Differences in Participation by Diagnostic or Mobility Device Group

Stephanie J. Hayes, OTS

April 6, 2006

The Problem: Low Levels of Participation

More people with serious impairments are surviving as a result of improvements in health care

People with mobility impairments participate less frequently than people without mobility impairments

Unknown whether: People with different diagnostic conditions and prognoses show similar

patterns of participation Different mobility device users report comparable patterns of

participation

Study of group differences in participation may provide insight into the factors that are important to consider in developing rehabilitation interventions and community based activities

Participation Framework

International Classification of Functioning, Disability, and Health (ICF) A revolutionary framework with a new focus on

participation and environment Participation: “the involvement in life

situations, which include being autonomous… or being able to control one’s own life”

Few studies examine people with mobility impairments, in part, because measures of participation have only recently been developed(Perenboom, R. J. M., & Chorus, A. M. J. 2003).

Current Participation Measures

Craig Handicap Assessment and Reporting Technique (CHART)

(Whiteneck, G. G. Charlifue, S. W., Gerhart, K. A., Overholser, J. D., & Richardson, G. N. 1992)

Participation Survey/ Mobility (PARTS/M)(Gray, D. B., Hollingsworth, H. H., Stark, S. L., & Morgan, K. A. 2005)

Community Participation and Perceived Receptivity Survey (CPPRS)

(Gray, D. B., Hollingsworth, H. H., & Morgan, K. A. submitted)

Comparison of CHART, PARTS/M, and CPPRS

CHART defines participation in broad categories; PARTS/M uses major life activities; and CPPRS uses specific sites of participation

The PARTS/M and CPPRS look at the person’s participation in relation to the environment, while the CHART deducts points for personal assistance and inaccessibility of the environment

The PARTS/M and the CPPRS ask about the person’s choice, satisfaction, and importance of an activity or site

Participation by Diagnostic Group: Using the CHART

Two studies examined differences in participation between diagnostic groups using the CHART The multiple sclerosis group had the highest overall

participation score The stroke group had a significantly lower total

participation score than all other diagnoses The spinal cord injury group was in the middle on all

domains Participants with post-polio have greater overall

participation than participants with spinal cord injury The cerebral palsy group has a higher participation than

people with stroke

(Walker, N., Mellick, D., Brooks, C. A., Whiteneck, G. G. 2003; Kumakura, N., Takayanagi, M., Hasegawa, T., Ihara, K., Yano, H., & Kimizuka, M. 2002)

People with Mobility Impairments and Participation

Over 6.8 million people use a mobility deviceCane users are the largest mobility device groupManual wheelchairs are used by nine times more people than power wheelchairsPeople who use scooters and wheelchairs report greater activity limitations than people who use ambulatory aids (C; C; W)Transportation is reported by mobility device users to be the greatest limitation for accessing the community

(Kaye, H. S., Kang, T. & LaPlante, M. P. 2000)

Mobility Device and Quality of Participation using PARTS/M

A cross-sectional study found a relationship between type of mobility device used and quality of participation using the PARTS/M Overall, scooter users reported the highest quality

of participation, except in community activities Powered wheelchair users had the highest

participation score for community activities In addition, a person’s diagnosis did not influence

quality of participation

(Davinroy, J. L., Hollingsworth, H. H., & Gray, D. B., 2004)

Community Participation and Perceived Receptivity Survey (CPPRS)

Measures participation through performance in the person’s current community environment Focus on the specific places in the community where the person participatesSelf-report questionnaire 5 most important monthly places 5 most important yearly places

Components of Participation: personal assistance, assistive technology, temporal, evaluative quality of participation, features, and person (effects of pain / fatigue)

Current Study: Measuring Participation Using the CPPRS

Variables Examined Evaluative Quality of Participation (EQOP)

Value computed from choice of participation at a site, satisfaction at that site, and importance of going to that site

Mean monthly and yearly scores are computed from the important sites the participant chooses

Range: 1 - 5 for each site Temporal (Frequency)

Number of times the participant visits a particular site Scored: In days per month or days per year

Research Questions: Evaluative Quality of Participation

1. Do people who use mobility devices have a higher EQOP for monthly or yearly activities?

2. Is there a difference in EQOP by diagnosis?

3. Is there a difference in EQOP by device group?

Research Questions: Frequency & Correlations with EQOP

4. Are there differences in frequency of participation by device group?

5. Are there differences in frequency of participation by diagnostic group?

6. Is there a correlation between frequency of visiting sites and the EQOP for those sites?

Hypotheses

Null hypotheses No difference in EQOP will be found for

diagnostic groups No difference in EQOP will be found for device

groups No differences in diagnostic groups will be found

in the frequency of going to community sites No differences between device groups will be

found in the frequency of going to community sites.

Methods: Recruitment

Through disability organizations, support groups, newsletters, independent living centers, in-service trainings, or from previous studies

Sample compiled from two previous studies 99 participants from validity and reliability study

of the CPPRS assessment (54.7%) Participants located nationwide

82 participants through NIDRR study examining the benefits of exercise (45.3%)

Participants located locally

Methods: Inclusion Criteria

Mobility limited and use a mobility device: cane, crutches, walker, manual wheelchair, powered wheelchair, or scooterOne of 5 selected diagnoses: Spinal Cord Injury (SCI), Multiple Sclerosis (MS), Cerebral Palsy (CP), Polio, or Stroke Over 18 years of age Answer survey questions independentlyCurrently living in the communityPost-rehabilitation at least one year

Results: Demographics of Participants (n = 181)

Age 47.6 +/- 13.63

Gender 80 (44.2%): Male 101 (55.8%): Female

Ethnicity 128 (70.7%): Caucasian 41 (22.8%): African American

8 (4.4%): Hispanic/ Latino 2 (1.1%): American Indian

Education Level 1 (0.6%): Never entered school

9 (5.0%): Grades 1-11

34 (18.7%): High School Graduate/ GED

59 (32.6%): College 1-3 years

78 (43.1%): College 4 or more years

Personal Annual Income

61 (33.7%): $0 - $14,99952 (28.7%): $15,000 - $34,99924 (13.3%): $35,000 - $54,99914 (7.7%): $55,000 - $74,00014 (7.7%): over $75,000

Results: Diagnosis and Device Groups of Participants (n = 181)

Primary Diagnosis

Number

Spinal Cord Injury

75 (44.1%)

Multiple Sclerosis

27 (14.9%)

Cerebral Palsy 31 (17.1%)

Polio 31 (17.1%)

Stroke 17 (9.4%)

Primary Device Number

Cane; Crutches; Walker

40 (22.1%)

Scooter 28 (15.5%)

Manual Wheelchair

53 (29.3%)

Powered Wheelchair

60 (33.1%)

Results: Do people who use mobility devices have a higher EQOP for monthly or yearly activities?

Overall monthly EQOP is significantly higher than the overall yearly EQOP for all participants

Monthly 3.80

Yearly 3.09

t - test -7.02***

*** significant to .001 level

Results: Is there a difference in EQOP by diagnosis?

No significant differences in EQOP between diagnostic groups

SCI MS CP Polio Stroke ANOVA

Monthly 3.87 3.58 4.01 3.92 3.26 1.21

Yearly 3.20 2.75 3.31 2.93 2.98 .95

Results: Is there a difference in EQOP by diagnosis?

Significant differences between monthly and yearly EQOP existed within all groups except stroke

SCI MS CP Polio Stroke

Monthly 3.87 3.58 4.01 3.92 3.26

Yearly 3.20 2.75 3.31 2.93 2.98

t - test -4.12*** -3.23** -2.85** -5.12*** -.64

** significant to .01 level; *** significant to .001 level

Results: Is there a difference in EQOP by device group?

No significant differences in EQOP existed between device groups

Cane; Crutches; Walker

Scooter Manual Wheelchair

Powered Wheelchair

ANOVA

Monthly 4.17 3.45 3.69 3.18 1.94

Yearly 2.95 2.63 3.31 3.82 1.91

Results: Is there a difference in EQOP by device group?

However, significant differences existed in participation within a device group

Cane; Crutches; Walker

Scooter Manual Wheelchair

Powered Wheelchair

Monthly 4.17 3.45 3.69 3.18

Yearly 2.95 2.63 3.31 3.82

t - test -6.09*** -3.62*** -1.89 -3.56***

*** significant to .001 level

Results: Are there differences in monthly frequency of participation by diagnostic group?

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Results: Are there differences in yearly frequency of participation by diagnostic group

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Results: Is there a correlation between frequency of visiting sites and the EQOP for those sites?

Categories Correlation Strength of Correlation

Monthly to Yearly Frequency

.51*** Moderate

Monthly Frequency to Monthly EQOP

.25*** Weak

Yearly Frequency to Yearly EQOP

.18*** Weak

Monthly EQOP to Yearly EQOP

.46*** Moderate

*** significant to .001 level

Discussion

Participants evaluated their quality of participation for monthly sites higher than yearly sites

No difference in EQOP based on diagnostic or device group

Powered wheelchair group was the one to consider quality of participation higher for yearly sites over monthly sites

Appeared to be large variability between groups for frequency of participation; yet, only monthly sites showed significance

A high monthly participator is likely to be a high yearly participator and visa versa

Similarly, if participants has a high EQOP for monthly sites; they will probably have a high EQOP for yearly sites

Clinical Implications

Working in direct care Establish goals for therapy based on the sites the client

finds important Determine the appropriate mobility device for the client Advocate for clients at community sites

Working as a consultant Educate sites on how they can accommodate people with

mobility impairments Educate workers about what people with mobility

impairments need to participate in the community

Acknowledgements

David Gray, PhD- A Wonderful MentorHolly Hollingsworth, PhD- “King of SPSS” Kerri Morgan, MS OTR/ L- “Queen of Assistive Technology” Denise Curl- “Master of Data”The GrayLab StaffGrayLab MSOT and OTD StudentsMy ParentsJames My Friends

THANK YOU!!GO GRAYLAB!!