Date Presented 04/03/2025
This study examines the relationships among professional wheelchair provision, patient falls, and mobility-related quality of life. The long-term goal is to generate large data evidence to reform reimbursement policy and improve patient outcomes.
Primary Author and Speaker: Corey Morrow
Contributing Authors: Mark Schmeler, Richard Schein, Michelle L. Woodbury, Jake Gliniak, Matt Mesoros, Gede Pramana
PURPOSE: The provision of complex rehabilitation technology (CRT), including customized manual and power wheelchairs, is a resource-intensive process with restrictive reimbursement policies. The purpose of this study was to examine the relationship between CRT provision, falls, and mobility-related quality of life to provide evidence for reimbursement and policy change.
DESIGN: This study was a retrospective cohort analysis of patients seeking a new wheelchair evaluation. Adult participants were extracted from the Functional Mobility Assessment Uniform Dataset which includes ongoing contributions from 31 nationwide seating and mobility clinics with a variety of diagnoses and device needs. Additionally, mobility-related quality of life was assessed using the validated Functional Mobility Assessment (FMA) which is made up of 10 categories: Daily Routine, Comfort, Health, Operation, Reach, Transfer, Personal Care, Indoor Mobility, Outdoor Mobility, and Transportation. Patient-reported falls and FMA scores were recorded at baseline and approximately one year post new wheelchair delivery.
METHODS: A binary fall/no variable at baseline was compared to falls at 1 year post new wheelchair delivery via chi-squares. Logistic regression modeling was used to determine the odds ratios and relative risk of falls from baseline to post while controlling for age and diagnosis. FMA scores were compared using t-tests with an alpha of .01.
RESULTS: Early results of the 1,568 participants indicate a 15.6% reduction in falls. This reduction is statistically significant even when controlling for age and diagnosis. Total FMA scores increased from a low satisfaction mean of 29.4 (SD 15.6) to a high satisfaction mean of 53.6 (8.0).
CONCLUSIONS: Professional wheelchair provision is associated with reduced falls and increased mobility-related quality of life while controlling for diagnosis and age. The results of this study could influence CRT reimbursement policy.
References
Schmeler MR, Schein RM, Saptono A, Schiappa VJ. Development and Implementation of a Wheelchair Outcomes Registry. Arch Phys Med Rehabil. Sep 2019;100(9):1779–1781. https://doi.org/10.1016/j.apmr.2019.03.007
Betz M, DiGiovine CP, Galbreath P, et al. Service delivery for complex rehabilitation technology: a scoping review. Disability and Rehabilitation: Assistive Technology. 2022:1–19. https://doi.org/10.1080/17483107.2022.2111609
Faieta J, Schmeler MR, Schiappa VJ, et al. Evaluation of Service Delivery Effectiveness Through Patient-Reported Outcome Measures. Am J Phys Med Rehabil. Dec 2019;98(12):1072–1078. https://doi.org/10.1097/phm.0000000000001245
