differences in participation by diagnostic or mobility device group stephanie j. hayes, ots april 6,...
TRANSCRIPT
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?
* significant difference in means to .05 level
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
Z S
core
of M
on
thly
Fre
qu
ency SCI MS CP Polio Stroke*
**
*
Results: Are there differences in yearly frequency of participation by diagnostic group
*-0.6
-0.4
-0.2
0
0.2
0.4
0.6
Physic
ian's
Office
s
Barber
shops
Airports
Vacat
ions
Public P
arks
Sports A
rena
s
Movi
e Th
eatre
s
Shopping M
alls
Durable
Med
ical
Equip
men
t
Z S
co
re o
f Y
ea
rly
Fre
qu
en
cy
SCI MS CP Polio Stroke
Results: Are there differences in monthly frequency of participation by device group?
-0.6
-0.4
-0.2
0.0
0.2
0.4
0.6
Power WC Manual WC Scooters CCW
Z S
co
re o
f M
on
thly
Fre
qu
en
cy
*
*
*
**
* significant difference in means to .05 level
Results: Are there differences in yearly frequency of participation by device group?
-0.6
-0.4
-0.2
0.0
0.2
0.4
0.6Power WC Manual WC Scooters CCW
Z S
co
re o
f Y
ea
rly
Fre
qu
en
cy
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!!