Wheelchairs as mobility restraints: predictors of wheelchair activity in nonambulatory nursing home residents.

OBJECTIVE

The purpose of this paper is to describe factors affecting wheelchair mobility in nonambulatory nursing home (NH) residents.

DESIGN

Prospective descriptive study of a convenience sample of nonambulatory NH residents.

SETTING

Seven nursing homes.

PARTICIPANTS

Sixty-five nonambulatory residents.

MEASUREMENTS

One-minute, time-sampled observations of behavior for each resident were made every 15 minutes for 8 to 11 hours across 2 days, noting wheelchair propulsion activity for the dependent variable; independent variables included measures of wheelchair level of assistance, speed, endurance, handgrip strength, and balance.

MAIN RESULTS

A stepwise Multiple Regression analysis found wheelchair speed to be the single best predictor of the percentage of time residents were behaviorally observed wheelchair propelling (Multiple r = .45, P < .02). Handgrip strength and wheelchair endurance measures were highly intercorrelated with wheelchair speed. Wheelchairs that were either dysfunctional or inappropriately fitted to the residents' size were a major barrier to wheelchair use, affecting 46% of residents using wheelchairs.

CONCLUSION

Improving wheelchair skills with targeted intervention programs, along with making chairs more "user friendly" (e.g., grip extensions on brakes, foot pedals that one can move without bending over), could result in more wheelchair propulsion with resultant improvements in the NH resident's independence, freedom of movement, and quality of life.