Factors associated with wheelchair use and the impact on quality of life among individuals with spinal cord injury

We systematically examined the standard of care for wheelchair provision, factors associated with wheelchair choice, disparities in access to wheelchair technology, and the impact of wheelchair use on quality of life among individuals with spinal cord injury (ISCI), participants of the National Model Spinal Cord Injury Systems (NMSCIS). We administered the Assistive Technology Survey developed by the consensus of the directors of the NMSCIS to a convenient sample of 635 adult full-time wheelchair users who met the eligibility criteria for the NMSCIS in 2 separate data collection periods. About 97% of manual and 54% power wheelchair users had customizable wheelchairs, lending evidence to show that ultralight weight customizable manual wheelchairs and customizable power wheelchairs with programmable controls are the standard of care for wheelchair users with SCI. Power wheelchair users were significantly older (p=0.000) than manual wheelchair users. However, regardless to the level of SCI, manual wheelchair users were able to use manual wheelchairs for an average of more than 10 years. Although the socioeconomic statuses (SES) of manual and power wheelchair users were similar, minorities with lower SES had less access to customizable wheelchairs and additional wheelchairs. We were not able to establish an association between the types and design features of wheelchair used on quality of life. Quality of life outcomes were measured in terms of physical/structural barriers, mobility, physical independence, social integration, and life satisfaction; all of these measures are part of the Craig Hospital Inventory of Environmental Factors, the Craig Handicap Assessment and Reporting Technique, and the Satisfaction With Life Scale. However, we were able to conclude that having additional wheelchairs significantly enhanced mobility for wheelchair users. The results of our study generated new knowledge for the field of SCI rehabilitation by elucidating the standard of care for wheelchair provision, the characteristics of wheelchair users with SCI, and the impact of wheelchair use for this population. Furthermore, this study also provided policy makers with valuable data to address disparities in access to customizable wheelchairs and the lack of insurance coverage for additional wheelchairs