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Wheelchair Breakdowns Are Associated With Pain, Pressure Injuries, Rehospitalization, and Self-Perceived Health in Full-Time Wheelchair Users With Spinal Cord Injury

  • Nathan S. Hogaboom
    Affiliations
    Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

    Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Lynn A. Worobey
    Correspondence
    Corresponding author Lynn A. Worobey, PhD, DPT, ATP, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206.
    Affiliations
    Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

    Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Bethlyn V. Houlihan
    Affiliations
    Spaulding New England Regional SCI Center, Boston, Massachusetts

    The Health and Disability Research Institute, Department of Health Policy and Management School of Public Health, Boston University, Boston, Massachusetts
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  • Allen W. Heinemann
    Affiliations
    Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, Illinois

    Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
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  • Michael L. Boninger
    Affiliations
    Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

    Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania

    Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Published:April 23, 2018DOI:https://doi.org/10.1016/j.apmr.2018.04.002

      Abstract

      Objectives

      To evaluate the relation between wheelchair breakdowns, their immediate consequences, and secondary health complications after spinal cord injury. “Immediate consequences” occur when part of a wheelchair breaks and leaves an individual stranded or injured, or causes him or her to miss medical appointments, work, or school.

      Design

      Survey, cross-sectional.

      Setting

      Spinal Cord Injury Model Systems Centers.

      Participants

      Full-time wheelchair users (N=771) with SCI from 9 Spinal Cord Injury Model Systems Centers, with data collected between 2011 and 2016.

      Interventions

      Not applicable.

      Main Outcome Measures

      Incidence of self-reported wheelchair breakdowns within the past 6 months that did or did not result in immediate consequences (ie, injury, being stranded, missing a medical appointment, or an inability to attend school/work); self-perceived health status scale; pain severity numerical rating scale; rehospitalizations; and self-reported pressure injury development within the past 12 months.

      Results

      A total of 610 participants with complete data sets were included in the analyses. When compared to those who reported no breakdowns, participants who reported 1 or more immediate consequences had worse secondary complications: higher self-perceived health status and pain scores (partial −η2=.009-.012, P<.05), and higher odds of rehospitalization (odds ratio: 1.86, P<.05) and pressure injury development (odds ratio: 1.73, P<.05). Secondary health complications were not different in those who reported no immediate consequences compared to those who reported no breakdown.

      Conclusions

      Wheelchair breakdowns that resulted in injury, being stranded, missing medical appointments, and/or an inability to attend work/school appear to have far-reaching impacts on health and secondary injury. Preventing wheelchair breakdowns, through either better maintenance or manufacturing, may be a means of decreasing secondary disability.

      Keywords

      List of abbreviations:

      CI (confidence interval), OR (odds ratio), SCI (spinal cord injury), SPHS (self-perceived health status)
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