Department of Occupational Therapy, University of Manitoba, Winnipeg, Canada.
Gerontology. 2012;58(4):378-84. doi: 10.1159/000334819. Epub 2012 Jan 4.
Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care.
To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors.
Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy.
The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6-64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (r(p) = -0.684, CI -0.143 to -0.910) was found.
Prevalence of need for seating assessment in long-term care is high overall but it varies considerably between facilities. Increasing access to occupational therapy services appears to mediate this need.
轮椅经常被开给长期护理机构中行动不便的居民。许多居民得到的轮椅都不合适，这会影响他们的功能独立性和活动能力，并导致随后出现压疮等健康问题。这个问题的严重程度以及导致不合适轮椅的因素还没有被充分了解；这样的证据将极大地促进长期护理中的有效和高效临床实践。
确定温哥华长期护理机构居民对轮椅座椅干预的需求程度，并探讨座椅干预需求与机构层面因素之间的关系。
使用一项探索居民移动性预测因素的横断面研究的二级数据进行逻辑回归分析。从温哥华卫生区域的 11 个长期护理机构中随机抽取 263 名居民（183 名女性和 80 名男性）（平均年龄 84.2 ± 8.6 岁）。使用座椅识别工具确定受试者对轮椅座椅干预的需求。计算了每个项目的频次。在每个机构中测量了六个环境变量，包括职业治疗人员配备、资金来源、与轮椅相关设备的政策以及决策理念。
不合适座椅的总体流行率为 58.6%（95%CI 52.6-64.5），个别机构的流行率范围为 30.4-81.8%。不适、定位和活动能力差以及皮肤完整性是最常见的问题。两个机构层面的变量是座椅评估需求的显著预测因素：每 100 名居民的职业治疗师比例[比值比（OR）0.11（95%CI 0.04，0.31）]和期望居民购买超出基本水平的轮椅设备[OR 2.78（1.11，6.97）]。发现机构流行率与职业治疗师比例之间存在负相关（r(p)=-0.684，CI-0.143 至-0.910）。
长期护理中对座椅评估的需求总体上很高，但各机构之间差异很大。增加获得职业治疗服务的机会似乎可以缓解这种需求。
