Wheeled Mobility Devices Research Articles

Use of Remote Focus Groups to Improve Inclusive Design Practice

This study examines the use of remote focus groups to obtain wheeled mobility device user’s ideas regarding Shared Autonomous Vehicles (SAVs). Given the global increase in the aging population and disabled people, inclusive design is essential for accessible transportation. Using remote focus groups, this research collected statements from nine wheeled mobility device users about their design preferences, needs, and challenges with SAVs. Participants attended four virtual sessions featured with presentations and videos of SAVs. Discussions were video recorded in Zoom, with transcripts reviewed for accuracy. Data analysis included cleaning, coding, and assessing interrater reliability using the ICC. The findings not reported here highlighted the diverse needs and preferences of participants, emphasizing the importance of collecting information from this group early in the design process. This study shows well-planned remote focus groups can be an effective tool to gather human factors system design information from user populations that face transportation barriers.

Initial validation and feasibility of a Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN) course for wheelchairs

Many Canadian manual wheelchair users face many challenges in winter months such as slippage on ice- or snow-covered ramps, snow windrows, and casters becoming stuck in deep or hard packed snow. These barriers impact wheelchair users’ ability to participate in the community. This study aimed to evaluate the validity and feasibility of a winter wheelchair obstacle course known as the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN). The results demonstrated that the SNOWMAN course authentically represented real-world winter conditions, as confirmed by participant responses and qualitative feedback from four manual wheelchair users. The course was comprehensive, covering a range of winter obstacles typically encountered by wheelchair users. Construct validity was established by differentiating performance between manual wheelchairs and a motorized platform with snow tracks, showcasing varying completion times and device satisfaction levels. Feasibility was also assessed, with the administration protocol being mostly adhered to, safety measures implemented, and usability scores meeting acceptable thresholds. The SNOWMAN course showed promise for evaluating wheelchair adaptations and devices for winter conditions, as well as training users in winter mobility skills. Future research directions include comparing different wheeled mobility devices, exploring adaptations for usability in winter, and developing new technology tailored for challenging terrains and winter conditions. The SNOWMAN course could serve as a valuable tool for both research and clinical applications in enhancing winter mobility for wheelchair users.

Wheeled mobility use outcomes: a systematic review protocol of measurement properties.

Numerous tools have been developed to measure constructs related to wheelchair use. Currently, no toolkit comprehensively details assessments of wheeled mobility device use based on the quality of their measurement properties. The current review aims to systematically identify high-quality assessment tools that measure different aspects of wheeled mobility use. The objectives are two-fold: i) to synthesize outcome measures that assess use of wheeled mobility devices, and ii) to evaluate measurement properties of the assessment tools. The populations of interest are manual wheelchair users, power wheelchair users, and scooter users of any age, diagnosis, or setting. Instruments of any type will be included. The JBI methodology for systematic reviews of measurement properties will guide this review. A search strategy will be developed to search the following databases: MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), PsycTests (EBSCOhost), Web of Science, and Google Scholar. The article selection process, data extraction, and quality appraisal will be performed by 2 independent reviewers, with a third reviewer being consulted to achieve consensus. The methodological quality of the studies will be assessed through the Consensus Standards for the Selection of Measurement Instruments (COSMIN) Risk of Bias tool and the COSMIN Checklist. The quality of the pooled evidence and individual measurement properties will be graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the COSMIN Criteria for Good Measurement Properties recommendations. Measurement properties of each instrument will be described, with the goal of developing a toolkit that identifies appropriate assessment tools for wheeled mobility use outcomes. PROSPERO CRD4202276169.

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.

Wheeled and Seated Mobility Devices Provision: Quantitative Findings and SWOT Thematic Analysis of a Global Occupational Therapist Survey.

To better understand the global role of occupational therapists and explore facilitators and barriers impacting user access to high quality, affordable wheeled and seated mobility device (WSMD) provision worldwide. Mixed-method approach utilizing quantitative findings and qualitative strengths, weaknesses, opportunities, and threats (SWOT) analysis of a global online survey. A total of 696 occupational therapists from 61 countries completed the survey. Almost 49% had 10 or more years of experience with the provision of WSMDs. WSMD provision had positive, significant associations with attainment of certification (0.000), higher service funding (0.000), higher country income (0.001), standardized training (0.003), continuous professional development (0.004), higher experience (0.004), higher user satisfaction (0.032), custom-made device provision (0.038), higher staff capacity (0.040), and more time working with users (0.050); negative, significant associations were identified with high cost of WSMDs (0.006) and pre-made device provision (0.019). SWOT analysis identified high country income, funding, experience, training, certification from global partners, variety of roles and practice settings, and interdisciplinary teamwork as strengths and opportunities for professional growth, while low country income, lack of time/staff capacity/standardization/support services, and poor access to proper devices were indicated as weaknesses and threats. Occupational therapists are skilled healthcare professionals and provide a variety of WSMD services. Efforts to build collaborative partnerships, enhance access to occupational therapists and funding options, improve service and standards for WMSD service delivery, and promote professional development will help to overcome challenges and facilitate WSMD provision globally. Promoting practices based on best available evidence for WSMD provision worldwide should be prioritized.

Investigation of Wheeled Mobility Device Orientation and Movement on Streetcars and Light Rail Vehicles during Normal and Emergency Braking

Wheeled mobility devices have been accessing public transit vehicles for decades, and most new rail transit systems are accessible. This has increased ridership by people with disabilities. Side-facing orientation on rail transit vehicles often is considered an option to increase capacity for wheeled mobility devices. This paper reports findings of a study of vehicle dynamics and wheeled mobility device orientation on rail transit vehicles. The study used acceleration data and field observations to evaluate wheeled mobility devices in longitudinal and side-facing orientations on streetcar and light rail vehicles. Results from the study include recommendations for longitudinal-oriented areas for wheeled mobility devices as well as additional public outreach on best practices for passengers who use wheeled mobility devices on rail transit vehicles.

Ingress/Egress Incidents Involving Wheelchair Users in a Fixed-Route Public Transit Environment

The objectives of this study were to characterize the ingress and egress activities of wheeled mobility device (WhMD) passengers using fixed-route large, accessible transit vehicles (LATVs), and to examine factors associated with incidents occurring on ramps. A retrospective review of public transit video surveillance footage of WhMD-seated passengers accessing fixed-route LATVs was conducted. Ingress and egress activities were characterized based on travel conditions and characteristics of the WhMD and LATV ramp. Incidents were identified based on predetermined criteria, and chi-square analysis was performed to identify WhMD and/or ingress/egress characteristics associated with incidents. Video records of 250 WhMD trips were analyzed. A total of 39 incidents occurred during ingress and 12 incidents occurred during egress. Results indicated that the frequency of incidents was significantly greater for scooter users and passengers who ascended the ramp using a rear-facing WhMD orientation. Narrow LATV ramp width was associated with the greatest number of incidents, followed by problems related to LATV door width and steep ramp slope.

Effects of Speed, Curves, and Driver Behavior on Passive Securement Systems on Large Transit Buses

Wheeled mobility devices that are not secured properly on large transit vehicles pose risks to all passengers. The purpose of this study was to increase the understanding of the effects of horizontal and vertical curves, speed, and driver behavior on the safety and security of people using wheeled mobility devices in rear-facing passive containment systems on large transit buses. Testing included the use of manual wheelchairs and lightweight scooters on an articulated low-floor transit bus. The project conclusions were derived from data produced by accelerometers placed on the bus as well as visual observations of wheeled mobility device movement. The data showed a clear difference in the amount of movement of the wheeled mobility devices and the comfort of the seated passenger when the bus traveled on a combination of horizontal and vertical curves at different driving speeds.

Transit Operator Evaluation of Three Wheelchair Securement Systems in a Large Accessible Transit Vehicle

The safety, ease of use, and independent use of three wheelchair securement systems and three different types of wheeled mobility devices (WhMD), including a manual wheelchair, a powered wheelchair, and a three-wheeled scooter, were evaluated by eight vehicle operators of a large accessible public transit vehicle (LATV). The securement systems included a forward-facing four-point tiedown system, a prototype forward-facing autodocking system, and a prototype rear-facing-wheelchair passenger (RF-WP) system. The eight LATV operators transported wheelchair-seated passengers in each wheelchair securement system, after which they completed a questionnaire.Operators responded generally positively to the autodocking and RF-WP systems because they were observed by the drivers to be quicker and easier to use and allowed more independent use by wheelchair-seated passengers compared to the four-point tiedown system. From all three securement systems, operators favored the forward-facing autodocking system, because no assistance from operators is required to use it and most users preferred the forward-facing orientation in the vehicle. The autodocking system was perceived to be safe and easy to use by wheelchair- and scooter-seated passengers. These study results promote the need for alternative and improved securement systems that can be used by wheelchair and scooter-seated passengers that travel in LATVs in forward- or rearward-facing directions. Ideally, future securement solutions should not require assistance from LATV operators for their operation and should allow wheelchair- and scooter-seated passengers to ride public transportation safely and independently.

Patient Satisfaction with Occupational Therapy Services for Wheeled Mobility and Seating Devices

Satisfaction of 81 patients was evaluated before and after receiving occupational therapy services. There was a statistically significant difference between patients’ scores before and after receiving occupational therapy services (p < .05). Over 85% indicated a high satisfaction in relation to quality and health outcomes attributed to occupational therapy services, 44% reported barriers related to limited availability, accessibility, and knowledge of occupational therapy services, and 35% made suggestions for improvements. Patient-therapist communication and easy access to occupational therapy services can enhance occupational therapy knowledge, lead to positive patient experience and quality health outcomes, and higher patient satisfaction.

The struggle for access – a qualitative document study of how people using wheeled mobility devices experience exclusion and discrimination

Purpose The overall aim of this study was to describe experiences of discrimination due to inaccessibility among people using mobility devices. Material and methods We conducted a thematic qualitative analysis of 88 complaints about wheeled mobility device use, inaccessibility, and discrimination submitted to the Swedish Equality Ombudsman (DO) during 2015 and 2016. Results The analysis resulted in three themes: instigating change by invoking laws and regulations and highlighting lack of compliance; demanding to be recognised, understood, and listened to; and struggling for equal access and social participation. Regulations and treaties were invoked as the basis for complaints by people using mobility devices regarding their lack of access to physical environments and impediments to their enjoyment of their full right to participate in and contribute to society. The complaints described feelings of discrimination, the disadvantages and exclusion due to physical inaccessibility, and experiences of being prevented from living one’s life as others do. Conclusions Complaints filed by people using mobility devices showed that they were denied access to a wide range of contexts, including offices, theatres, restaurants, schools, and public transportation, though they desired to live an active and social life outside their homes. Filing a complaint was a way to take action, highlight present inaccessibility, and express a hope for change. IMPLICATIONS FOR REHABILITATION Difficulties experienced by people using wheeled mobility devices can reveal knowledge important for revising existing design and renovation standards for housing and public buildings. Documenting facilitators and barriers in different environments is important for giving voice to the needs of wheeled mobility device users and revealing standards that need to be strongly enforced or revised. People using wheeled mobility devices should be supported in finding solutions in inaccessible environments, both to fulfil their wishes and to enable their participation in society.

Usability of a navigation application for travel in Quebec City with wheeled mobility device and, further validation of the Evaluation of satisfaction with geospatial assistive technology

Purpose Knowledge of route accessibility is indispensable for “wheeled mobility device” users to travel safely and efficiently; however, current navigation technologies hardly provide adapted information for this population. Aims of the study were to collect data on the usability of a navigation application and to propose a version 1.0 of the Evaluation of satisfaction with geospatial assistive technology (ESGAT), by addressing the criterion, construct and cross-cultural validities. Method A filmed field trial and a methodological study were conducted in parallel. Thirty wheeled mobility device users were filmed planning and making a 10-minute known journey using the HERE WeGo app. The ESGAT, ÉSTGA (French version) and the Computer System Usability Questionnaire were administered. A video observation grid addressed the effectiveness and efficiency during the journey. Descriptive, correlation and multiple match analyses were performed. Results Fourteen men and 16 women averaging 45.9 years old tried out HERE WeGo; 14 were powered wheelchair users. Usability of the app was moderate (good effectiveness, moderate efficiency and quite satisfied). The criterion validity of the ÉSTGA was good (r = 0.598; p < 0.001). The construct validity was average considering the results for factor 1 (α = 0.789, acceptable), factor 2 (α = 0,586, low) and factor 3 (α = 0.409, unacceptable). The cross-cultural validity (French vs English) was moderate (r = 0.861; p < 0.001). Conclusion ESGAT and ÉSTGA 1.0 questionnaires are now available in English and French with a total mean score (11 items), an informatics subscore (mean of 5 items) and a geomatic subscore (mean of 6 items). Their validation should be pursued with new navigation applications. IMPLICATIONS FOR REHABILITATION Clinicians should ask their clients using a wheeled mobility device to test navigation applications to ensure their safety and complete the Evaluation of satisfaction with geospatial assistive technology (ESGAT 1.0), also available in French. Clinicians should inquire about satisfaction for items addressing informatics (Ease of access, Learnability, Hands-free function, Ease of use, Transportability and Appearance) and items addressing geomatic (Content, Geographic information, Effectiveness, Efficiency, Real-time navigation assistance, Aspect of security). Rehabilitation clinicians should inquire about the efficiency of the navigation app, considering avoiding or announcing potential obstacles such as: travelling on the street for a long portion of the trip and not on the sidewalk; verbal indication too soon or too late; incorrect indication; damaged, and congested sidewalk.

A descriptive analysis of wheelchair repair registry data

ABSTRACT 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.

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 rehabilitation The 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.

National Institutes of Health Pathways to Prevention Workshop: Physical Activity and Health for Wheelchair Users

Health benefits of physical activity are well recognized in the general population for reducing the risk of chronic health conditions. Less is known about the effects of physical activity on people currently using or who may use wheeled mobility devices in the future, specifically individuals with multiple sclerosis, cerebral palsy, and spinal cord injury who are at increased likelihood for use of a wheeled mobility device. On December 1-3, 2020, the National Institutes of Health convened the Pathways to Prevention workshop: “Can Physical Activity Improve the Health of Wheelchair Users?” to consider the available scientific evidence on the clinical benefits and harms of physical activity for people currently using or who may use wheeled mobility devices in the future, with the aim of developing recommendations to fill gaps in the evidence base. A multidisciplinary team of content area experts developed the agenda and an evidence-based practice center prepared the evidence report. An independent panel, selected by the National Institutes of Health, attended the workshop; convened to develop recommendations on the basis of the systematic review, presentations, and public comments received during the workshop; and revised recommendations based on public comments received. This final report summarizes the panel's findings and identifies current gaps in knowledge. The panel made recommendations for new research efforts, including novel methods and new research infrastructure to improve the evidence base about the effects of physical activity on people currently using or who may use wheeled mobility devices in the future.

Understanding the Experiences of New Mobility Scooters: a Phenomenological Analysis

<h3>Research Objectives</h3> To explore the lived experiences of new mobility scooter users. <h3>Design</h3> Data were collected as part of a larger mixed-methods intervention study. Based on critical phenomenology1,2 each participant was interviewed multiple times before and after their scooter training. Examples of the questions included: What kind of problems do you have getting around currently (using manual wheelchair/walker/cane, if applicable)? How do you feel about using a manual wheelchair/power wheelchair/walker/cane? How do other people respond to you when you are using your scooter? <h3>Setting</h3> Metro Vancouver, British Columbia, Canada. <h3>Participants</h3> Participants were a convenience sample of 20 community dwelling, scooters users (with less than one-month experience using their devices) who were able to transfer in and out of a scooter independently. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Not applicable. <h3>Results</h3> The analysis revealed five themes. Transitioning to scooter use described how participants struggled to embrace scooters into their daily lives. Experiencing accessibility challenges revealed the challenges of navigating the outdoor and the indoor spaces in a scooter. Strategic and personalized use of devices for mobility illustrated how and why participants rely on other mobility devices. Navigating the social environment and being (un)seen demonstrated the stigma that participants experience from other people. Scooter appropriation over time revealed how participants see themselves and their use of scooters over time. <h3>Conclusions</h3> The experiences of new scooter users reflected the complexities of navigating the structural barriers and the challenges of integrating scooters into their lives3, 4, 5. The tension between the lived spaces and the scooters suggests that the design and specifications of some of these spaces do not meet the needs of modern wheeled mobility devices. <h3>Author(s) Disclosures</h3> There are no conflicts of interest for any author.

Comorbidities and medical complexities of mobility device users: a retrospective study

Objective To determine the medical complexities and comorbidities of individuals who utilise wheeled mobility devices. As well as, to examine costly events including the number of urinary tract infections (UTIs), hospitalizations, urgent care(UC)/emergency department (ED) visits that are commonly seen in this population over a period of time one year prior to and one year post receiving their wheeled mobility equipment. Design/Setting A retrospective data review of 857 individual medical charts at a Level 1 Trauma Hospital and Clinic System Participants 330 male and female (24–92 years old) mobility device users with a wide range of diagnoses, of which: 56 used manual wheelchairs (MWC),138 scooters (POV), 123 power wheelchairs without integrated standing (PWC), and 13 power wheelchairs with integrated standing (iS-PWC). Results Overall, 92% (n = 304) had at least three medical comorbidities and medical complexities. The most common comorbidity was pain (91%). A change was noted in a lower incidence of UTIs in those using an iS-PWC, respectively 23% with at least 1 UTI in the year prior to and 8% in the year after the mobility device evaluation. Conclusions The large number of comorbidities and medical complexities amongst all mobility device users is concerning. The burden and the accompanying healthcare costs of this population is high. The potential that iS-PWC and other interventions could have on reducing these issues should be explored further. Implications of rehabilitation Regardless of a person's primary diagnosis or the wheeled mobility device they use, 100% have at least one and 92% have at least three comorbidities and medical complexities if they spend the majority of their day sitting The high healthcare cost situations such as Emergency Department visits, Urgent Care visits, hospitalizations, and Urinary Tract Infections are present across those that use all mobility device types and the means to potentially reduce these incidences should be further explored The introduction of integrated standing within a power wheelchair, as a means to minimize the frequency of comorbidities and medical complications, should also be investigated further

Wheeled Mobility Use on Accessible Fixed-Route Transit: A Field Study in Environmental Docility.

Multiple field studies provide qualitative accounts of usability barriers experienced by users of wheeled mobility devices on public transit. This study aimed to examine these usability barriers from the theoretical perspective of Environmental Docility by quantifying the relationship between functional capabilities of wheeled mobility device users and ingress–egress performance on accessible fixed-route transit vehicles in an urban setting. Twenty-eight wheeled mobility users each completed three trips on a predetermined route through the local public transit system. Ingress and egress times, user-reported usability ratings and open-ended comments were analyzed. Regression analyses indicated significant interactions between age and minimum parallel-park length on ingress and egress times. Specifically, lower functional capability reflected in older age and less maneuvering ability predicted decreased performance (longer ingress–egress times), indicating less adaptability to environmental demands and agreement with the Environmental Docility Hypothesis. Usability ratings and comments revealed difficulty with negotiating access ramps and turning maneuvers in the vehicle interior and in proximity to other passengers. Despite compliance with accessibility standards, current design of transit vehicles present substantial usability barriers for wheeled mobility users. Environmental Docility provides a theoretical basis to identifying modifiable factors related to person and environment for improving usability of public transit for people aging and/or with mobility impairments.

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

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. 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 metall 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. 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. 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.

Urban Environmental Barriers and Facilities to Mobility and Participation for Older Mobility Device Users

Many people use mobility devices to get around. Unfortunately, these mobility device users frequently encounter environmental features and social practices that restrict mobility and social participation. For example, barriers in the built environment can exclude mobility devices users from certain spaces. They also report experiencing discrimination and stigma in the community. However, much of the research in this area has not examined the experiences of older mobility device users in a holistic manner. The purpose of our study was to explore the barriers and facilitators of mobility and participation among people who use wheeled mobility devices. This mixed-methods project used multiple participatory research methods including qualitative interviews, participant-led, community environmental audits, photovoice, mobility tracking using global positioning satellite data and building accessibility audits of participant nominated buildings. We used standardized tools to measure participants’ perceived, physical functioning, anxiety and depression, mobility and mobility device confidence among device users living. The study included 104 participants (64 from the Metro Vancouver and 41 from Quebec City). The primary mobility devices used included manual and power wheelchairs, mobility scooters, canes, crutches and walkers. On average, participants were 58 years of age and 53% were female. Our analysis revealed four main themes: 1) wayfinding challenges; 2) barriers and facilitators in the built environment; 3) the influence of social practices; and 4) temporal and climatic fluctuations. Our findings identified policies and changeable features in the built and social environment that restrict accessibility, which could be remedied by working collaboratively with municipalities and service providers.