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Review article

Mobility devices to promote activity and participation: A systematic review

doi: 10.2340/16501977-0427

Open access

Abstract:

OBJECTIVE: To determine the effectiveness of mobility device interventions in terms of activity and participation for people with mobility limitations.
DESIGN: Systematic review. Search of 7 databases during the period 1996 to 2008.
METHODS: Controlled studies and non-controlled follow-up studies were included if they covered both baseline and follow-up data and focused on activity and participation. Study participants had to be aged over 18 years with mobility limitations. Mobility device interventions encompassed crutches, walking frames, rollators, manual wheelchairs and powered wheelchairs (including scooter types). Two reviewers independently selected the studies, performed the data extraction, and 4 reviewers assessed the studies’ methodological quality. Disagreements were resolved by consensus.
RESULTS: Eight studies were included: one randomized controlled trial, 4 controlled studies, and 3 follow-up studies that included before and after data. Two studies dealt with the effects of powered wheelchair interventions and the other studies with various other types of mobility device. Two studies were of high, internal and external methodological quality. Interventions were found to be clinically effective in terms of activity and participation in 6 studies. The results did not, however, give a unanimous verdict on the effectiveness of mobility devices in enhancing the activity and participation of mobility impaired people.
CONCLUSION: Interventions and outcome measurement methods varied between the studies; consequently, it was not possible to draw any general conclusions about the effectiveness of mobility device interventions. However, evidence was found that mobility devices improve users’ activity and participation and increase mobility. A lack of high-quality research hampers conclusions about effectiveness. More original, well-designed research is required.

Authors:

Anna-Liisa Salminen, Åse Brandt, Kersti Samuelsson, Outi Töytäri, Antti Malmivaara

References

  1. Table I. Contd.

    Reference

    Participants

    Intervention and control intervention

    Study design and follow-up time

    All outcomes and instruments used in the study*

    Uustal & Minkel

    2004 (29)

    n = 20, male 80%, mean age 43.7 years (age range 27–67 years)

    Dg: SCI (4 tetra, 9 para) 13, SCI with knee amputation 3, NMD 4

    Mobility limitation: Manual wheelchair, powered wheelchair or scoter main means of mobility.

    Inclusion criteria are very detailed, among other things: Persons residing in the community, currently using manual wheelchair or PWC or scooters with seat width 35.5 –50.8 cm as their primary means of mobility. Weight 113.6 kg. Able to operate a joystick, propel faster than walking speed and travel in a wheelie position for 3.05 m. Able to bend knees to fit on a regular footrest and to bend hips to sit in a wheelchair with a regular upright back. Willing to ride in the passenger seat of the van or bus when using private or public transport during the 2-week trial.

    The Independence IBOT 3000 Mobility System (4 functions: standard, 4-wheel drive, stair climbing, balance).

    Control: User’s own device.

    Cross-over design

    Follow-up: 2 weeks

    Activities: Telephone reporting of type and number of daily activities,

    Safety: Telephone reporting falls and adverse effects

    Effective use (independent functional mobility skills in a community environment, stair climbing): Community Drive Test, SSQ

    ADL: activities of daily living; Dg: diagnosis; FIM: Functional Independence Measure; NMD: neuromuscular disease; NR: not reported; PAPAW: push-rim-activated power-assist wheelchair; PWC: powered wheelchair; RCT: randomized controlled trial; SCI: spinal cord injury.

    *For abbreviations of instruments and scales used, see Table II.

  2. Table IV. Contd.

    Reference

    Intervention

    mobility device: type, frequency of use

    Activity and participation,

    Mobility and mobility without personal assistance (baseline/follow-up)*

    Quality of life and

    User satisfaction (baseline/follow-up)*

    Trefler et al.

    2004 (27)

    Individually fitted manual wheelchair system, including cushion, back component, seat belt, position components.

    Frequency of use: NR

    Social functioning (SF-36) increased: Group A 83.8/ 89.4 (dropped to 77.3 after 6 months) and Group B 65.0/77.7 (p = 0.009).

    Driving test: The speed in straight driving and straight driving with right hand turn increased in both groups (p = 0.03).

    QoL in aim and conclusion, but not in instrumentation and in results.

    Satisfaction (QUEST): Group A 3.72/4.65 and Group B 2.72/4.72

    Trudeau et al.

    2003 (28)

    The Merry Walker

    Frequency of use: NR

    Engagement increased: Experiment 63.97/control 40.45 (p = 0.009).

    Interaction increased: Experiment 220.16 min/control 69.99 min (p = 0.014).

    Sleeping decreased: Experiment 1.37 min/ control 19.59 min (p = 0.007).

    Walking increased: Experiment 268.55 min/control 11.75 min (p = 0.000).

    Uustal & Minkel

    2004 (29)

    The Independence IBOT 3000 Mobility System, including assessment and training in use.

    Frequency of use: All were full-time users.

    Daily activities increased (SSQ): 162 activities with the IBOT 3000, 115 activities when using their own device (p < 0.003).

    Community driving (SSQ): Total score improved overall (p < 0.001) and for subgroups (skilled manual wheelchair users, slow manual wheelchair users, power wheelchair users (p < 0.016 for all 3 groups).

    Need for assistance: reported in detail for each subject, but no quantitative data at group level was provided. Need for assistance was reduced for all subgroups when using the stair climbing function (p < 0.016–0.031). In the other 2 functions, the results were not uniform between groups or items, but the general tendency was reduced need for assistance when using the IBOT 3000.

    ES: effect size (mean change); NR: not reported; NS: non-significant; PAPAW: push-rim-activated power-assist wheelchair; PWC: powered wheelchair; S: significant; WC: wheelchair.

    *For abbreviations of instruments and scales used, see Table II.

  3. Brandt Å. Outcomes of rollator and powered wheelchair interventions. User satisfaction and participation [Dissertation]. Lund, Sweden: Faculty of Medicine, Division of Occupational Therapy, Lund University; 2005.
  4. Löfqvist C, Nygren C, Szésman Z, Iwarsson S. Assistive devices among very old people in five European countries. Scand J Occup Ther 2005; 12: 181–192.
  5. Sørensen HV, Lendal S, Schultz-Larsen K, Uhrskov T. Stroke rehabilitation: assistive technology devices and environmental modifications following primary rehabilitation in hospital – a therapeutic perspective. Assist Technol 2003; 15: 39–48.
  6. Dahlin-Ivanoff S, Sonn U. Changes in the use of assistive devices among 90-year-old persons. Aging Clin Exp Res 2005; 16: 85–92.
  7. De Crean AJM, Westendorp RGJ, Willems CG, Buskens ICM, Gussekloo J. Assistive devices and community-based services among 85-year-old community-dwelling elderly in the Netherlands: ownership; use, and need for intervention. Assist Technol 2006; 1: 199–203.
  8. Ekholm O, Kjøller M, Davidsen M, Hesse U, Eriksen L, Christensen AI, et al. Sundhed og sygelighed i Danmark og udviklingen siden 1987 [Sickenss in Denmark and its development since 1987]. Copenhagen: Statens Institut for Folkesundheds (SIF); 2006 (in Danish).
  9. Tiresias demographics [cited 2009 Feb 3]. Available from: http://www.tiresias.org/research/reports/hdti1.htm.
  10. Kaye H, Kang T, LaPlante M. Mobility device use in the United States. Disability Statistics Report (14). Washington, DC, US Department of Education, National Institute on Disability and Rehabilitation Research; 2000.
  11. United Nations. Standard rules on the equalisation of opportunities for persons with disabilities. New York: United Nations Department of Public Information; 1994.
  12. WHO. Disability and rehabilitation WHO action plan 2006–2011. Geneva: Disability And Rehabilitation (DAR) Team; Department of Injuries and Violence Prevention (VIP); Noncommunicable Diseases and Mental Health (NMH) Cluster, World Health Organization; 2006.
  13. NUH. Provision of assistive technology in the Nordic countries. 2nd ed. Helsinki: NUH – Nordic Centre for Rehabilitation Technology; 2007.
  14. Svensson M, Ödegaard K, Persson U. Hjälpmedel och läkesnära produkter – en kartläggning av marknaden [Assistive technology market survey]. IHE e-rapport 2007: 1. Institutet för hälso- och sjukvårdsekonomi [cited 2008 Jan 27]. Available from: http://www.ihe.se/publiceringar/IHE_e-rapport_2007.pdf (in Swedish).
  15. Reid D, Laliberte-Rudman D, Hebert D. Impact of wheeled seated mobility devices on adult users’ and their caregivers’ occupational performance: a critical literature review. Can J Occup Ther 2002; 69: 261–280.
  16. Field D. Powered mobility: a literature review illustrating the importance of a multifaceted approach. Assis Technol 1999; 11: 20–33
  17. Simpson RC. Smart Wheelchairs: a literature review. J Rehabil Res Dev 2005; 42: 423–438.
  18. Auger C, Demers L, Gelinas I, Jutai J, Fuhrer M. Powered mobility for middle-aged and older adults: systematic review of outcomes and appraisal of published evidence. Am J Phys Med Rehabil 2008; 87: 666–680.
  19. WHO. International Classification of Functioning, Disability and Health: ICF. Geneva: WHO; 2001.
  20. Dahl TH. International Classification of Functioning, Disability and Health: an introduction and discussion of its potential impact on rehabilitation services and research. J Rehabil Med 2002; 34: 201–204.
  21. Khan KS, Kuntz R, Kleinen J, Antes G. Systematic reviews to support evidence-based medicine. How to review and apply findings of healthcare research. London: Royal Society of Medicine Press Ltd; 2003.
  22. Pettersson, I, Törnquist K, Ahlstöm G. The effect of an outdoor wheelchair on activity and participation in users with a stroke. Study III. Disabil Rehabil: Assist Technol 2006; 1: 235–243.
  23. Pettersson I, Ahlstöm G, Törnquist K. The value of an outdoor powered wheelchair with regard to the quality of life of persons with a stroke: a follow-up study. Assist Technol 2007; 19: 143–153.
  24. Borghouts AJ, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain 1998; 77: 1–13.
  25. Shekelle PG, Andersson G, Bombardies C, Cherkin D, Deyo R, Keller R, et al. A brief introduction to the critical reading of the clinical literature. Spine 1994; 19 Suppl 18: 2028–2031.
  26. Van Tulder M, Malmivaara A, Hayden J, Koes B. Statistical significance versus clinical importance: trials on exercise therapy for chronic low back pain as example. Spine 2007; 32: 1785–1790.
  27. Hoenig H, Pieper C, Bransch L, Cohen H. Effect of motorized scooters on physical performance and mobility: a randomized clinical trial. Arc Pys Med Rehabil 2007; 88: 279–286.
  28. Ding D, Souza A, Cooper R, Fitzgerald S, Cooper R, Kelleher A, et al. A preliminary study on the impact of push-rim-activated power-assist wheelchairs among individuals with tetraplegia. Am J Phys Med Rehabil 2008; 87; 821–829.
  29. Trefler E, Fitzgerald SG, Hobson DA, Bursick T, Joseph R. Outcomes of wheelchair systems intervention with residents of long-term care facilities. Assist Technol 2004; 16: 18–27.
  30. Trudeau SA, Biddle S, Volicer L. Enhanced ambulation and quality of life in advanced Alzheimer’s disease. J Am Ger Soc 2003; 51: 429–431.
  31. Uustal H, Minkel JL. Study of the Independence IBOT 3000 Mobility System: an innovative power mobility device, during use in community environments. Arch Phys Med Rehabil 2004; 85: 2002–2010.
  32. Hellbom G, Persson J. Cost-effectiveness of walkers and wheelchairs. In: Craddock G, McCormack LP, Reilly RB, Knops H, editors. Assistive technology – shaping the future. AAATE 03. Amsterdam: IOS Press; 2003, p. 931–935.
  33. Persson J, Hellbon G, Husberg M, Fries A. Kostnader och effekter vid förskrivning av rollatorer [Effectiveness and cost-effectiveness of walkers]. CMT Rapport 2007: 3 (in Swedish).
  34. Scherer MJ, Sax C, Vanbiervliet A, Cushman LA, Scherer JV. Predictors of assistive technology use: the importance of personal and psychosocial factors. Disabil Rehabil 2005; 27: 1321–1331.
  35. Tse S, Blackwood K, Penman M. From rhetoric to reality: use of randomised controlled trials in evidence-based occupational therapy. Austral Occup Ther J 2000; 47: 181–185.
  36. Sudsawad P. Definition, evolution, and implementation of evidence-based practice in occupational therapy. In: Kielhofner G, editor. Research in occupational therapy: methods of inquiry for enhancing practice. Philadelphia MA: FA Davies Co.; 2006.
  37. Rust KL, Smith RO. Assistive technology in the measurement of rehabilitation and health outcomes. Am J Phys Med Rehabil 2005; 84: 780–793.
  38. Kramer P, Hinojosa J, Royeen CR. Perspectives in human occupation: participation in life. Philadelphia: Lippincott Williams & Wilkins; 2003.
  39. The QUOROM statement checklist. [cited 2008 March 9]. Available from: URL: http://www.consort-statement.org/mod_product/uploads/QUOROM%20checklist%20and%20flow% 20diagram%201999.pdf.
  40. van den Ende CHM, Steultjens EM, Bouter LM, Dekker J. Clinical heterogeneity was a common problem in Cochrane reviews of physiotherapy and occupational therapy. J Clini Epidemiol 2006; 59: 914–919.
  41. Anttila H, Malmivaara A, Kunz R, Autti-Rämö I, Mäkelä M. Quality of reporting of randomized, controlled trials in cerebral palsy. Pediatrics 2006; 117: 2222–2230.
  42. Edyburn DL, Smith RO. Creating an assistive technology measurement system: Validating the components. Assistive Technol Outcomes Benefits 2004; 1: 6–15.
  43. Demers L, Weiss-Lambrou R, Ska B. The Quebec User Evaluation of Satisfaction with Assistive Technology QUEST version 2.0. An Outcome Measure for Assistive Technology Devices. Webster, New York: The Institute for Matching Person & Technology; 2000.
  44. Harris F. Conceptual issues in the measurement of participation among wheeled mobility device users. Disabil Rehabil: Assist Technol 2007; 2: 137–148.

    Appendix I. Search strategy. Database: Ovid MEDLINE(R) < 1996 to November Week 3 2006 >

    1 exp mobility limitation/ (122)

    2 exp locomotion/or motor activity/or running/or walking/ (80484)

    3 dependent ambulation/ (4)

    4 Patient Satisfaction/ (31800)

    5 (independence or participation).tw. (67706)

    6 (mobility or locomotion or ambulation).tw. (72677)

    7 1 or 2 or 3 or 4 or 5 or 6 (240540)

    8 self-help devices/ or exp wheelchairs/ (4438)

    9 exp canes/ or exp crutches/ or exp walkers/ (855)

    10 (wheelchair$ or rollator$ or cane? or crutch$ or walking stick? or walking frame?).tw. (4965)

    11 ((mobility or locomot$ or ambulat$) adj2 aid?).tw. (269)

    12 ((mobility or locomot$ or ambulat$) adj2 device?).tw. (336)

    13 ((mobility or locomot$ or ambulat$) adj2 equipment?).tw. (34)

    14 ((mobility or locomot$ or ambulat$) adj2 product?).tw. (34)

    15 8 or 9 or 10 or 11 or 12 or 13 or 14 (8710)

    16 exp “Outcome Assessment (Health Care)”/ (331992)

    17 (outcome? or impact? or effectiveness or efficac$ or efficien$).tw. (1195841)

    18 (score? or scoring or scale? or instrument?).tw. (429115)

    19 (evaluation or assessment).mp. [mp = title, original title, abstract, name of substance word, subject heading word] (1120615)

    20 16 or 17 or 18 (1670405)

    21 7 and 15 (1890)

    22 20 and 21 (676)

    23 limit 22 to “all adult (19 plus years)” (519)

    24 exp Clinical Trials/ (201963)

    25 clinical trial.pt. (470405)

    26 controlled clinical trial.pt. (78416)

    27 randomized controlled trial.pt. (244089)

    28 (random$ or rct?).mp. [mp = title, original title, abstract, name of substance word, subject heading word] (508839)

    29 ((control$ adj5 trial$) or (control$ adj3 stud$)).mp. [mp = title, original title, abstract, name of substance word, subject heading word] (524742)

    30 24 or 25 or 26 or 27 or 28 or 29 (935894)

    31 exp consensus development conferences/ or exp consensus/ or exp consensus development conferences, nih/ (3030)

    32 (consensus development conference or NIH consensus development conference).pt. (5507)

    33 consensus.ti,ab. (57254)

    34 congresses.pt. (46997)

    35 31 or 32 or 33 or 34 (107442)

    36 exp Evidence-Based Medicine/ (23641)

    37 evidence-based.ti,ab. (18062)

    38 36 or 37 (32283)

    39 exp double-blind method/ or exp single-blind method/ (104550)

    40 ((singl$ or doubl$ or trebl$ or tripl$) adj5 (blind$ or mask$)).ti,ab. (90959)

    41 39 or 40 (126202)

    42 Research design/ (47651)

    43 technology assessment, biomedical/ (6058)

    44 (technology adj2 assessment).mp. [mp = title, original title, abstract, name of substance word, subject heading word] (6885)

    45 30 or 35 or 38 or 41 or 42 or 43 or 44 (1103690)

    46 (volunteer? or placebo$ or control or prospective).mp. [mp = title, original title, abstract, name of substance word, subject heading word] (1632697)

    47 (guideline$ or recommendat$).mp. [mp = title, original title, abstract, name of substance word, subject heading word] (193641)

    48 exp Longitudinal studies/ (580632)

    49 (followup or follow up or “over the past”).tw. (382405)

    50 multicenter study.pt. (86943)

    51 exp Cross-over studies/ (19853)

    52 exp Comparative study/ (1387095)

    53 Questionnaires/ (154750)

    54 46 or 47 or 48 or 49 or 50 or 51 or 52 or 53 (3442233)

    55 45 or 54 (3890733)

    56 22 and 55 (457)

    57 limit 56 to “all adult (19 plus years)” (362)

    58 limit 57 to “review articles” (5)

    59 57 not 58 (357)

    60 *self-help devices/ or *wheelchairs/ (3041)

    61 *canes/ or *crutches/ or *walkers/ (458)

    62 *locomotion/ or *walking/ (9634)

    63 60 or 61 or 62 (12943)

    64 59 and 63 (165)

    65 23 not 64 (354)



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Volume 41, Issue 9

DOI: 10.2340/16501977-0427

Pages: 697-706

View at PubMed