CHAMPAIGN, Ill. — More than 98% of adults who predominantly used wheelchairs and scooters for mobility reported some level of concern about falling, researchers at the University of Illinois Urbana-Champaign and University of Illinois Chicago found in a recent study. These individuals' concerns were assessed as part of the ongoing development of an interactive fall management and safety training program to be delivered through a mobile app.
Heightened concerns about falling are prevalent among mobility device users, causing "some individuals to avoid essential physical and social activities, leading to physical deconditioning, secondary health issues, and mental performance decline. This creates a cycle of worsening disability with reduced mobility, increased fall risk, greater dependence and a decline in health-related quality of life," said study leader Laura A. Rice , a health and kinesiology professor at Illinois.
"In this research, we were trying to bring light to the idea that interventions are needed for people who use wheelchairs. While giving someone a wheelchair can help a lot, we need to go further: We need to intervene to make sure that people are not significantly limiting their participation in activities because they lack confidence in their wheelchair skills and are afraid of falling," Rice said.
Elizabeth W. Peterson , a clinical professor and the director of professional education in occupational therapy at UIC; and Sahel Moein, a doctoral student in health and kinesiology at Illinois, co-wrote the paper, published in Disability and Health Journal.
Using their newly created "Fall Concerns Scale for People who Use Wheelchairs and Scooters," the researchers assessed these effects among 137 adults who used these devices full time, regardless of their underlying medical condition.
Although various fall risk assessments are available, Rice said many of them include items that lack relevance to wheelchair users because they do not perform those activities. Likewise, when asked a single yes or no question to assess these risks, many people will respond that they have no concerns about falling, the team wrote. The newly developed scale measures participants' concerns across various types of activities, offering a more detailed analysis than prior assessments, the researchers said.
"We wanted to develop an outcome measure that would be able to effectively evaluate wheelchair and scooter users' nuanced concerns so that we can better understand them and develop interventions to manage them," Rice said.
About 63% of the study participants were male and 37% were female. With a median age of 34, these individuals represented a range of health conditions, including Parkinson's disease, spinal cord injuries, multiple sclerosis and muscular dystrophy. About 77% of the participants said they received assistance with activities of daily living.
Within the past year, 68% of the study participants experienced a fall-related injury, the team found.
Those who had sustained at least one injury, people whose physical, emotional and functional well-being were the most negatively affected by dizziness and those who were less able to get up from the ground unassisted were more apprehensive about falling, according to the study.
Nearly all of those in the study reported some level of concern about falling. By contrast with prior research, those in the current study who were younger and male had the most trepidation, possibly because they attempted riskier activities or they lacked the training and skills of those with more experience using wheelchairs, Rice said.
The team said the work was used to evaluate the efficacy of an interactive mobile app to support the delivery of iROLL — the Individualized Reduction of Falls program — a six-week group-based intervention focused on reducing falls among people with multiple sclerosis and spinal cord injuries who use wheelchairs. Rice and Peterson developed iROLL in collaboration with Jacob Sosnoff , the associate dean for research and a professor in the School of Health Professions at the University of Kansas; and Deborah Backus , the vice president of research and innovation at the Shepherd Center in Georgia.
"iROLL aims to build users' confidence in their wheelchair and transfer skills," Rice said. "We also teach people how to get up if they do experience a fall. It is important that we have a good assessment tool to evaluate their concerns about falling, so we can see how effective our intervention is."
Falling and related concerns among people who use mobility devices is an understudied area, Rice said.
"We are trying to ensure that the public and practitioners understand that this is a significant problem for people who use wheelchairs," Rice said. "We cannot simply provide a device and expect people to be able to use it effectively. Training is critical to ensure that people can use a device to its full extent."
The Paralyzed Veterans of America funded the work associated with developing the Fall Concerns Scale. The iROLL research was funded by the Craig H. Neilsen Foundation and the National Institute on Disability, Independent Living and Rehabilitation Research in the National Institutes of Health.
