Differences in Participation by Diagnostic or Mobility Device Group

1
Differences in Participation by Diagnostic or
Mobility Device Group

• Stephanie J. Hayes, OTS
• April 6, 2006

2
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

3
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 ones 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).
4
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)

5
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 persons
  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 persons
  choice, satisfaction, and importance of an
  activity or site

6
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)
7
People with Mobility Impairments and Participation

• Over 6.8 million people use a mobility device
• Cane users are the largest mobility device group
• Manual wheelchairs are used by nine times more
  people than power wheelchairs
• People 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)
8
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 persons diagnosis did not
  influence quality of participation

(Davinroy, J. L., Hollingsworth, H. H., Gray,
D. B., 2004)
9
Community Participation and Perceived
Receptivity Survey (CPPRS)

• Measures participation through performance in the
  persons current community environment
• Focus on the specific places in the community
  where the person participates
• Self-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)

10
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

11
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?

12
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?

13
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.

14
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

15
Methods Inclusion Criteria

• Mobility limited and use a mobility device cane,
  crutches, walker, manual wheelchair, powered
  wheelchair, or scooter
• One 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 independently
• Currently living in the community
• Post-rehabilitation at least one year

16
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 - 14,999 52 (28.7) 15,000 - 34,999 24 (13.3) 35,000 - 54,999 14 (7.7) 55,000 - 74,000 14 (7.7) over 75,000
17
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)
18
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
19
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
20
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
21
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
22
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
23
Results Are there differences in monthly
frequency of participation by diagnostic group?




significant difference in means to .05 level
24
Results Are there differences in yearly
frequency of participation by diagnostic group

25
Results Are there differences in monthly
frequency of participation by device group?





significant difference in means to .05 level
26
Results Are there differences in yearly
frequency of participation by device group?
27
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
28
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

29
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

30
Acknowledgements

• David Gray, PhD- A Wonderful Mentor
• Holly Hollingsworth, PhD- King of SPSS
• Kerri Morgan, MS OTR/ L- Queen of Assistive
  Technology
• Denise Curl- Master of Data
• The GrayLab Staff
• GrayLab MSOT and OTD Students
• My Parents
• James
• My Friends
• THANK YOU!!
• GO GRAYLAB!!