["If you're no longer able to get out and about …" Validity and differentiation of the concepts of being homebound, wheelchair-bound and bedridden: A Delphi study].

INTRODUCTION

Being place-bound, including the dimensions of being homebound, wheelchair-bound and bedridden, has multifactorial consequences and carries an increased risk of mortality. The prevalence of being homebound and bedridden is high. Valid concepts are necessary to recognize the dimensions of being place-bound in practice and to act preventively or reductively. In preliminary studies, literature-based concept analyses of being homebound, wheelchair-bound and bedridden were carried out and a conceptual model with the following six characteristics was developed: life-space confinement, in need of help, powerlessness, mobility limitation, endurance, weakness. The aim of this study was to test the concept by differentiating and validating the dimensions of the model with regard to characteristics, antecedents, and risk factors.

METHOD

Concept testing was carried out employing the Delphi method based on Fehring's DDV (Differential Diagnostic Validation) model. The CREDES guideline was used for reporting.

RESULTS

Apart from the characteristic of endurance in connection with being wheelchair-bound, general approval was achieved for all six characteristics. Mobility limitation and weakness are the main characteristics of differentiation. Antecedents (physiological instability, physical immobility) and risk factors (illness, complexity, stress, endogenous/exogenous booster) were also consented. Regarding the concepts of being wheelchair-bound and bedridden, there was little consensus on the antecedents of physiological instability. The antecedents of physical immobility through hand strength and hand use received no consensus in any of the dimensions. The German terms of the dimensions, originally coined in English, were confirmed: Hausgebundenheit (being homebound) 78.26%, Rollstuhlgebundenheit (being wheelchair-bound) 60%, Bettlägerigkeit (being bedridden) 80%.

DISCUSSION

With a few exceptions, a high level of consensus regarding the approval/rejection of the characteristics, antecedents, and risk factors of the dimensions of being homebound and bedridden is shown. This unambiguity is not evident in the dimension of wheelchair-boundness. One possible cause is the ambiguity of the term itself (active/passive/permanent/temporary wheelchair use). The rejection of physical immobility through hand strength/use is to be seen critically since this is essential in independent movement of the wheelchair and when turning/sitting down in bed. The fact that bedridden people, on the one hand, need a wheelchair to move and, on the other hand, cannot maintain a sitting position, must also be questioned. If an upright sitting position can be maintained, this must be promoted to support orthostatic stability, which would correspond to being wheelchair-bound.

CONCLUSION

The validity of the dimensions of the model of being place-bound is an essential contribution to evidence-based health care and provides a basis for the development of nursing and interdisciplinary interventions to prevent and reduce being place-bound. Mobility does not only have a major impact on the individual quality of life, but also on the resources of the health care system. Therefore, a valid concept is not only important for science and research, but also for health economy and health policy. However, further studies on validity testing in clinical settings including those affected are necessary.