R1 - Remote Wheelchair Prescription

Task Leader: Mark Schmeler, Ph.D., OTR/L, ATP*

Co-Investigators: Richard Schein, MS*, Jongbae Kim, PhD*, David Brienza, PhD* Kyoung Yun Kim, PhD**, Angela Regulski, OTR/L***, Amy Fatula, COTA/L***, Colleen White, MS, OTR/L****, Amy Zakel, OTR/L****, Tammy Munro, PT****, & Kim Ferry, PTA****

* Department of Rehab. Sciences & Technology, University of Pittsburgh, Pittsburgh, PA 15261

** Department of Industrial and Manufacturing Engineering, Wayne State University, Detroit, MI 48202

*** Department of Rehab. Services, Dubois Regional Medical Center, Dubois, PA 15801

**** Department of Rehab. Services, Charles Cole Memorial Hospital, Coudersport, PA 16915

Other participants: NSF Center for e-Design, Center for Assistive Technology at UPMC, Allegheny County Agency on Aging, PA Dept. Public Welfare COMMCARE Waiver managed by Three Rivers Center for Independent Living

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Objectives of task :

The objective of this study is to determine the effectiveness and accuracy of procuring wheeled mobility and seating devices for individuals with mobility impairments through the use of Telerehabilitation (TR) consultation model.  TR uses videoconferencing, data acquisition, and sharing of technologies to establish a secure connection between individuals. The need for wheeled mobility devices is increasing as our population is aging and people are surviving trauma and disease.  The availability of practitioners with specific expertise in this area is limited especially in rural areas and travel to specialty clinics by people with disabilities is often problematic. The specific aims of the study include:

• evaluate the effectiveness of remote telerehabilitation consultation using both the Functioning Everyday with a Wheelchair (FEW) and Functioning Everyday with a Wheelchair - Capacity (FEW-C) outcome measure tools
• evaluate the effectiveness of wheeled mobility and seating assessments delivered under two conditions: Gold Standard vs. Telerehabilitation
• develop a web-based Multimedia Decision Support System (MDSS) tool to be used by service providers, remote consulting practitioners, clients, or other stakeholders to reduce the complexity of navigating the web to obtain mobility product information. This will be used to show and discuss potential mobility solutions prior to obtaining devices for clinical trial.

Project update:

April 3, 2006

On March 28, 2006, the University of Pittsburgh’s Institutional Review Board has reviewed and approved the study’s protocol, informed consent, and appendices. On March 8, 2006, the Fiscal Review of Patient Research Studies at University of Pittsburgh Medical Center (UPMC) also approved the study.

Practitioners, both Occupational and Physical Therapists, from Charles Cole Memorial Hospital (CCMH), located about 180 miles from Pittsburgh, and Dubois Regional Medical Center (DRMC) located about 130 miles from Pittsburgh, have attended and observed in-person client assessments at the Center for Assistive Technology (CAT) on different days to develop further knowledge in the area of wheeled mobility and seating devices.  There have been meetings between project leaders and management of both hospitals over the past few months. With the assistance from project leaders, DRMC and CCMH have opened wheelchair clinics modeled after the CAT.  They both have verbally agreed to participate in this RERC project signing a Memorandum of Understanding and have a scheduled meeting with their own respective IRB’s to review the study’s protocols. Figure 1 provides an example of the assessment process  for both the In-Person (IP) and TR assessments.

Figure 1: Clinical/Service Delivery Protocol:

Most recently, version 1.0 of the Multimedia Decision Support System for Remote Wheelchair Selection (MDSS-RWS) has been created.  The MDSS-RWS provides efficient access to detailed manufacturer information to assist clinicians, suppliers, and consumers as to available wheeled mobility and seating interventions (see Figure 2)

Figure 2: Framework of MDSS-RWS; web based RWS

The current wheelchair selection and evaluation process, which is based on in-person assessment, is often not available to clients in rural areas. Remote clinics will also not have an abundance of demonstration equipment; therefore potential devices need to be displayed on the web via guided tours by the expert practitioner. The main purpose of the RWS is to improve cumbersome web searching for ever-changing wheelchair products and Healthcare Common Procedure Coding System (HCPCS) codes for mobility assistive equipment.  The RWS is not to replace trial of equipment that may potentially address a consumer’s seating and mobility needs but rather assist in identifying solutions as well as to foster discussion regarding interventions. 

The main activities of the RWS include:

• wheelchair browsing capability that shows a list of all manufacturers with their products and direct links to their sites to avoid excessive navigation (see figure 3)
• advanced wheelchair sorting capability that is represented of the new HCPCS codes that will also accommodate customized queries (see figure 4)
• a web-based internet “plug and play” capability (see figure 5)

Figure 3: Wheelchair Browsing Capability

Figure 4: Advanced Wheelchair Sorting

Figure 5: “Plug and Play” Capability

The effectiveness of remote telerehabilitation consultation will be measured using both the Functioning Everyday with a Wheelchair (FEW) and Functioning Everyday with a Wheelchair - Capacity (FEW-C) outcome measure tools.  The FEW is a validated and reliable 10 item self-report outcome measurement tool. An example of one of a FEW questions is:

5.   The size, fit, postural support and functional features of my wheelchair/scooter allow me to reach and carry out tasks at different surface heights as independently, safely, and efficiently as possible:  (e.g., table, counters, floors, shelves)

The FEW-C, however is a criterion-referenced, performance-based observation tool, for use by practitioners and researchers to measure functional outcomes of wheeled mobility and seating interventions in a clinical setting. An example of one of a FEW-C item is:

Task # 5:     FEW–C : Reach and Carry Out Tasks at Different Surface Heights

Task Instructions & Therapist Task Guide
1. High ↓ Mid-Level	Please describe how you would retrieve   *    from here  [Point to item on surface above Ss shoulder height -- within Ss arm’s length] and then place it here  [Point to surface at Ss shoulder level -- directly below area where item was retrieved]  [Wait for response].  Now show me.  Ready?  [Wait for response] Item/Location/Feature(s) Used: __________________________________________________________________
2. Mid-Level Side → Side	Please describe how you would retrieve the   *    from here  [Point to item far back in drawer/on countertop -- at Ss shoulder level] and then hand it to me  [Wait for response]. Now show me.  Ready?  [Therapist holds out hand, palm up, approximately arm’s length away from Ss -- at the same height as the drawer/ countertop, but on opposite side Ss used to retrieve item] Item/Location/Feature(s) Used: ________________________________________________________________
3. Deep Mid-Level ↑ Floor	Please describe how you would retrieve the   *     [Point to item on floor] and then place it here  [Point to nearby counter/table surface at Ss shoulder level -- just beyond Ss arm length]  [Wait for response]. Now show me.  Ready?  [Wait for response] Item/Location/Feature(s) Used: _________________________________________________________________

SCORE	INDEPENDENCE DATA	SAFETY DATA	QUALITY DATA
3	No assists given for task initiation, continuation, or completion	SP = Safe practices observed	SM = Acceptable (Standards met)
2	VA = No physical assists given, but < 2 verbal assists or < 2 visual assists; or < 4 verbal and visual assists given	MR = Minor risks evident – no assistance provided	IP = Acceptable (Standards met – improvement possible)
1	VSA = < 2 physical assists given, but no total assistance; or 3 verbal assists or 3 visual assists, or > 5 verbal and visual assists given	PH = Risks to safety evident – assistance provided to prevent potential harm	PM = Marginal (Standards partially met)
0	PA = 3 physical assists given; or total assistance required for task initiation, continuation, or completion	SR = Severe risks evident – assistance provided to prevent harm	NM = Unacceptable  (Standards not met)

©Schmeler, Mills, & Holm, 2003  Adapted from the Performance Assessment of Self-Care Skills (PASS), Home, Version 3.1 (Rogers & Holm, © 1989, 1994); (Holm, 2001)