Original research| Volume 99, ISSUE 1, P1-8, January 2018

Mobility Device Quality Affects Participation Outcomes for People With Disabilities: A Structural Equation Modeling Analysis

Published:August 04, 2017DOI:



      To test the effect that indicators of mobility device quality have on participation outcomes in community-dwelling adults with spinal cord injury, traumatic brain injury, and stroke by using structural equation modeling.


      Survey, cross-sectional study, and model testing.


      Clinical research space at 2 academic medical centers and 1 free-standing rehabilitation hospital.


      Community-dwelling adults (N=250; mean age, 48±14.3y) with spinal cord injury, traumatic brain injury, and stroke.


      Not applicable.

      Main Outcomes Measures

      The Mobility Device Impact Scale, Patient-Reported Outcomes Measurement Information System Social Function (version 2.0) scale, including Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities, and the 2 Community Participation Indicators' enfranchisement scales. Details about device quality (reparability, reliability, ease of maintenance) and device type were also collected.


      Respondents used ambulation aids (30%), manual (34%), and power wheelchairs (30%). Indicators of device quality had a moderating effect on participation outcomes, with 3 device quality variables (repairability, ease of maintenance, device reliability) accounting for 20% of the variance in participation. Wheelchair users reported lower participation enfranchisement than did ambulation aid users.


      Mobility device quality plays an important role in participation outcomes. It is critical that people have access to mobility devices and that these devices be reliable.


      List of abbreviations:

      CFA (confirmatory factor analysis), CI (confidence interval), PROMIS (Patient-Reported Outcomes Measurement Information System), RMSEA (root mean square error of approximation), SCI (spinal cord injury), SEM (structural equation modeling), TBI (traumatic brain injury), TLI (Tucker-Lewis index)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • LaPlante M.P.
        • Kaye H.S.
        Demographics and trends in wheeled mobility equipment use and accessibility in the community.
        Assist Technol. 2010; 22: 3-17
        • Kaye H.S.
        • Kang T.
        • LaPlante M.P.
        Mobility device use in the United States. Disability Statistics Report Volume 14.
        National Institute on Disability and Rehabilitation Research, U.S. Dept of Education, Washington (DC)2000
        • Aminzadeh F.
        • Edwards N.
        Factors associated with cane use among community dwelling older adults.
        Public Health Nurs. 2000; 17: 474-483
        • Jutai J.
        • Coulson S.
        • Teasell R.
        • et al.
        Mobility assistive device utilization in a prospective study of patients with first-ever stroke.
        Arch Phys Med Rehabil. 2007; 88: 1268-1275
        • World Health Organization
        Guidelines on the provision of manual wheelchairs in less resourced settings.
        World Health Organization, Geneva2008
        • World Health Organization
        United Nations standard rules for the equalization of opportunities for persons with disabilities.
        World Health Organization, Geneva1982
        • United Nations
        Convention on the Rights of Persons with Disabilities – Articles.
        United Nations, Geneva2008
        • World Health Organization
        58th World Health Assembly: disability, including prevention, management and rehabilitation.
        World Health Organization, Geneva2005
        • Salminen A.L.
        • Brandt A.
        • Samuelsson K.
        • Toytari O.
        • Malmivaara A.
        Mobility devices to promote activity and participation: a systematic review.
        J Rehabil Med. 2009; 41: 697-706
        • Pettersson I.
        • Hagberg L.
        • Fredriksson C.
        • Hermansson L.N.
        The effect of powered scooters on activity, participation and quality of life in elderly users.
        Disabil Rehabil Assist Technol. 2016; 11: 558-563
        • Brandt A.
        • Lofqvist C.
        • Jonsdottir I.
        • et al.
        Towards an instrument targeting mobility-related participation: nordic cross-national reliability.
        J Rehabil Med. 2008; 40: 766-772
        • Sund T.
        • Iwarsson S.
        • Anttila H.
        • Brandt A.
        Effectiveness of powered mobility devices in enabling community mobility-related participation: a prospective study among people with mobility restrictions.
        PM R. 2015; 7: 859-870
        • Clarke P.J.
        The role of the built environment and assistive devices for outdoor mobility in later life.
        J Gerontol B Psychol Sci Soc Sci. 2014; 69: S8-S15
        • Toro M.L.
        • Worobey L.
        • Boninger M.L.
        • Cooper R.A.
        • Pearlman J.
        Type and frequency of reported wheelchair repairs and related adverse consequences among people with spinal cord injury.
        Arch Phys Med Rehabil. 2016; 97: 1753-1760
        • Worobey L.
        • Oyster M.
        • Nemunaitis G.
        • Cooper R.
        • Boninger M.L.
        Increases in wheelchair breakdowns, repairs, and adverse consequences for people with traumatic spinal cord injury.
        Am J Phys Med Rehabil. 2012; 91: 463-469
        • Worobey L.
        • Oyster M.
        • Pearlman J.
        • Gebrosky B.
        • Boninger M.L.
        Differences between manufacturers in reported power wheelchair repairs and adverse consequences among people with spinal cord injury.
        Arch Phys Med Rehabil. 2014; 95: 597-603
        • Wang H.
        • Liu H.Y.
        • Pearlman J.
        • et al.
        Relationship between wheelchair durability and wheelchair type and years of test.
        Disabil Rehabil Assist Technol. 2010; 5: 318-322
        • Mayer S.
        Those scamming little rascals: power wheelchair fraud and the flaw in the Medicare system.
        DePaul J Health Care Law. 2015; 17: 149
        • Reschovsky J.D.
        • Ghosh A.
        • Stewart K.A.
        • Chollet D.J.
        Durable medical equipment and home health among the largest contributors to area variations in use of Medicare services.
        Health Aff (Millwood). 2012; 31: 956-964
        • Pedersen J.P.
        • Harmon D.
        • Kirschner K.L.
        Is an appropriate wheelchair becoming out of reach?.
        PM R. 2014; 6: 643-649
        • Medicare Payment Advisory Commission
        Report to Congress: Medicare payment policy, March 2016.
        Medicare Payment Advisory Commission, Washington (DC)2016
        • Hammel J.
        • Magasi S.
        • Heinemann A.
        • Whiteneck G.
        • Bogner J.
        • Rodriguez E.
        What does participation mean? An insider perspective from people with disabilities.
        Disabil Rehabil. 2008; 30: 1445-1460
        • Heinemann A.W.
        • Magasi S.
        • Hammel J.
        • et al.
        Environmental factors item development for persons with stroke, traumatic brain injury, and spinal cord injury.
        Arch Phys Med Rehabil. 2015; 96: 589-595
        • World Health Organization
        International classification of functioning, disability and health.
        World Health Organization, Geneva2001: 1-303
        • Whiteneck G.
        • Dijkers M.P.
        Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors.
        Arch Phys Med Rehabil. 2009; 90: S22-S35
        • Badley E.M.
        Enhancing the conceptual clarity of the activity and participation components of the International Classification of Functioning, Disability, and Health.
        Soc Sci Med. 2008; 66: 2335-2345
        • Heinemann A.W.
        • Magasi S.
        • Bode R.K.
        • et al.
        Measuring enfranchisement: importance of and control over participation by people with disabilities.
        Arch Phys Med Rehabil. 2013; 94: 2157-2165
        • Heinemann A.W.
        • Lai J.S.
        • Magasi S.
        • et al.
        Measuring participation enfranchisement.
        Arch Phys Med Rehabil. 2011; 92: 564-571
        • Hammel J.
        • Magasi S.
        • Heinemann A.
        • et al.
        Environmental barriers and supports to everyday participation: a qualitative insider perspective from people with disabilities.
        Arch Phys Med Rehabil. 2015; 96: 578-588
        • DeWalt D.A.
        • Rothrock N.
        • Yount S.
        • Stone A.A.
        • PROMIS Cooperative Group
        Evaluation of item candidates: the PROMIS qualitative item review.
        Med Care. 2007; 45: S12-S21
        • Wilson M.
        Constructing measures: an item response modeling approach.
        Routledge, New York, NY2004
        • Smith Jr., E.V.
        • Smith R.M.
        Introduction to Rasch measurement: theory, models and applications.
        Jam Pr, Maple Grove, MN2004
        • Hahn E.A.
        • DeWalt D.A.
        • Bode R.K.
        • et al.
        New English and Spanish social health measures will facilitate evaluating health determinants.
        Health Psychol. 2014; 33: 490
        • Hahn E.A.
        • Kallen M.A.
        • Jensen R.E.
        • et al.
        Measuring social function in diverse cancer populations: evaluation of measurement equivalence of the Patient Reported Outcomes Measurement Information System® (PROMIS®) Ability to Participate in Social Roles and Activities Short Form.
        Psychol Test Assess Modeling. 2016; 58: 403
        • Cella D.
        • Riley W.
        • Stone A.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
        • Magasi S.
        • Hammel J.
        • Heinemann A.
        • Whiteneck G.
        • Bogner J.
        Participation: a comparative analysis of multiple rehabilitation stakeholders' perspectives.
        J Rehabil Med. 2009; 41: 936-944
        • Curran P.J.
        • West S.G.
        • Finch J.F.
        The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis.
        Psychol Methods. 1996; 1: 16
        • Kline R.
        Principles and practice of structural equation modeling.
        Guilford Press, New York2005: 59
        • Weston R.
        • Gore Jr., P.A.
        • Chan F.
        • Catalano D.
        An introduction to using structural equation models in rehabilitation psychology.
        Rehabil Psychol. 2008; 53: 340-356
        • Browne M.W.
        • Cudeck R.
        Alternative ways of assessing model fit.
        in: Bollen K.A. Long J.A. Testing structural equation models. Sage, Thousand Oaks1993: 136-162
        • Hu L.
        • Bentler P.M.
        Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives.
        Struct Equ Modeling. 1999; 6: 1-55
        • Byrne B.M.
        Testing for multigroup invariance using AMOS graphics: a road less traveled.
        Struct Equ Modeling. 2004; 11: 272-300
        What's the competitive bidding program?.
        (Available at:) (Accessed April 20, 2017)
        • Rehabiltation Engineering and Assistive Technology Society of North American (RESNA)
        RESNA policy position statement.
        RESNA, Arlington2015
        • Magasi S.
        • Wong A.
        • Gray D.B.
        • et al.
        Theoretical foundations for the measurement of environmental factors and their impact on participation among people with disabilities.
        Arch Phys Med Rehabil. 2015; 96: 569-577