assessment (FMA)-Uniform Dataset (UDS) Registry. INTRODUCTION: The WMSDP is a standard framework for the provision of wheeled mobility devices, and several factors influence the client's experience throughout the process. Patient-reported outcomes are one way to measure the client's experience as part of a quality improvement program. METHODS: A retrospective descriptive study was conducted on the FMA-UDS Registry to measure the response rate during the outcome measurement step of the WMSDP and describe the reasons an individual did not complete the FMA-UDS. The FMA-UDS was examined at two time points: pre-delivery and post-delivery of the wheeled mobility device. RESULTS: As of September 2, 2021, 10,253 cases have been entered into the FMA-UDS Registry. 2,247 cases were no longer participating pre-delivery, and an additional 3,905 cases were no longer participating post-delivery. The most common reasons for non-participation in the FMA-UDS pre-delivery and post-delivery included: equipment not delivered; provider no longer participating in the FMA-UDS; funding issues; no new equipment; client opted out; loss in contact; deceased; returned equipment; and other. DISCUSSION: The type and frequency of non-participation in the outcome measurement step of the WMSDP is critical to understanding why individuals participate in outcome measures and provides insight into the barriers and facilitators for the implementation of quality improvement programs.

The outcome measurement system provides a structured mechanism for consistent communication between the client and the professionals providing the service, thereby identifying issues earlier in the process and mitigating frustration throughout the wheeled mobility service delivery process.The role of a credentialed professional, specifically an Assistive Technology Professional, in the wheeled mobility service delivery process could emphasize the importance of the follow-up and outcome measurement steps, which may increase the consumers' participation rate and demonstrate the effectiveness of devices and services.Clients who no longer participate in the outcome measurement process do not have the sustained support of the interprofessional team, and possess an increased chance that they will not get their mobility needs met through the health care system.

Development of a Home-Based Telerehabilitation Service Delivery Protocol for Wheelchair Seating and Mobility Within the Veterans Health Administration.

INTRODUCTION: The provision of seating and wheeled mobility devices is a complex process that requires trained professionals and multiple appointments throughout the service delivery process. However, this can be inconvenient and burdensome for individuals with mobility limitations or for individuals who live in rural areas. Rural areas often present unique difficulties regarding the provision of healthcare services including lengthy travel times to medical facilities and lack of specialized providers and medical technology. The purpose of this article is to provide a comprehensive overview of the development and implementation of a service delivery protocol for a home-based telerehabilitation assessment for wheelchair seating and mobility. MATERIALS AND METHODS: The telerehabilitation team consists of a trained wheelchair seating and mobility therapist and a telehealth clinical technician (TCT). In order to determine veterans that are appropriate for a home-based telerehabilitation assessment, a three-phase pre-assessment screening process was conducted by the therapist and TCT, including consult, chart, and phone review. Veterans that met all of the predetermined eligibility criteria were recommended for a telerehabilitation wheelchair assessment. The TCT traveled to the veteran's residence with necessary evaluation and safety equipment and connected with the therapist remotely using the VA Video Connect platform. Assessment and veteran data were collected during the initial evaluation and then during a 21-day follow-up. RESULTS: Forty-three veterans were successfully seen via telerehabilitation for a seating and wheeled mobility assessment between November, 2017 and July, 2018. The average travel distance between the veteran's residence and the clinic was 34.1 miles. The total telerehabilitation encounter times ranged from 45 min to 145 min. CONCLUSIONS: The implementation of this service delivery protocol for wheelchair seating and mobility assessments demonstrated the benefits of using telehealth services including reaching rural veterans, reducing distance traveled, maximizing efficiency of provider schedules, and conducting realistic assessments in veterans' home environments. Success can be attributed to being able to deliver best practice remotely and to the rapport of the TCT with the providers. Cultivating provider buy-in, selecting appropriate outcome measures, and restructuring workflows were additional lessons learned. The VA Video Connect platform is an accessible tool that can be easily learned by both veterans and providers and used beyond initial wheelchair seating evaluations for improved access to follow-up healthcare services.

Service delivery for complex rehabilitation technology: a scoping review.

PURPOSE: Complex rehabilitation technologies (CRT) support independence for individuals with disabilities by enabling mobility for function, employment, education, and independent living. CRT service delivery is evolving, with changes to funding, provider qualifications, consumer needs, and technological advances. This scoping review investigated service delivery processes for individuals with disabilities who have a mobility impairment, while specifically identifying best practices, barriers, and unique features of health delivery policies and practices. METHODS: We used a framework described by Colquhoun et. al. for conducting scoping reviews, a six-step process that includes: 1) identifying the research question, 2) identifying studies, 3) selecting studies 4) data charting, 5) reporting results and 6) consultation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was also used for reporting results of the review. RESULTS: Common categories were identified and organised into a hierarchical structure of four categories and 16 sub-categories. The primary categories included "policy", "consumer", "service delivery", and "wheeled mobility devices". The sub-categories described funding sources, consumer and professional populations, service delivery guidelines, and types of mobility devices. Analysis indicated the data were from 21 countries and 14 combinations of funding sources, and the articles were primarily descriptive studies. CONCLUSION: This scoping review identified evidence from various countries, health systems, and stakeholder. Currently, this process does not proactively address the needs of individuals with mobility disabilities. The scoping review provides the foundation for the development of a novel policy on the provision of CRT services and devices to address these needs.Implications for RehabilitationExamination of national and international service delivery practices in diverse clinical and funding environments indicate various challenges and opportunities for improvement.CRT consumers are negatively impacted by current service delivery practices, including long wait times, lack of specialised clinical expertise, and limited consumer education opportunities.More consistent and widespread research is needed within the CRT provision industry to grow evidence-based practice related to complex rehabilitation technology and individuals with disabilities.

Face validity of standardized assessments for wheeled mobility & seating evaluations.

A problem in the Complex Rehabilitation Technology industry is the lack of standardization in the assessment for wheeled mobility and seating (WMS). The aim of this paper was to identify assessment tools commonly used by clinicians during WMS evaluations. After the tools were identified by a panel of 12 subject matter experts, a presentation at the 2018 International Seating Symposium in Vancouver, Canada and the 2018 European Seating Symposium in Dublin, Ireland polled attendees via the Sli.do polling application to determine professional opinions of each tool, resulting in face validity for use in wheelchair evaluations. The Lawshe Content Validity Ratio was used to convert this anecdotal data into numerical data, indicating which tools were most and least used by attendees. Finally, a literature search was conducted to determine the reliability, validity, and International Classification of Functioning, Disability, & Health domain for each measure. The findings indicate that while there are many standardized and reliable assessment tools available for wheeled mobility and seating evaluations, most clinicians use only a few standardized assessment tools during WMS evaluations.

Development and content validation of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) outcome tool.

This study describes the development and content validation of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA), a self-report outcome measure for assessing satisfaction with completing instrumental Activities of Daily Living (IADL) for People With Disabilities (PWD) using internet-Connected Assistive Devices (iCAD). For this study, an iCAD is defined as any information communication technology/electronic device or software that assists with promoting, maintaining, and/or enhancing the ability of a PWD to live independently in society. Phase 1 of development involved generating an initial item pool based on a literature review. Content validity of the EISA was computed in Phase 2 using the Qualtrics on-line research platform. Utilizing the content validity index procedure, EISA demonstrated acceptable content validity: item level (I-CVI of 0.78 or higher) and scale level (S-CVI/Ave of 0.90 or higher). EISA version 1.0 was generated in Phase 3 where it is the first of its kind outcome measure specifically designed for assessing satisfaction with completing IADL for PWD using iCAD.

Exploratory Review: Self-Report IADL Assessments in the age of Internet-Connected Assistive Devices.

Internet-Connected Assistive Devices (iCAD), like accessible smartphones, tablets, computers, and apps, have become an integral part of everyday functioning for people with disabilities (PWD). The objective of this article was to identify self-report assessments having the relevance and clinical applicability for assessing satisfaction with performing Instrumental Activities of Daily Living (IADL) for PWD using iCAD. An exploratory review was conducted to identify self-report assessments that were appropriate, practical, clinically fit, and psychometrically acceptable, for assessing satisfaction with performing IADLs for PWD using iCAD. Thirty-two IADL assessments were identified, of which six met inclusion criteria. Four of six assessments did not specifically address iCAD usage, while two assessments had limited relevance and clinical applicability, for assessing satisfaction with performing IADLs for PWD using iCAD. This review establishes the growing need for a self-report IADL assessment that has been specifically designed and validated for assessing satisfaction with performing IADLs for PWD using iCAD.

An exploratory study analyzing demographics and opinions of assistive technology professionals within the complex rehab technology industry.

This exploratory study investigated the demographics of Assistive Technology Professionals (ATPs) regarding their age, education, certifications, ethnicity, gender, veteran status, disability status, method of financial compensation, company type, and category. In addition, it analyzed opinions on the Complex Rehab Technology (CRT) industry regarding education level and licensure. An 18-question survey developed and disseminated by the University of Pittsburgh in collaboration with the National Coalition for Assistive & Rehab Technology (NCART) resulted in 252 responses from current ATPs in the Supplier/Manufacturing industry. The average age of respondents of 51.9 years showed to be above the national average workforce age of 42.2 years. Data were analyzed as a whole and by comparing answers for respondents below and above the average age. 92.4% of the respondents were Caucasian and 79.0% were male showing a need for diversity in the field. Forty-five percent of the younger age group had additional certifications compared to 30% of the older group. 79.8% of all respondents would recommend the ATP profession to someone looking for a career. Findings support the need to increase awareness of the ATP supplier/manufacturing profession to attract younger professionals including those from minority groups. Findings also support the need for additional training for the profession.

Demographic and Functional Characteristics of National Veterans Wheelchair Games Participants: A Cross-sectional Study.

INTRODUCTION: Although many studies report the impact of adaptive sports and recreation on quality of life for people with disabilities across several age groups, few have focused on the Veteran population. The purpose of this study was to establish a baseline of common characteristics of the Veteran population that participated in the National Veterans Wheelchair Games (NVWG) in 2017 and 2018, including their perception on how their participation is associated with function and social factors. MATERIALS AND METHODS: A cross-sectional study was implemented as part of a quality assurance collaboration between the University of Pittsburgh and the Veterans Administration National Veterans Sports Programs and Special Events. Demographic and quality-of-life data were collected through the Functional Mobility Assessment (FMA) and associated Uniform Dataset as well as the Sports Participation Outcome Research Tool and Comprehensive Uniform Survey (SPORTACUS). This report provides and discusses the descriptive analyses that were performed on the data and establishes a framework to assess the impact of sports and exercise for Veterans with disabilities. RESULTS: A sample of 426 Veterans, 87% who were male and an average population age of 56 years old, reported high FMA scores on each of 10 items (daily routine, comfort, health, operate, reach, transfer, personal care, indoor mobility, outdoor mobility, and transportation) along with SPORTACUS scores scoring above 5, based on a 1-6 scoring scale (1 being "completely disagree" and 6 being "completely agree"), on each domain indicating sports participation is associated with their ability to function and participate in the community. CONCLUSION: Based on these results, it can be concluded for this military Veteran population that participation in a large, organized adaptive sports programs such as the NVWG has a positive association with daily function, quality of life, community participation, and use of higher quality assistive technology.

Functional mobility assessment is reliable and correlated with satisfaction, independence and skills.

Mobility is essential for activities of daily living and therapists should give priority to evaluate its effects in their client's performance. We aimed to ascertain the intra- and inter-rater reliability of Functional Mobility Assessment (FMA) and to identify correlations among satisfaction, independence, and skills in 44 users of manual wheelchairs and three users of powered wheelchairs. We analyzed the test-retest and inter-rater reliability of the FMA in a sample of 47 wheelchair users using the Cronbach's Alpha. For correlations with FMA were used the Quebec User Evaluation of Satisfaction with Assistive Technology, Functional Independence Measure, and Wheelchair Skills Test Questionnaire (manual and powered forms). The test-retest reliability showed good internal consistency (α > 0.9). Associations between functional independence, wheelchair skills, and functional mobility were significant (p < .05). The Brazilian version of the FMA is reliable for use among wheelchair users, and its correlation with other measurements suggests cohesion among assessments related to mobility devices.

Telerehabilitation wheeled mobility and seating assessments compared with in person.

OBJECTIVE: To evaluate the equivalency of wheeled mobility and seating assessments delivered under 2 conditions: in person (IP) at a local clinic and via Telerehabilitation at remotely located clinics. DESIGN: The study used a prospective, multicenter controlled nonrandomized design to investigate wheeled mobility and seating assessments. SETTING: Five wheelchair clinics in Western Pennsylvania. PARTICIPANTS: Participants (N=98) in need of new wheeled mobility and seating were recruited and consented for IP assessments at the Center for Assistive Technology (n=50) and Telerehabilitation (n=48) assessments at remotely located clinics. INTERVENTIONS: The telerehabilitation condition used a custom videoconferencing system to connect a wheeled mobility and seating expert at the University of Pittsburgh's Rehabilitation Engineering Research Center on Telerehabilitation to a remote clinic. MAIN OUTCOME MEASURES: Study findings were based on the level of function the participants showed with their new wheeled mobility and seating devices as measured by using the Functioning Everyday with a Wheelchair (FEW) outcome tool. RESULTS: The results revealed no significant differences between the FEW pretest average or item scores for the 2 conditions or the FEW posttest average or item scores except for the FEW transportation item. The average FEW and FEW item scores reached the established clinically relevant pretest-posttest difference of 1.85, and the change scores were significantly different. The difference between FEW means based on posttest confidence intervals indicated that telerehabilitation was equally effective as IP rehabilitation. CONCLUSIONS: An expert practitioner located at least 125 miles away from each of the remote sites used a secured videoconferencing system to consult from a geographic distance on wheeled mobility and seating evaluations via telerehabilitation. Compared with participants receiving standard IP care, the telerehabilitation treatment condition was equally effective on all but 1 outcome.

VISYTER: versatile and integrated system for telerehabilitation.

The versatile and integrated system for telerehabilitation (VISYTER) is a software platform for developing various telerehabilitation applications. VISYTER has been designed to take into account the environments and requirements of rehabilitation services. The requirements considered in the platform design include minimal equipment beyond what is available in many rehabilitation settings, minimal maintenance, and ease of setup and operation. In addition, the platform has been designed to be able to adjust to different bandwidths, ranging from the very fast new generation of Internet to residential broadband connections. VISYTER is a secure integrated system that combines high-quality videoconferencing with access to electronic health records and other key tools in telerehabilitation such as stimuli presentation, remote multiple camera control, remote control of the display screen, and an eye contact teleprompter. The software platform is suitable for supporting low-volume services to homes, yet scalable to support high-volume enterprise-wide telehealth services. The VISYTER system has been used to develop a number of telerehabilitation applications, including a remote wheelchair prescription, adult autistic assessments, and international physical therapy teleconsultations. An evaluation of VISYTER for delivering a remote wheelchair prescription was conducted on 48 participants. Results of the evaluation indicate a high level of satisfaction from patients with the use of VISYTER. The versatility and cost-effectiveness of the platform has the potential for a wide range of telerehabilitation applications and potentially may lower the technical and economic barriers of telemedicine adoption.