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User Satisfaction With Mobility
User Satisfaction With Mobility
User Satisfaction With Mobility
RESEARCH PAPER
Abstract
Background. An assistive device often means an evident change in a person’s ability, more easy to notice than the effects of
most of other types of physiotherapy or occupational therapy intervention. In spite of this, there is very little evidence in this
area.
Purpose. The objective was to follow-up user satisfaction with and the use and usefulness of rollators and manual wheel-
chairs. The objective was also to determine any difference in satisfaction between users of the two different types of mobility
assistive products.
For personal use only.
Methods. A random sample of 262 users participated in the study, 175 rollator users and 87 wheelchair users. The Quebec
User Evaluation of Satisfaction with Assistive Technology—QUEST 2.0 and an additional questionnaire were used for data
collection.
Results. Overall satisfaction with both types of device was high and most clients reported use of their device on a daily basis.
There was a difference in how the users estimated the usefulness and other characteristics as well as some service aspects
related to prescription and use of the two types of device. Most users reported not having had any follow-up; however, most
users had not experienced any need for one.
Conclusions. A standardized follow-up will give rehabilitation professionals continuous and valuable information about the
effect of and satisfaction with assistive devices.
Correspondence: Kersti Samuelsson, PhD, Department of Rehabilitation Medicine, University Hospital, SE 581 85 Linköping, Sweden. Tel: þ46 13 2221560.
Fax: þ46 13 221564. E-mail: kersti.samuelsson@lio.se
ISSN 0963-8288 print/ISSN 1464-5165 online ª 2008 Informa UK Ltd.
DOI: 10.1080/09638280701355777
552 K. Samuelsson & E. Wressle
Act states that both county councils and municipa- working in that county council. Each device is
lities have the responsibility to provide people who distributed through the device centre, which means
have a need for assistive devices with suitable that each device centre has a register of all prescribed
products. The caregiver has the responsibility to assistive devices in that county council. Manual
ensure that prescribers of assistive devices have wheelchair users and rollator users 20 – 84 years of
sufficient knowledge. What kind of knowledge does age, who had received their device during a
a prescriber need, and what kind of support in the 12-month period, were identified from each register.
prescribing process is recommended, to secure a The size of each sub-group was proportional to the
good quality and evidence based supply of assistive total number of prescriptions.
devices? The health care provider must provide care
(including assistive devices) that enhances the
Procedure
patient’s self-reliance, while maintaining quality in a
cost-effective way [4]. An assistive device often means A postal package comprising two questionnaires was
a very evident change in a person’s ability, far more sent to a random sample of 510 users of rollators
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easy to describe than most effects of other kinds of (n ¼ 340) and manual wheelchairs (n ¼ 170) during
physiotherapy or occupational therapy interventions. summer 2004. One questionnaire included items
Despite this, there is very little evidence in this area concerning demographic data, questions about usage
[5]. An assistive device should compensate for a as well as user’s opinion of how the device had
decreased or lost function and ability to manage daily influenced activity and participation and the pre-
life, increase or maintain function and ability and scription process (Appendix). The other question-
prevent future loss of function and ability. The main naire was the QUEST 2.0 form (described below).
prescribing process has been illustrated and described Sampling was done using the county councils’
by the Swedish Handicap Institute [6]. registers containing all prescriptions for rollators
Evidence-based practice should form the basis of all and manual wheelchairs over a 12-month period.
rehabilitation including assistive devices. This is a The sizes of the sub-groups were proportional to the
For personal use only.
challenge, as few measures are available which target total number of prescriptions.
the measurement of assistive device outcomes. An addressed reply envelope and a letter explaining
Therapists are under increasing pressure to base their the objective of the study were enclosed. The letter
practices more firmly on ‘evidence’ and to verify the also gave the user the option to not take part in the
effects of certain interventions. An empirical and study by returning the letter with a mark saying that
useful ‘evidence base’ for the outcome of assistive he/she did not want to participate. Type of device and
devices requires more research based on relevant and product were already filled in in the questionnaire in
valid evaluation tools as well as a client-centred order to clarify which assistive device was being
working model. The selection and clinical evaluation referred to (if the user had more than one).
of each device should, as far as possible, involve the
client.
Outcome measures
QUEST 2.0. The Swedish version of QUEST 2.0
Purpose
was used [7]. This paper and pencil format instru-
The objective of this study was to follow up client ment was developed by an occupational therapist in
satisfaction concerning products, service and the Canada during the 1980s and can be either
prescribing process related to manual wheelchairs self-administered or completed with the help of an
and rollators. The objective was also to determine evaluator [8]. It is designed to evaluate a person’s
whether there was any difference in satisfaction satisfaction with his or her assistive device and can be
between users of the two different types of mobility used with adolescents, adults and elderly people who
assistive products. have acquired an assistive device as a result of phy-
sical or sensory impairment. QUEST 2.0 focuses on
satisfaction with specific features of the assistive
Method device as well as certain characteristics of the services
related to the device [8]. The QUEST 2.0 form
Design
displays the scoring of the 12 satisfaction items in
A cross-sectional follow-up study design was used. two parts; device (eight items) and services
Three assistive device centres in three county (four items). The satisfaction items related to the
councils in Sweden participated. characteristics of the device are dimensions, weight,
In Sweden, each county council decides the adjustment, safety, durability, simplicity of use,
available selection of assistive devices possible to comfort and effectiveness. Each item is scored using
prescribe for occupational- and physiotherapists a 5-point satisfaction scale, where 1 denotes
User satisfaction with mobility assistive devices 553
‘not satisfied at all’ and 5 ‘very satisfied’. The declined participation. Included in the data analysis
satisfaction items associated with the related services are 262 users of mobility assistive devices, i.e.,
are service delivery, repairs and servicing, profes- rollators (n ¼ 175) and manual wheelchairs (n ¼ 87).
sional services and follow-up. The same 5-point In all, 165 women and 95 men participated. There
satisfaction scale is used to rate these items. A was a significant difference in gender frequency
checklist with the 12 satisfaction items is subse- (p ¼ 0.002) as well as age (p ¼ 0.000) between the
quently presented on the QUEST 2.0 form and the user groups (Table I).
user is asked to select the three most important Respondents in both groups still used their pres-
items. The psychometric properties of QUEST 2.0 cribed assistive device to a very high degree (rollators
have been tested in several studies [9 – 13]. 96% and manual wheelchairs 99%, respectively). An
The means for the sub-scale scores could provide absolute majority reported that they used their device
useful summary statistics about the relative satisfac- on a ‘daily basis’ or ‘several times/week’ (rollators
tion or dissatisfaction of the Device and Services 91% and manual wheelchairs 84%, respectively).
dimensions as suggested in the QUEST 2.0 manual The users were asked to rate in what way the
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[12]. Another method, also described in the manual, assistive device had affected their activity and parti-
for interpreting the results is to perform an item-by- cipation possibilities (Table II). In the analysis, the
item analysis, which then gives the evaluator the answer alternatives ‘No influence’ and ‘Negative’
opportunity to identify those areas where improve- were summarized and compared with the ‘Positive’
ments should be made. The users who report that alternative. There was a difference in how the users
they are ‘more or less satisfied’ or less (scores 1, 2 or estimated the influence of the device insofar as the
3) could be treated as one group and those who are rollators seemed to have a significantly more
‘quite satisfied’ or ‘very satisfied’ (scores 4 and 5) as positive influence on users’ feeling of ‘mobility’,
one group. The groups could then be compared ‘independence’, ‘self-esteem’ and ‘security’ than
according to percentage [12]. manual wheelchairs. However, the wheelchair
seemed to have a more positive effect on ‘possibility
For personal use only.
Table II. User perception of device influence on activity and participation, illustrated as percentage of those users who answered each item,
respectively. In the analysis are the answer alternatives ‘No influence’ and ‘Negative’ summarized.
Possibility to work 46 26 *
Positive 48 73
No influence 46 27
Negative 6
Possibility to lead an active leisure life 100
Positive 66 77 64 **
No influence 20 13
Negative 14 11
Possibility to socialize 121 74 ns
Positive 80 78
No influence 14 14
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Negative 6 8
Possibility to go shopping or similar 124 64 ns
Positive 82 77
No influence 15 14
Negative 3 9
Possibility to be mobile 140 76 *
Positive 87 76
No influence 7 12
Negative 6 12
Feeling of safety/security 150 75 ***
Positive 94 80
No influence 3 12
For personal use only.
Negative 3 8
Feeling of independence 130 71 ***
Positive 83 61
No influence 12 25
Negative 5 14
Self-esteem 137 73 *
Positive 82 68
No influence 9 19
Negative 9 12
A majority of both manual wheelchair (75%) and items. However, rollator users seemed more satisfied
rollator users (83%) answered ‘No’ here. Only 28% in all significant parts.
of the wheelchair users and 21% of the rollator users A separate analysis was performed to look for
answered that there had been a follow-up. differences in estimated satisfaction with the char-
The last question in the additional questionnaire acteristics of the assistive device as opposed to
was about fulfilment of expectations. The answer satisfaction with service and follow-up. The esti-
alternatives were ‘Not at all’, ‘To a little extent’, ‘To mated satisfaction from the first eight questions,
some extent’, ‘To a great extent’ and ‘To a very great about assistive product qualities, was compared with
extent’. Wheelchair users answered ‘To a great the estimated satisfaction from the last four items on
extent’ or ‘To a very great extent’ in 61% of cases service and follow-up. The 5-point scale was divided
and rollator users had the same answers in 81% of into two categories as in the previous analysis. There
cases ( p ¼ 0.001). was a difference in users estimated satisfaction with
The five alternatives in QUEST 2.0 were grouped device characteristics compared to satisfaction with
into two categories; Satisfied (4 & 5), Not quite service. Both rollator and wheelchair users scored
satisfied (3, 2 & 1). User satisfaction with the assis- higher satisfaction with characteristics of the device
tive device and with service was high for both groups, than with service aspects (Table IV).
as illustrated in Table III. A majority of all users The two most important items identified were the
rated most items 4 ¼ ‘quite satisfied’ or 5 ¼ ‘very same for both rollators and manual wheelchairs, viz.
satisfied’. There was a difference in satisfaction ‘Ease of use’ (88% and 69%, respectively) and
between users of the two device groups for most ‘Safety’ (81% and 57%, respectively). The third most
User satisfaction with mobility assistive devices 555
Table III. Item-by-item analysis for rollator and manual wheelchair users.
1. Dimensions 92 8 139 83 17 75 *
2. Weight 80 20 117 67 33 72 *
3. Adjustment 87 13 130 64 36 73 ***
4. Safety 92 8 139 78 22 74 **
5. Durability 90 10 133 82 18 73 ns
6. Ease of use 94 6 140 72 28 74 ***
7. Comfort 90 10 137 74 26 74 **
8. Effectiveness 95 5 139 81 19 73 ***
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Table IV. Percentage of all answers comprised into two answer were less satisfied compared to rollator users.
categories: satisfied (scores 4 & 5) and not very satisfied (scores 1,
Overall, wheelchair users had a lower satisfaction
2 & 3). The p-value represents the difference between the
estimated satisfaction with assistive device characteristics (items score than rollator users. The difference could be an
1 – 8) compared to service and follow-up (items 9 – 12). expression of the different kind, function and com-
For personal use only.
different organizations. This might be useful in the scription to this survey was too short to get an idea of
local perspectives of all aspects included in the users’ need for a follow-up. Or is the need for a
assistive device delivery system. follow-up exaggerated? The authors do not think so,
The additional questionnaire used in this study they believe that the follow-up is of extraordinary
brought up some useful information about the use importance, both to the user and therapist. Without a
and usefulness of the devices. Those who answered follow-up, it is not possible to correct unsatisfactory
the questionnaire reported a very high level of use in solutions and extend the therapist’s knowledge and
both user groups. This result is not in accordance experience.
with other studies like the ones summarized by User expectation is probably one of the most
Scherer [15], who reported prevalence of disuse of important aspects in relation to satisfaction. In this
devices between 30 – 50% in aggregation, ranged study rollator users considered their expectations
from 8 – 75% for particular devices. Of course, aban- met to a greater extent than wheelchair users. This
donment is not the only indicator of user dissatisfac- difference might be due to the fact that a wheelchair
tion and probably there are users who continue to use is a symbol of a handicap and not so easy to consider
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assistive devices despite dissatisfaction due to a lack of as something positive, as opposed to the rollator,
more suitable alternatives. An analysis of the external which gives the user a greater opportunity to con-
drop-outs in this study might have resulted in another tinue an active and social life to a greater extent.
interpretation. Those who answered the questions in
this study might be the most satisfied.
Limitations and considerations
The difference in the answers between the wheel-
chair and rollator users was significant for several The objective of this study was to measure and
items. When the users were asked to rate how the compare client satisfaction concerning product,
present device influenced the opportunity for activity service and prescribing process for manual wheel-
and participation, the rollator users were more chairs and rollators. These objectives are clearly
positive, in particular with regard to the feeling of related to relevant clinical questions, which are to be
For personal use only.
safety/security and the feeling of independence. focused in today’s medical care, such as client
Users of manual wheelchairs considered the wheel- satisfaction, cost-effectiveness and usability.
chair to have a positive influence on their possibility In all, 368 persons responded (72%) and 106 of
to work and to have an active leisure life. Consider- these declined participation. Users of mobility
ing the purpose and field of application, there is a assistive devices are often elderly and disabled, which
difference in rollators and wheelchairs and the body might explain the high number of dropouts. No
function of its users. A rollator user is able to walk reminder was sent out which might have increased
with the support of the device. A feeling of insecurity the number of participants. The responding groups
and impaired balance might be the cause of in this study are heterogeneous in several aspects but
prescription. The user is probably a person who representative of the user groups. There are several
expects a continuous active life in all areas of life. A different types of manual wheelchairs and rollators
rollator might then be experienced as a barrier in used by the respondents and the experience,
certain activities such as work and leisure. A manual expectations, environment and personal character-
wheelchair user is probably a person with a sig- istics of the users probably varies substantially. These
nificantly decreased or total loss of walking ability. aspects are not considered in this study, which means
The wheelchair then means the possibility to be at that the study has a limited explanatory value.
work and enjoy certain leisure activities, which would However, this was never the intention. Neither did
not be possible at all without the device. this study look at different age groups in relation to
The answer to the question concerning to what results. This might be very interesting but needs an
extent the prescriber had shown consideration for increased number of included subjects.
needs, wishes and demands of the user during the QUEST 2.0 was chosen as a follow-up tool and an
prescribing process showed a difference between outcome variable as this is one (if not the only)
groups. It may be that rollator users are more active standardized evaluation tool, especially developed to
and resourceful than wheelchair users. This question measure user satisfaction with assistive devices [8]. It
is an important one to develop and needs further has been used in several outcome studies and has
research. been translated and is used in several countries
An obvious and unexpected result was related to [14,16,17]. QUEST 2.0 is suitable in studies with a
the questions about follow-up. Very few respondents large sample since it is possible to collect data
in both groups answered that they had a need for through a postal survey. However, QUEST 2.0 does
follow-up and less than 30% of respondents had not include any questions about user characteristics
actually had a follow-up, according to what they such as age, living conditions, use of the device or the
themselves say. Perhaps the time-span from pre- effects on activity and participation. An additional
User satisfaction with mobility assistive devices 557
17. Brandt Å, Iwarsson S, Ståhl A. Satisfaction with rollators 20. Lee KR. Where does assistive technology fit in ICIDH-2? Am
among community-living users: A follow-up study. Disabil J Phys Med Rehabil 2002;81:636.
Rehabil 2003;25:343 – 353. 21. Stineman M. Assistive technology outcomes: Commodity or a
18. Edyburn DL, Smith RO. Creating an assistive technology therapy? Am J Phys Med Rehabil 2002;81:636.
outcomes measurement system: Validating the components. 22. McMillen A-M, Söderberg S. Disabled persons’ experience
Assist Technol Outcomes and Benefits 2004;1:8 – 15. of dependence on assistive devices. Scand J Occup Ther
19. World Health Organization (WHO). International Classifica- 2002;9:176 – 183.
tion of Functioning, Disability and Health: ICF. Geneva. 23. Edyburn DL. Measuring assistive technology outcomes: Key
Switzerland: WHO; 2001. concepts. J Special Educ Technol 2003;18:53 – 55.
1. Your age . . . . . . . . . . . . . . . . . . . . . . .
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2. Gender Male ¤
Female ¤
3. Use of the assistive device.
I still use the device ¤
I do not use the device any more ¤
4. How often do you use the device?
Every day ¤
Several times/week ¤
Several times/month ¤
More seldom ¤
5. How would you say that the device has influenced the following?
For personal use only.