Disability and Rehabilitation: Assistive Technology

ISSN: 1748-3107 (Print) 1748-3115 (Online) Journal homepage: http://www.tandfonline.com/loi/iidt20

A survey of adult power wheelchair and scooter users Kara Edwards & Annie Mccluskey To cite this article: Kara Edwards & Annie Mccluskey (2010) A survey of adult power wheelchair and scooter users, Disability and Rehabilitation: Assistive Technology, 5:6, 411-419, DOI: 10.3109/17483101003793412 To link to this article: http://dx.doi.org/10.3109/17483101003793412

Published online: 08 May 2010.

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Date: 23 January 2017, At: 06:04

Disability and Rehabilitation: Assistive Technology, November 2010; 5(6): 411–419

RESEARCH PAPER

A survey of adult power wheelchair and scooter users

KARA EDWARDS & ANNIE MCCLUSKEY Discipline of Occupational Therapy, Faculty of Helath Sciences, The University of Sydney, Cumberland Campus, Lidcombe, New South Wales, Australia 1825 Accepted March 2010.

Abstract Purpose. Power wheelchairs and scooters have the potential to increase community participation for people with mobility limitations. However, there are also challenges associated with use. The aims of this study were to investigate the characteristics of adults who use power wheelchairs and scooters, explore the process of power-mobility provision and examine the benefits and challenges of use. Methods. A cross-sectional survey design was used to recruit power wheelchair or scooter users, aged over 18 years, or their carer, living in New South Wales, Australia. The survey was distributed by mail and e-mail. Results. Two hundred and two usable surveys were returned, 25% were power wheelchair users (median age: 57 years, IQR: 40–69) and 74% were scooter users (mean age: 81 years, IQR: 72–85). Only one-third of users (33%) consulted a health professional prior to purchasing their device. Benefits included increased independence and quality of life. Challenges included environmental barriers and accidents. A sizeable proportion of respondents (21%) reported accidents in the previous year, often resulting in personal injury and damage to their device. Conclusion. Power-mobility devices have many benefits for users, but can also have negative outcomes, like accidents resulting in injuries. Further high quality studies need to be conducted to determine whether the positive benefits outweigh the negative outcomes such as accidents and injuries.

Keywords: Scooter, power wheelchair, powered mobility devices, safety

Introduction People with physical disabilities and older people often have mobility limitations that restrict community participation. Many individuals are prescribed an assistive device such as a walking stick, fourwheeled walker or wheelchair. Power-mobility devices, including wheelchairs and scooters are also used by people with more significant mobility limitations, and people who wish to travel longer distances [1]. More recently, the Segway has been used to enable participation [2]. Most of these devices are powered by rechargeable batteries, controlled by a joystick or handlebar controls and enable users to move around their community environment more independently [3,4]. In the United States of America (USA), 159,000 power wheelchairs were prescribed in 2002 under the

Medicare benefit scheme at a total cost of US$1.2 billion [5]. The nature of users has been investigated in the USA through a national registry [6]. Between 2003 and 2006, the registry collected demographic and descriptive data on 1107 power wheelchair and scooter users, as well as manual wheelchair users. The mean age of users was 51 years (SD: 13) for power wheelchair users and 53 years (SD: 13) for scooter users. Just over half of respondents were manual wheelchair users (54%) with a smaller proportion of power wheelchair (38%) and scooter users (5%). In Australia, where the current authors work, no equivalent registry exists. Limited data are available on who buys, rents and uses powermobility devices in many countries despite the potential benefits. The benefits of power-mobility devices are reported to include improved quality of life, an

Correspondence: Annie MCCluskey, Community-Based Health Care Research Unit and Discipline of Occupational Therapy, Faculty of Helath Sciences, The University of Sydney and Royal Rehabilitation Centre Sydney, Cumberland Campus, PO Box 170s, Lidcombe, New South Wales, Australia 1825. E-mail: [email protected] ISSN 1748-3107 print/ISSN 1748-3115 online ª 2010 Informa UK, Ltd. DOI: 10.3109/17483101003793412

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increased sense of freedom and improved self-esteem [7–9]. Several qualitative studies with relatively small samples have described the benefits of using power wheelchairs and scooters including energy conservation and decreased dependence on others [7,9,10]. Other benefits include being able to participate in valued occupations and new activities that were previously inaccessible [9,11]. In a quantitative study involving 111 Danish power wheelchair and scooter users aged over 65 years [11], participants described an increased ability to participate in activities which they previously found difficult, including shopping and visiting family or friends. A large majority of the Danish sample (91%) deemed their device very important. One pre-post study that investigated the impact of power mobility use on activity and participation [9] found that all participants (n ¼ 32) reported positive outcomes from using their device. A mean withingroup difference of 9.3 points was reported by users on the 25-point scale, the Individually Prioritised Problem Assessment (95% CI: 6.8–11.8, p 5 0.001) as a result of using their device [12]. One-third of participants in that study (n ¼ 10) stated in a followup interview that they were able to perform new activities not previously mentioned or considered possible at the initial interview [9]. Another Canadian study tested the hypothesis that obtaining a wheelchair would increase social participation, as measured by the Reintegration to Normal Living Index (RNLI). The pre-post study involving a single group indicated that participants (n ¼ 42) experienced significant improvements in social participation ( p 5 0.001) after an average of 134 days of use [13]. These two previous studies both reported positive outcomes from power mobility use. However, neither study included a control group which make the findings prone to bias. Outcomes of power mobility use have been investigated in a systematic review [14]. Although that review included 19 studies, a variety of study designs and lower levels of evidence were represented. As a consequence, no conclusive findings were presented about the outcomes of power mobility. Only one randomised controlled trial was included in that review, which investigated the effect of scooter provision on physical performance in adults with arthritis of the knee compared to a usual care control group [15]. Participants’ physical abilities were measured using the 6-minute walk distance (6MWD). There was no significant between-group difference on the 6MWD after the 3 month period of scooter provision. This finding may have been due to the control group being significantly different at baseline for age (p ¼ 0.01) and wheelchair use (p ¼ 0.04) compared to the experimental group. Hoenig et al. found that

scooters were used several times per week, and 41% of participants used their scooter on a daily basis. Of those in the experimental group 73% (16/22) found the scooter very helpful, and 10 intended to obtain a scooter when the study ended. Scooter users also reported some difficulties accessing the community. Finally, a small proportion (18%, n ¼ 4) reported a total of nine accidents over the 3-month period, which raises concerns about safety while using power-mobility devices. The African Disability Scooter is manually propelled, designed for use by people with a lower limb amputation, and was recently evaluated with a small sample of 10 volunteers [16]. The scooter was twice as efficient and twice as fast as crutches over level ground with the mean speed increasing from 54.6 m/ min using crutches, to 110.4 m/min using the scooter. The scooter also rated highly for comfort and usability. Despite the benefits of power-mobility devices, there are also challenges. Challenges and risks associated with power-mobility device use include difficulty learning how to use the device and barriers to community access and safety. Initial difficulties faced by users include adjusting to responses of the public toward them while using the power-mobility device, learning to instruct the public to move out of their way in a considerate but effective manner, as well as learning the technical aspects of driving the device [7]. Scooter driving skills of able-bodied adults who had never used a scooter were recently assessed in an Australian study [17]. Two-thirds of new users (66%) failed at least one of the 13 subtests, indicating that driving a scooter can be difficult for new users. When 10 of the participants repeated the test three times, the majority (7/10 or 70%) drove without any failure on test-items. This study highlighted that with practice, new scooter users can improve their driving competency and skills. Reliable and valid assessments such as the Power-Mobility Community Driving Assessment [18] are available for health professionals to use to assess the competency and driving skills of new users. However, it is unknown if this type of test is being used by health professionals or if new power-mobility users have an opportunity to practice driving skills before using their device in the community. People who use power-mobility devices often face another challenge – environmental barriers – when trying to access their community. Common environmental barriers include stairs and doorsteps, which make some buildings inaccessible. Difficulty accessing public and private buildings was described as a major concern in a survey of 203 powered wheelchair users in the UK [19]. Participants in that study also highlighted difficulties using their device on buses and trains [19]. Although environmental barriers

A survey of adult power wheelchair and scooter users were a challenge for these power-mobility users in the UK, Australian users may face different challenges. Research is needed in Australia to determine whether these barriers are similar or different, and how challenges are managed by users. Safety while using a power-mobility device is a significant concern for users, members of the public, local councils and health professionals. A number of studies have described accidents involving users and suggest that more safety research is needed [8,15,17]. Power wheelchair and scooter users often have impairments that limit their ability to safely use a device. Unsafe driving may lead to accidents and injuries to users, and to members of the public. Injuries over a 5-year period due to scooter accidents in one state of Australia have recently been reported [20]. In that study, 151 people were treated in hospital for injuries sustained during a scooter accident. These injuries included fractured bones (50%) and open wounds (34%). Six deaths involving scooter use were also recorded. Although two studies have been conducted in Australia about the safety of scooter users, little is known about who uses power wheelchairs and scooters, or their experience of use. Therefore, the current study had three aims: first, to investigate the characteristics of adult power wheelchair and scooter users; second, to explore the process of powermobility provision; third, to investigate the benefits and risks associated with power wheelchair and scooter use. Findings will provide demographic data about respondents and details of device provision.

Methods A cross-sectional survey design was used. An 8-page self-administered survey was developed by the researchers, based on literature about provision, use and outcomes of power-mobility devices. For example, the most frequently reported activities of users in a Danish study [11] (shopping and visiting family or friends) were included as response options. The survey was not tested for validity and reliability prior to use. However, an earlier version of the survey was pilot tested with a group of students, for advice about readability and layout, and a small sample of power-mobility users (n ¼ 5). Adjustments were made to the wording of items to improve clarity and understanding. The final survey included 35 questions and five sections: (1) ‘Demographic information’, (2) ‘Your power-mobility device’, (3) ‘Use of your device’, (4) ‘Scooter or wheelchair related incidents’ and (5) ‘Your experience of power wheelchair/scooter use’. In Section 1, respondents were asked to provide information about their social situation, health

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conditions affecting their mobility and period of ownership. Sections 2 and 3 pertained to the device and how it was used, and included questions about features considered during the selection process (e.g., cost, accessories), how often the device was used outdoors and the type of destinations commonly visited. Sections 4 and 5 enquired about respondents’ experience of using a power-mobility device, including benefits, risks and negative outcomes such as accidents. The survey mostly included closed questions. A university ethics committee approved the study. Approximately 650 surveys were distributed between March and July 2008 using convenience sampling. Disability organisations, local municipal councils and personal contacts of the researchers helped to distribute surveys and recruit participants. Representatives of these groups distributed the survey by mail, e-mail or in person. Researchers were not directly involved in recruiting participants. Multiple strategies described in a Cochrane systematic review [21] were used to maximise response rates, including using the university’s logo on participant information sheets and providing postage paid envelopes for return of surveys. Data from completed surveys were entered into SPSS and analysed using descriptive statistics (means and proportions) and cross tabulation (chisquare). Relationships and differences between power wheelchair users and scooter users were the focus of cross tabulation analyses. Differences between other categorical variables such as gender were also examined using chi-square analysis. Qualitative written comments from the survey were coded and organised into main themes and categories, based on how often the topics were mentioned by respondents. Themes and categories were based on the language used by respondents, such as ‘independence’ and ‘increased mobility’.

Results A total of 202 surveys were returned and analysed, a response rate of approximately 31%. Only 20 surveys were returned electronically. Demographic data are displayed in Table I. The median age of respondents was 77 years (IQR: 58–84) with a range from 18 to 98 years. The median age of power wheelchair users was 57 years (IQR: 40–69) compared to 81 years (72–85) for scooter users. Respondents lived in urban areas (n ¼ 124, 61%) and regional areas of New South Wales (n ¼ 77, 38%). The most commonly reported health condition that affected mobility was arthritis (40%); however, a large minority had genetic conditions (n ¼ 14, 7%) that affected their mobility.

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Table I. Demographic characteristics of the sample (N ¼ 202). Characteristic

n

%

Gender Male

109

54.0

Device used (n ¼ 202) Power wheelchair and scooter Power wheelchair Scooter 3-wheeled 4-wheeled

1 51 150 42 107

0.5 25.2 74.3 28.2 71.8

21 24 69 85

10.5 12.1 34.7 42.7

72 101 24 3

36.0 50.5 12.0 1.5

Marital status (n ¼ 201) Married/defacto relationship Widowed Divorced or separated Never married

78 58 36 29

38.8 28.9 17.9 14.4

Health conditions affecting mobility* Arthritis Heart condition Knee or hip joint replacement High blood pressure Spinal cord injury

81 44 30 27 27

40.1 21.8 14.9 13.4 13.4

124 70 52 43 39 22

61.4 34.7 25.7 21.3 19.3 10.9

Period of device ownership (n ¼ 199) 56 months 6 months but 51 year 1 year but 53 years 3 years Living situation (n ¼ 197) Living alone Living with family/defacto partner Living with other residents/tenants/friends Other

Reasons for power mobility use* Difficulty walking Unable to walk Ceased driving Poor health Suggested by family Recommended by a health professional

*Note. Respondents could tick more than one option therefore totals do not add up to 100%.

Duration of ownership ranged from less than 6 months to 17 years. Three-quarters of respondents (76%) had owned their device for 1 year or more, and 42% had owned their device for 3 years or more. When selecting their device, two-thirds of respondents (n ¼ 128, 63.4%) had received advice prior to purchase from a sales representative (n ¼ 77, 38.1%) or health professional (n ¼ 65, 32.9%), including an occupational therapist (n ¼ 45), general practitioner (n ¼ 11) or physiotherapist (n ¼ 9). Some respondents received advice from a number of sources prior to purchase. There was a statistically significant difference in pre-purchase advice between the two groups of users ( p 5 0.001). Power wheelchair users were more likely to receive pre-purchase advice (n ¼ 43, 87%) compared to scooter users (n ¼ 84, 57%). Funding sources for power-mobility devices are presented in Figure 1. Overall, two-thirds of the

Figure 1. Funding sources: proportion of power wheelchair users versus scooter users.

sample (n ¼ 136, 67%) self-funded their device. Government assistance schemes provided a small proportion of devices (n ¼ 31, 15%) for a small contribution from users. Most of these devices were power wheelchairs (n ¼ 24). Less than half of the power wheelchair users purchased their own device (n ¼ 20, 39%), whereas the majority of scooter users purchased their device (n ¼ 116, 77%). Conversely, nearly half of the power wheelchair users obtained their device free through a government assistance scheme (n ¼ 24, 47%), whereas few scooter users used this method (n ¼ 7, 5%). Devices were also purchased by family (n ¼ 14, 7%), donated (n ¼ 3, 1.5%) or supplied by other means including worker’s compensation claims or the Department of Veterans Affairs (n ¼ 13, 6.5%). There was a statistically significant difference ( p 5 0.001) between power wheelchair users and scooter users, in terms of how their devices were purchased. Power wheelchair users were more likely to have received their device through a government assistance scheme, whereas scooter users more often purchased the device with their own funds, as shown in Figure 1. When respondents were asked to describe the frequency of outdoor journeys while using their power-mobility device, the majority went out once a day or more (n ¼ 79, 39%), as shown in Figure 2. There was no statistically significant difference between power wheelchair and scooter users with regard to frequency of outdoor journeys. Power-mobility devices enabled respondents to participate in four main types of activities: leisure activities, daily activities, social activities and work/ volunteer activities. Leisure activities included going to the movies, walking the dog and attending special events. Power-mobility devices were used for

A survey of adult power wheelchair and scooter users completing daily activities such as shopping and attending appointments. Visiting and socialising with family or friends were also common activities, as were work and productivity-related activities, such as volunteering and education roles. Table II displays the five most common tasks completed by respondents when using their device.

Benefits The benefits of using a power-mobility device included increased independence and freedom,

Figure 2. Frequency of outdoor use (N ¼ 202).

Table II. Top five activities completed by respondents when using their power mobility device (N ¼ 202). Activity completed Shopping Medical appointments Social outings Just to get out of the house Visiting family and friends

n*

%

160 116 92 92 76

79.2 57.4 45.5 45.5 37.6

*Note. Respondents could tick more than one option therefore totals do not add up to 100%.

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increased ability to move around the community and decreased dependence on others. Some respondents also reported increased social benefits as a result of easier community access, and subsequent increased confidence and self-esteem. Table III shows the main benefits of power-mobility use and quotes from selected respondents. Open-ended responses totalled 155. Some respondents reported multiple benefits. Respondents were asked to rate whether they agreed or disagreed with statements about their experience of using power mobility on a 5-point Likert scale. The majority (n ¼ 188, 93%) agreed that: they were more independent and their quality of life had improved (n ¼ 183, 90%) since using their device; access to a power-mobility device had increased the number of outdoor journeys made each week (n ¼ 163, 81%); and the majority agreed that their power wheelchair or scooter was important to them (n ¼ 192, 95%). There were no statistically significant differences between power wheelchair users and scooter users in relation to reported benefits. Despite the barriers previously mentioned, twothirds of respondents (n ¼ 125, 62 %) agreed that they could access most locations when using their device. However, when comparing power wheelchair users and scooter users, there was a statistically significant difference between groups (p 5 0.001). Power wheelchair users (53%) were more likely to report that they could not get to places they wanted to go, compared to scooter users (18%).

Challenges Respondents described challenges faced when using their device. Technical difficulties were most often reported, particularly tyre and battery problems. In response to a question about battery reliability and

Table III. Benefits reported by power mobility users. Benefit

Quotes from respondents

Increased mobility

‘I would be bed-ridden if I didn’t have it’ (Respondent 20) ‘It is my life, if I didn’t have it I’d be stuck at home’ (Respondent 33) ‘I can go to places and do things without the assistance of another person’ (Respondent 49) ‘Enables me to get out by myself, I didn’t have a life before scooter’ (Respondent 116) ‘I love the freedom and mobility of my life [that] having a scooter gives me’ (Respondent 42) ‘My freedom has been given back to me’ (Respondent 66) ‘Meet more people. I now take more interest in the community’ (Respondent 25) ‘Change of environment, alive to enjoy the trees and flowers, also to enjoy other scooter riders company’ (Respondent 142) ‘Able to get out in the fresh air’ (Respondent 197) Power wheelchair use enables ‘social networking, community participation, sense of belonging to society’ (Respondent 2) ‘I’ve regained my confidence and independence. I’m better able to assist my wife and family’ (Respondent 130)

Increased independence Increased freedom Able to be more social Enjoyable to use

Able to contribute to family and society

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performance, one-third of respondents (n ¼ 78, 38%) said they worried about the battery running out while they were away from home. However, a similar proportion (n ¼ 76, 37%) said that they did not worry about the battery running out while away from home. There were no statistically significant differences between power wheelchair users and scooter users reporting battery problems. Other challenges described by respondents included environmental barriers such as difficulty accessing kerbs and uneven footpaths or ground. The most frequently reported barriers are presented in Table IV.

Accidents One-fifth of respondents (n ¼ 42, 21%) reported having an accident in the previous year when using their device. Only six respondents did not complete this optional section. The most commonly reported accidents were caused by running into doors and walls, the device tipping over, being hit by a car or knocking into/over objects such as shop displays. Of those who experienced an accident, 33.3% (n ¼ 14) also reported damage to their device as a result. A small number (n ¼ 5, 11.0%) were hospitalised due to injuries sustained, such as broken bones, lacerations and bruising. There were no statistically significant differences between power wheelchair users and scooter users for the number of accidents reported.

Discussion The aim of this study was to investigate the characteristics of users, the process of power mobility provision, and reported benefits and challenges. This study presents the demographic characteristics of 202 power wheelchair and scooter users. There were

Table IV. Proportion of respondents reporting barriers to power mobility use (N ¼ 202). Barrier Uneven footpaths Uneven ground Kerbs Narrow doorways and aisles Potholes Stairs Hills and slopes Crowded places Access to public transport (bus) Access to public transport (train)

n*

%

154 135 126 112 105 100 88 81 36 28

76.2 66.8 62.4 55.4 52.0 49.5 43.6 40.1 17.8 13.9

*Note. Respondents could tick more than one option therefore totals do not add up to 100%.

several key findings. First, the characteristics of power wheelchair were different to scooter users, including the age of users and funding sources used. Second, when decisions were made about obtaining a device, two thirds of scooter users made their decision without consulting a health professional. Third, Australian respondents described similar benefits and challenges to those described in earlier overseas studies, with environmental barriers being a common problem for users. Finally, one-fifth of the sample reported having had an accident in the previous year, raising concerns about safety of users and the general public. Sample characteristics are similar to those of other older Australians with mobility impairments, suggesting that the sample is reasonably representative of the broader Australian population. Half of the population of the state of New South Wales (49.5%) is male [22], and just over half of our sample (54%) was male. Two-thirds of Australia’s population lives in major cities [23], and 62% of the sample lived in urban areas. The most common long-term health condition affecting older people in New South Wales and Australia is arthritis (48% [24] and 27% [23], respectively). In our sample, the most frequently reported health condition affecting mobility was arthritis (affecting 40%). The benefits and barriers to use of power mobility use were consistent with these described in overseas studies [5,11]. No previously unreported benefits or barriers were identified. One implication is that local authorities and peak disability organisations in Australian face similar challenges to overseas groups, when working to make our local communities more accessible to people who use power mobility devices. The characteristics of users were different for power wheelchair users compared to scooter users. One of the main differences was the median age of the two groups, with power wheelchair users being much younger than scooter users (57 vs. 81 years, respectively). This difference is not unexpected, considering that scooters are most commonly used by people who can only walk short distances due to conditions of older age such as arthritis. However, the U.S. National Wheelchair registry shows the mean age of power wheelchair users these was quite similar to the mean age of scooter users (51 vs. 53 years, respectively) [6]. Power wheelchair users in our sample more often had mobility limitations due to an inherited genetic condition, or had acquired their disability as the result of an accident. A large majority was unable to walk. Power wheelchairs are often a practical option for people with chronic or permanent conditions, as power wheelchairs can be modified to suit the postural support and pressure care needs of a user. Scooters cannot easily be modified [4,5].

A survey of adult power wheelchair and scooter users Another characteristic that revealed differences across users was the funding source. Less than 10% of scooter users obtained their device through a government assistance scheme compared to nearly half of power wheelchair users. Unlike other countries, the Australian health system does not readily fund power mobility devices if a person has already been provided with a free manual wheelchair. When approval is given, anecdotal reports suggest that the waiting list can be several years, leading many older adults to self-fund their device. The study by Fitzgerald et al. [6] unfortunately did not provide data on the source of funding for many of their respondents, and 37% of their samples were veterans. Accidents involving power mobility devices have been documented by a number of authors. Hoenig et al. [15] reported an accident rate of 18% during the 3-month period of scooter provision in their randomised controlled trial in England. This incidence is comparable to that reported in our study (21%). Scooter-related injuries and deaths in Victoria, Australia totalled 151 over a 5-year period (injuries significant enough to be treated in hospital) [20]. Although that study reported six scooterrelated deaths, some of these deaths appear to have been caused by problems unrelated to dangerous driving, with one elderly man having a heart attack while driving the scooter, resulting in a serious accident and injury. Hoenig et al. suggested that safety of scooter users should be a major concern for users, their families and health professionals. Findings from this study suggest that power wheelchair users were just as likely as scooter users to experience an accident. No research related to power wheelchair-related accidents was located. That topic warrants further research. Training on safe power mobility use was rarely provided to respondents in out sample, according to their self-reports. Most users received only an initial demonstration and trial before leaving the shop. Findings suggest that power mobility users and their families are making purchase decisions without consulting a health professional or specialist service. Health professionals involved in power mobility provision and driving rehabilitation, as well as stakeholders in the community such as local councils, have a responsibility to educate and train users of power wheelchairs and scooters, in order to reduce accidents, injuries and deaths. However, research also needs to be conducted to determine if education and training does decrease the frequency of accidents and the best method to educate users. Several competency-based assessments have been developed to test the skills and abilities of new power mobility users. One example of these tests is The

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Power-Mobility Community Driving Assessment, a validated, reliable test [18,25]. The format of this test could be used as an education and training tool to assist new power mobility users learn the skills required to safely access the community. Another power mobility test developed in Australia [17] assesses basic scooter driving skills and more complex skills such as weaving through cones while reading a road sign. As reported earlier, two-thirds of healthy adults failed at least one test item at their first attempt. Nitz concluded that competency testing should be conducted with all new power mobility users before they are allowed to use their device in the community. However, universal competency testing cannot be recommended based on existing research. Extensive funding and a large number of health professionals would need to be available as testers for such an assessment programme to succeed, and considering the cost involved, a research project such as a randomised controlled trial should be conducted to ensure an assessment programme would be effective in reducing accidents. Perhaps a more efficient way of spending funds earmarked for power mobility safety and community awareness would be to expand safety education courses currently run at easily accessible locations, such as local council offices. Safety for power mobility users should be a matter of concern for users, their local communities, sales representatives and health professionals who often prescribe these devices. Ensuring power mobility users are educated about safety issues is the responsibility of the users and those who support them, including health professionals as well as sales representatives and suppliers. Although health professionals may be considered experts in this field, they may have difficulty keeping up to date with the new products and technology associated with power mobility devices. Perhaps an effective way of providing safety education would be for health professionals to work as consultants to other stakeholders, such as local councils and companies that sell power mobility devices, to provide up to date education and training of new and current power mobility users. Health professionals may also have a role in disseminating knowledge from assessment and research to power mobility equipment suppliers. Educational material should be made widely available to power mobility users and their families. Written information that visually shows the skills that should be practised prior to going out in the community could be made available at the point of sale of power mobility devices. A web site providing similar information would allow families of users, who are often involved in the decision making process, to access important information and become aware of the safety issues associated with power mobility devices.

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As with most studies, this research had limitations. First, recruitment was conducted through disability organisations and personal contacts. This limited method of recruitment may have resulted in a nonrepresentative sample as people who do not access these specific organisations, or are not currently involved with these services did not have the opportunity to be involved. As a consequence, the response rate was only approximately 31%. Second, the survey instrument was devised by the authors and has not yet been tested for validity. Also, all but one of the 202 respondents in this sample lived in the state of New South Wales, so the results from this study cannot necessarily be generalised to all Australians who use power-mobility devices. To gain more specific data on accidents and so that the findings relate to Australian power mobility users, further research needs to be conducted using a larger sample throughout all states. Further, more indepth research should be conducted to expand on this descriptive study, including causes of power mobility use and whether cognition is a factor in the high accident rate. Research also needs to be conducted to more thoroughly outline the physical and environmental barriers power mobility users face when attempting to access their community. This would include considering the methods employed by users to overcome these barriers. Accidents and ways to improve safety for users should be the focus of much more future research.

Conclusions People who use power wheelchairs have different characteristics and therefore different needs from those who use scooters. These two groups of users should be treated separately. While there appears to be many benefits to power mobility use, future studies need to be more rigorous and include control groups, but also need to collect data on potential negative outcomes. Considering the challenges expressed by power mobility users in this study there is a role and responsibility for health professionals and companies that sell power mobility devices to educate and train new users to ensure safe use. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. References 1. Gitlin LN, Luborsky MR, Schemm RL. Emerging concerns of older stroke patients about assistive device use. The Gerontologist 1998;38:169–180.

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