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 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).

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 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

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 person’s 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 person’s 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)

17. Results: Diagnosis and Device Groups of Participants (n = 181)

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 *** significant to .001 level

19. Results: Is there a difference in EQOP by diagnosis? • No significant differences in EQOP between diagnostic groups

20. Results: Is there a difference in EQOP by diagnosis? • Significant differences between monthly and yearly EQOP existed within all groups except stroke ** 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

22. Results: Is there a difference in EQOP by device group? • However, significant differences existed in participation within a device group *** 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? *** 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!!