A clinical trial of a rehabilitation expert clinician versus usual care for providing manual wheelchairs.
OBJECTIVES: To determine the effect of differing methods of dispensing wheelchairs. DESIGN: Quasi-experimental by day of week. SETTING: Department of Veterans Affairs Medical Center. PARTICIPANTS: Eighty-four community-dwelling, cognitively intact patients prescribed a standard manual wheelchair. INTERVENTION: A multifactorial intervention consisting of an expert physical/occupational therapist who used a scripted evaluation that included an evaluation based on medical record review and self-reported and physical performance measures; individualization of the wheelchair and initiation of orders for additional occupational/physical therapy, equipment, or home modifications as needed; multimodal patient education; and telephone follow-up at 3 and 6 weeks. MEASUREMENTS: The primary outcome was amount of wheelchair use. Secondary outcomes were shoulder pain, wheelchair comfort and confidence, and home modifications. RESULTS: The intervention group had significantly greater wheelchair use than usual care at 2 weeks, 3 months, and 6 months (P=.01). Wheelchair use declined monotonically over time for the entire study sample (P<.001). There were no significant differences between the two groups in shoulder pain, wheelchair comfort or confidence, or home modifications. CONCLUSION: New wheelchair owners used the wheelchair more often if they received it from an expert therapist using a multifactorial intervention.
Hoenig, H; Landerman, LR; Shipp, KM; Pieper, C; Richardson, M; Pahel, N; George, L
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