Index

Research Tasks

Design and Development Tasks

Support Tasks

RERC-I Final Report-(1993-98)

R-5: Investigation Outcome Measurement Tools for Seating and Mobility

Task Leader: Margo B. Holm, PhD, OTR/L, FAOTA, ABDA (research design specialist)

Co-Investigators: Elaine Trefler, MEd, OTR/L, ATP (seating clinician); Shirley Fitzgerald, PhD (biostatistician); Michael Boninger, MD (physiatrist); Tamara Mills, MS, OTR/L (doctoral student); Mark Schmeler, MS, OTR/L, ATP (seating clinician, doctoral student), Tamra Pelleschi (seating clinician)

Duration/Staging of Task: This 60-month research task will be conducted throughout the RERC cycle.

Rationale/Task Summary

When evaluating quality of life related to one's ability to use a wheelchair, the issues do not relate as much to the medically driven questions but more to the ability to function in an environment. It is not a question of whether a person is sick, but rather can they do what they want to do, where they want to do it and in a timely fashion. The medical condition or disability is a factor but not usually with the traditional medical implications. Validated outcome tools are necessary to make convincing arguments that funding be made available for consumers who require seating intervention.

This project will develop outcome measures of seating and wheeled mobility intervention for the majority of individuals who use wheelchairs and seating systems as their primary seating and mobility device. The subject population that has been chosen for the validation of the tool are persons who have relatively static conditions such as spinal cord injury and cerebral palsy.

Research Objectives

This task has as its primary goal the development of a new outcome measure. As such, we elected to list specific objectives that will achieve this goal over three phases, as opposed to specific hypotheses testing.

Phase 1

• Develop a new outcome measure focusing on function while seated in a wheelchair.
• Identify existing functional measures that may be valid when seated in a wheelchair.

Phase 2

• Determine the test-retest reliability of the FEW, Beta Version 1.0.
• Determine the content validity for the FEW, Beta Version 2.0 item expansion.

Phase 3

• Determine the test-retest reliability of the FEW, Beta Version 2.0.
• Conduct a non-randomized clinical trial to determine the ability of the FEW to detect differences in consumer function with new seating-mobility technology

Progress Report (12/31/99)

In the first year of this project, we have reviewed existing outcome measures for content that is useful in measuring a persons functional status while sitting in a wheelchair. We also received training in administration of the Canadian Occupational Performance Measure (COPM), and created probe questions specific to performance of functional measures while in a wheelchair. Next, training in interview techniques was provided for the four persons who will be doing the face-to-face interviews. Subjects are being recruited and the videotaped interviews will begin in January.

Progress Report (12/31/00)

Margo Holm joined the RERC study in 9/00 and is now an adjunct faculty member in the Rehabilitation Science & Technology. Tamara Mills joined the RERC study in 9/00 on a half-time basis and is full time as of 1/01. Tom Bursick has graduated and is no longer involved in the study.

The study will be conducted in three phases over a period of 5 years. The objectives of Phase I:(a) select and evaluate existing functional measurement instruments with relevant factors to wheelchair users, (b) conduct videotaped interviews with 20 manual and powered wheelchair users with various causes of disability to determine what functional tasks are important for them to perform while seated in the wheelchairs, and (c) develop the items for the new outcome measure. The Functional Evaluation in a Wheelchair (FEW) will be designed as a questionnaire that will be administered over time to consumers of wheelchair and seating system technology, as a dynamic indicator or profile of perceived function related to wheelchair use. The objectives of Phase 2: (a) determine internal validity and test-retest reliability of the FEW, and (b) use Rasch Analysis to evaluate the new outcome measure. Phase 3 consists of clinical trials to determine if the FEW is capable of detecting changes in function, following acquisition of a new wheelchair and seating system.

Trained interviewers administered a modified version of the Canadian Occupational Performance Measure (COPM) to twenty participants. Inter-rater reliability was conducted by randomly selecting a videotaped interview of three raters/participants. Inter-rater reliability: 100% for content and 95% for rank order of items. All responses in the COPM areas of self-care, productivity, and leisure were placed into a chart and ordered according to the frequency of response by the consumers. All items were sorted into 21 categories, and members of the research team then reviewed all items and by consensus reallocated them into 10 new categories. As part of the validation study, consumer participants received a questionnaire asking them to rank order the importance of each new category for function related to their wheelchair mobility and seating systems.

We have submitted a paper to the annual RESNA conference. We have also been invited to submit papers to Disability and Rehabilitation. The content of the two manuscripts will focus on the qualitative and quantitative aspects of the study. Mark Schmeler, Shirley Fitzgerald, and Elaine Trefler will author the qualitative paper. Tamara Mills, Margo Holm, and Elaine Trefler will author the quantitative paper.

Modifications have been made to the IRB to reflect addition of new investigators, and other protocol changes. We anticipate submitting the IRB modifications in early February. Also, we plan to implement Phase 2 of the study in March 2001.

Progress Report (12/31/01)

Elaine Trefler transferred the role of principal investigator to Margo B. Holm, effective June 2001. Laura Cohen has assumed full-time responsibilities on another study, and thus is no longer involved in this study.

At the RERC Advisory Board meeting in April, members provided helpful recommendations concerning the development and organization of the FEW instrument. Their recommendations were discussed with the team and the following recommendations were successfully implemented: (a) order of FEW items was changed, (b) the naming of items was simplified, and (c) the wording of the scoring scale was adapted.

The IRB renewal was submitted and approved in May 2001, and an additional IRB modification request was approved in November 2001 to include the cross-validation of the FEW items with consumer goals.

After learning of the FEW instrument at conferences, several clinicians have expressed interest in the tool, and the FEW has been listed on the Assistive Technology Outcomes Listserv sponsored by the Adaptive Technology Resource Centre (ATRC).

Phase 1: Completed

Approximately 6 months after completion of the interviews, 17 of the 20 Phase 1 participants validated the following 10 new categories based on perceived importance for function in their seating-mobility system: accessing task surfaces, transfers, human-machine interface (i.e., consumers’ ability to do what they want to do in their wheelchair), architectural barriers, transportation-securement, reach, wheelchair accessories, natural barriers, transportation-portability, and transportation-accessibility (1). These 10 categories were used to develop the first version of the FEW, and then consumers’ self-administered the FEW and provided feedback on the content, wording, and scoring system. The wording of the first version of the FEW was “My seating-mobility system allows me to,” and the scoring system ranged from 6 = completely agree to 1 = completely disagree (3). Based on consumers’ feedback and consensus of the research team, the current FEW, Beta Version 1.0 consists of 10 questions in the following format: My wheelchair/scooter allows me to … easily (a) operate it, (b) transfer from surface to surface, (c) use accessories, (d) do tasks at different surface heights, (e) reach, (f) get around indoors, (g) get around outdoors, (h) ride public transportation, (i) secure it during transportation, and (j) stow it in a vehicle (2). Consumer responses on the FEW, Beta Version 1.0 are scored using a 7 point scale with a reverse ranking system: 6 = completely agree, 5 = mostly agree, 4 = slightly agree, 3 = slightly disagree, 2 = mostly disagree, 1 = completely disagree, and 0 = does not apply to me (2).

The Phase 1 results (2, 3) indicated that consumers have unmet needs in their current seating-mobility systems that affect their quality of life and occupational performance in the areas of self-care, leisure, and productivity. Our data also showed that consumer responses changed when they were asked to prioritize the importance of categories for wheelchair users in general versus themselves.

Phase 2: In Progress

The test-retest reliability process involved an initial administration of the FEW, Beta Version 1.0 by trained researchers to a total of 40 manual or power wheelchair users with a non-progressive condition. Next, consumers self-administered the FEW, Beta Version 1.0 4-7 days after the initial administration, and returned the instrument by mail. Currently, 30 consumers (see Table 1) have consented to participate, and four consumers have not returned the self-administered FEW. The cross-validation of the FEW, Beta Version 1.0 items involved obtaining consumer goals from an internet-based (IB) study database (n = 78), a telerehabilitation (TR) study database (n = 20), and the CAT medicalized (CAT-M) (n = 20) and CAT consumer-reported (CAT-C) (n = 20) clinical databases (see Table 1) (2). Frequency data from the four databases were collected by a consensus approach each time a FEW item captured a consumer goal. If a consumer goal reflected more than one FEW item, then each item was coded as appropriate. Cross-validation of the FEW, Beta Version 1.0 items with consumer goals from two research study databases and two clinical databases examined the strength of the FEW items, and identified new content items to be included in Beta Version 2.0.

The Phase 2 test-retest reliability results yielded an ICC (2,k) = 0.93, [CI = .84, .97; p < .001] indicating that the FEW, Beta Version 1.0 demonstrated a high level of stability in the measurement of seating-mobility goals over time. Table 2 included the cross-validation results of the 10 FEW, Beta Version 1.0 items with consumer goals from four databases, and 15 additional categories of goals not captured by the instrument. The cross-validation revealed the 10 FEW, Beta Version 1.0 items would have captured 79%, 46%, 50%, and 54% of consumers’ goals in the IB, TR, CAT-M, and CAT-C samples, respectively. The high frequency of “w/c fit/accommodation” and “w/c feature” (see Table 2) goals, particularly in the TR and CAT-M samples, has influenced the reformatting of the FEW question for the Beta Version 2.0 to: “My wheelchair/scooter features allow me to”. Utilization of this wording and addition of the new categories, “w/c fit/accommodation” and “w/c feature,” in Phase 2 would have led to capturing 80%, 94% 64%, and 61% of consumers’ goals in the IB, TR, CAT-M, and CAT-C samples, respectively. Cross-validating the FEW, Beta Version 1.0 items with goals identified by four diverse samples of seating-mobility system users has generated 15 new categories for consideration for Beta Version 2.0, and further validated the FEW items.

Table 1. Demographics of the Phase 1, Test-Retest, and Cross-Validation Sample (2)

Graphic description of table 1: A table displaying demographic data, consisting of age, gender, diagnosis, type of wheelchair, years of wheelchair use, and age of wheelchair, for the Phase 1 sample (n = 20), Phase 2, test-retest sample (n = 26), and the four cross-validation samples: IB (n = 71), TR (n = 20), CAT-M (n = 20), and CAT-C (n = 20).

Table 2. Frequency of Consumer Goals with the FEW Items and New Categories in Four Samples(2)

Graphic description of table 2: A table displaying the frequency of consumer goals from the four cross-validation samples with the 10 FEW items (operate wheelchair, transfers, accessories, surface height access, reach, indoor mobility, outdoor mobility, public transportation, secure wheelchair for transportation, and stow wheelchair for transportation. The total number of goals captured by the FEW: IB sample = 354, TR sample = 251, CAT-M sample = 120, and CAT-C sample = 52. The following are the 15 additional categories of consumer goals not captured by the FEW: wheelchair comfort, drive from wheelchair with adaptive controls, personal self-care in wheelchair, wheelchair caregivers can operate, wheelchair reliability/maintenance, steps, wheelchair safety, wheelchair fit/accommodation, wheelchair aesthetics, wheelchair efficiency, wheelchair features, pressure distribution, postural control, increase independence in self-care, and increase sitting time and tolerance. The total number of goals not captured by the FEW: IB sample = 95, TR sample = 299, CAT-M sample = 119, and CAT-C sample = 44.

Progress Report (11/22/02)

Tamra Pelleschi, Program Manager, Center for Assistive and Rehabilitative Technology (CART), has joined the research team as a co-investigator.

Phase 2: Completed

Beta Version 1.0 Final Test-Retest Reliability Results:

The FEW, Beta Version 1.0 was administered to 40 participants, and the self-administered FEW was returned by 35 participants. A typical participant was a 45 (range 19-83) year old male or female manual wheelchair user with cerebral palsy (see Table 3). The test-retest reliability results yielded an ICC (2,k) = 0.93, [CI = .84, .97; p < .001].

The FEW, Beta Version 1.0 was highly stable in its measurement of seating-mobility goals for pilot study II participants over a one-week interval. Further psychometric testing of the FEW is needed to yield a valid outcome measurement tool that will help document the cost-effectiveness and functional value of seating-mobility interventions to consumers and third-party payers.

Table 3. Beta Version 1.0 Final Test-Retest Sample Demographics

Graphic description of Table 3: A table displaying demographic data, consisting of age, gender, race, diagnosis, type of wheelchair/mobility device, years of wheelchair use, and age of wheelchair, for the FEW, Beta Version 1.0 final Phase 2, test-retest sample (n = 40).

Final Cross-Validation Method:

In testing the content validity of the FEW, consumers’ goals obtained from five sources: an internet-based (IB) study database; (b) a telerehabilitation (TR) study database; (c) the CAT medicalized (CAT-M) clinical database; (d) the CAT consumer-reported (CAT-C) clinical database; and (e) the Hiram G. Andrews Center, Center for Assistive and Rehabilitative Technology (CART) clinical database were cross-validated with the FEW items to identify items to be included in the FEW, Beta Version 2.0.

The purpose of the IB study was to examine factors related to wheelchair decision-making and the effects of consumer exposure to WheelchairNet, a website designed to inform consumers, clinicians and others regarding wheelchair use. Seventy-one consumers reported mobility, self-care, productivity, and leisure goals on a pretest and posttest life goals questionnaire. In the TR study, the seating-mobility needs of 20 wheelchair users were assessed using a TR and “in person” method to establish a scientific basis for the reliable use and limits of video conferencing systems in maintaining appropriate standards of care. Four seating-mobility practitioners (two occupational therapists and two physical therapists) performed one “in-person” or TR mobility assessment for each consumer over a 3-7 day interval, for a total of 80 evaluations. Consumers were asked to report a maximum of five goals at each assessment. Next, the CAT-M sample, consisting of clinical goals for 20 consumers obtained from the therapist evaluation/prescription letter, and the CAT-C sample, goals individually reported by 20 consumers to therapists and recorded on an evaluation form, were systematically (CAT-M every 10th medical record, CAT-C every 3rd medical record) selected from the CAT clinical databases. For the final sample of consumers’ goals, every 10th medical record for seating-mobility clients was systematically drawn from the CART clinical database using the center’s mobility and wheelchair billing records. Data analysis consisted of matching consumer goals from each database to the FEW Beta Version, 1.0, to determine if the FEW would have captured each goal expressed by each consumer. Results were reported in percentage of captures.

Final Cross-Validation Results:

A typical participant from the IB, TR, CAT-M, CAT-C, and CART samples, respectively, was (a) a 43 year old (range 22-63) female manual wheelchair user with spinal cord injury; (b) a 42 year old (range unknown) male or female power wheelchair user with 1 of 12 other diagnoses; (c) a 48 year old (range 23-87) male manual wheelchair user with 1 of 12 other diagnoses; (d) a 52 year old (range 8-83) female manual wheelchair user with 1 of 29 other diagnoses; and (e) a 40 year old (range 18-80) male manual wheelchair user with 1 of 11 other diagnoses (see Table 4). The cross validation results for the 10 FEW, Beta Version 1.0 items with consumer goals from five databases, and 15 new categories of goals not captured by the FEW, Beta Version 1.0 instrument are included in Tables 5 – 8.

Table 4. Cross Validation Sample Demographics

Graphic description of Table 4: A table displaying demographic data, consisting of age, gender, diagnosis, type of wheelchair, years of wheelchair use, and age of wheelchair, for the final five cross-validation samples: IB (n = 71), TR (n = 20), CAT-M (n = 20), CAT-C (n = 63), and CART (n = 47).

** = Goal category was added after this sample’s cross validation
_ = No goals reported

Table 5. Frequency of Consumer Goals with the FEW Items and New Categories in Four Samples II

Graphic description of Table 5: A table displaying the rank order for the 10 FEW items based on the self-administered FEW, Beta Version 1.0 results from Phase 1: 1 = operate wheelchair, 2 = transfers,5 = accessories, 9 = surface height access,7 = reach, 4 = indoor mobility,10 = outdoor mobility, 3 = public transportation ,8 = secure wheelchair for transportation, and 6 = stow wheelchair for transportation. Additionally, the table displays the frequency of consumer goals from the five cross-validation samples with the 10 FEW items (operate wheelchair, transfers, accessories, surface height access, reach, indoor mobility, outdoor mobility, public transportation, secure wheelchair for transportation, and stow wheelchair for transportation. The total number of goals captured by the FEW: IB sample = 354, TR sample = 189, CAT-M sample = 120, CAT-C sample = 168, and CART sample = 212. The cross validation revealed the 10 FEW, Beta Version 1.0 items captured 79%, 54%, 50%, 51%, and 40% of consumers’ goals in the IB, TR, CAT-M, CAT-C, and CART samples, respectively. 15 additional categories of consumer goals not captured by the FEW: wheelchair comfort/pain management, drive from wheelchair with adaptive controls, personal self-care in wheelchair, wheelchair caregivers can operate, wheelchair reliability/maintenance, steps, wheelchair safety, wheelchair fit/accommodation, wheelchair aesthetics, wheelchair efficiency, wheelchair features, pressure distribution, postural control/support, increase independence in self-care, and increase sitting time and tolerance. The total number of goals not captured by the FEW: IB sample = 95, TR sample = 161, CAT-M sample = 119, CAT-C sample = 159, and CART sample = 323.

Table 6. Percentage Data on Number of Goals Captured by Sample and Inclusion/Exclusion of Items for FEW, Beta Version 2.0

Graphic description of Table 6: A table displaying the capture rate (percentage) by the original FEW, Beta Version 1.0 items, IB, TR, CAT-M, CAT-C, and CART sample, consecutively, based on the sequence of the cross-validating process by sample. The percentage rate was 100% across all six samples. The table also displays the percentage of goals captured without wheelchair aesthetics was 99.33%, 100%, 100%, 100%, and 99.81% for the IB, TR, CAT-C, CAT-M, and CART samples, respectively. The percentage of goals captured without wheelchair aesthetics and steps was 98.22%, 99.71%, 99.58%, 100%, and 99.81% for the IB, TR, CAT-C, CAT-M, and CART samples, respectively. The percentage of goals captured without wheelchair aesthetics, steps, and drive from wheelchair with adaptive controls was 96.88%, 99.71%, 99.58%, 99.69%, and 99.81% for the IB, TR, CAT-C, CAT-M, and CART samples, respectively. The percentage of goals captured without wheelchair aesthetics, steps, drive from wheelchair with adaptive controls, and increase sitting time and tolerance was 96.88%, 99.71%, 99.58%, 97.25%, and 99.07% for the IB, TR, CAT-C, CAT-M, and CART samples, respectively. The total percentage of goals captured across the five samples without wheelchair aesthetics was 99.79%, without wheelchair aesthetics and steps = 99.42%, without wheelchair aesthetics, steps, and drive from wheelchair with adaptive controls = 99.05%, and without wheelchair aesthetics, steps, drive from wheelchair with adaptive controls, and increase sitting time and tolerance = 98.45%.

Table 7. Order of Total Goal Categories for Each Cross Validation Samples (N = 221) by Frequency

Graphic description of Table 7: A table displaying the order(frequency) of all goal categories by cross validation sample (N = 221). The goal with the highest frequency for the IB sample (frequency) was operate wheelchair (59), followed by Outdoor mobility(56), Indoor mobility (44), Reach (40), Transfer (40), Surface height access (39), Public transportation (27), Wheelchair comfort/pain management (25), Stow wheelchair for transportation (21), Wheelchair safety (17), Accessories (15), Wheelchair reliability/ maintenance (15), Secure wheelchair for transportation (13), Personal self-care in wheelchair (12), Drive from wheelchair with adaptive controls (6), Wheelchair efficiency (5), Wheelchair fit/ accommodation (5), Steps (5), Wheelchair aesthetics (3), and Wheelchair others can operate (2). Increase independence in self-care, Increase sitting time & tolerance, Postural control/support, Pressure distribution, and Wheelchair features were added after this sample’s cross validation. The goal with the highest frequency for the TR sample (frequency) was Wheelchair features (72), followed by Wheelchair fit/ accommodation (55), Operate wheelchair (53), Outdoor mobility (33), Indoor mobility (25), Wheelchair comfort/pain management (22), Stow wheelchair for transportation (22), Accessories (17), Secure wheelchair for transportation (14), Transfer (12), Public transportation (9), Wheelchair safety (5), Wheelchair reliability/ maintenance (3), Wheelchair efficiency (3), Surface height access (2), Reach (2), Steps (1), Wheelchair others can operate (0), Personal self-care in wheelchair (0), Drive from wheelchair with adaptive controls (0), and Wheelchair aesthetics (0). Postural control/support, Pressure distribution, Increase independence in self-care, and Increase sitting time & tolerance were added after this sample’s cross validation. The goal with the highest frequency for the CAT-M sample (frequency) was Wheelchair features (19), followed by Wheelchair safety (18), Postural control/support (18), Indoor mobility (17), Operate wheelchair (16), Wheelchair reliability/ maintenance (16), Outdoor mobility (15), Wheelchair fit/accommodation (13), Secure wheelchair for transportation (13), Pressure distribution (12), Transfers (12), Wheelchair comfort/pain management (12), Stow wheelchair for transportation (11), Accessories (10), Public transportation (10), Reach (9), Surface height access (7), Wheelchair others can operate (6), Personal self-care wheelchairs (4), Steps (1), Wheelchair efficiency (0), Drive from wheelchair with adaptive controls (0), and Wheelchair aesthetics (0). Increase independence in self-care and Increase sitting time & tolerance were added after this sample’s cross validation. The goal with the highest frequency for the CAT-C sample (frequency) was Operate wheelchair (50), followed by Indoor mobility (48), Outdoor mobility (37), Wheelchair safety (27), Increase independence in self-care (25), Wheelchair comfort/pain management (22), Wheelchair features (18), Postural control/support (17), Wheelchair reliability/ maintenance (12), Pressure distribution (10), Wheelchair efficiency (9), Wheelchair fit/ accommodation (8), Increase sitting time & tolerance (8), Stow wheelchair for transportation (7), Surface height access (6), Secure wheelchair for transportation (6), Accessories (5), Reach (4), Public transportation (3), Personal self-care wheelchair (2), Transfer (2), Drive from wheelchair with adaptive controls (1), Wheelchair others can operate (0), Wheelchair aesthetics (0), and Steps (0). The goal with the highest frequency for the CART sample (frequency) was Wheelchair safety (46), followed by Indoor mobility (45), Postural control/support (42), Wheelchair features (42), Outdoor mobility (42), Operate wheelchair (40), Wheelchair fit/ accommodation (39), Wheelchair reliability/ maintenance (39), Pressure distribution (33), Wheelchair comfort/ pain management (31), Wheelchair efficiency (27), Transfer (23), Accessories (16), Stow wheelchair for transportation (15), Secure wheelchair for transportation (13), Surface height access (12), Increase independence in self-care (9), Wheelchair others can operate (8), Public transportation (5), Increase sitting time & tolerance (4), Personal self-care wheelchair (2), Reach (1), Wheelchair aesthetics (1), Steps (0), and Drive from wheelchair with adaptive controls (0).

** FEW Item

Table 8. Overall Order of 25 Goal Categories by Frequency

Graphic description of Table 8: A table displaying the frequency order for all goal categories (** equals FEW item). The goal category with the highest frequency was ** Operate wheelchair (218), followed by ** Outdoor mobility (183), ** Indoor mobility (179), Wheelchair features (151), Wheelchair fit/accommodation (120), Wheelchair safety (113), Wheelchair comfort/pain management (112), ** Transfer (89), Wheelchair reliability/ maintenance (85), Postural control/support (77), ** Stow wheelchair for transportation (76), ** Surface height access (66), ** Accessories (63), ** Secure wheelchair for transportation (59), ** Reach (56), Pressure distribution (55), ** Public transportation (54), Wheelchair efficiency (44), Increase independence in self-care (34), Personal self-care wheelchair (20), Wheelchair others can operate (16), Increase sitting time & tolerance (12), Drive from wheelchair with adaptive controls (7), Steps (7), and Wheelchair aesthetics (4). Cross-validating the FEW, Beta Version 1.0 items with goals identified by five diverse samples of seating-mobility system users (concurrent validity) generated 15 new categories for inclusion in Beta Version 2.0, and further validated the FEW items. The cross validation revealed the 10 FEW, Beta Version 1.0 items captured 79%, 54%, 50%, 51%, and 40% of consumers’ goals in the IB, TR, CAT-M, CAT-C, and CART samples, respectively. For the FEW items alone, the top three consumer goals (not based on consecutive order) for the IB, TR, CAT-M, CAT-C, and CART samples were operate wheelchair, indoor mobility, and outdoor mobility. None of the 15 new categories reflected a consistent pattern across the five samples. Because of the high frequency of “wheelchair fit/accommodation” and “wheelchair feature” goals, particularly in the TR and CART samples, the base question format for each FEW item was revised for Beta Version 2.0 to reflect these goals. With the wording of Beta Version 2.0, the FEW would have captured 80% (354 + 5 + 0= 359/449= .80); 90% (189 + 55 + 72= 316/350= .90); 64% (120 + 13 + 19= 152/239= .64); 59% (168 + 8 + 18= 194/327= .59); and 55% (212 + 39 + 42= 293/535= .55) of consumers’ goals in the IB, TR, CAT-M, CAT-C, and CART samples, respectively. In other words, FEW, Beta Version 2.0 captured an average of 70% of 1,900 goals identified by 221 consumers. However, with the addition of all new categories excluding wheelchair aesthetics, steps, driving from wheelchair with adaptive controls, and increase sitting time and tolerance, which were the four least (range 4-12) reported goals by consumers, the FEW, Beta. wheelchair with adaptive controls (7), Steps (7), and Wheelchair aesthetics (4), the next paragraph should begin with ....Cross-validating the FEW, Beta Version 1.0 items with goals identified by five diverse samples of.

Final Cross-Validation Method (cont.)

Version 2.0 captured 98% of consumer goals across the five samples.
Overall, cross validation of the FEW, Beta Version 1.0 items with goals identified by five diverse samples of seating-mobility system users generated important new information regarding the ability of the FEW to identify users’ needs for appropriate seating-mobility technology. Additionally, the findings supported the need to continue the cross validation of the FEW using larger samples. At the end of this phase, the FEW, Beta Version 2.0 was developed, and the name of the instrument was changed to Functioning Everyday with a Wheelchair (FEW) by consensus of research team members and feedback from the RERC Advisory Board, who approved the name change. reported goals by consumers, the FEW, Beta Version 2.0 captured 98% of consumer goals across the five samples.

Phase 3: Completed

FEW, Beta Version 2.0, Test-Retest Reliability
A minimum of 30 and a total of 40 wheelchair/scooter users with a non-progressive condition were recruited from the CAT or CART. Once again eligible participants were limited to individuals with non-progressive conditions to assure that disease progression did not impact reliability. The methodology for determining the test-retest reliability of the Functioning Everyday with a Wheelchair (FEW), Beta Version 2.0 was identical to the FEW, Beta Version 1.0. A trained researcher administered the instrument, and then each participant was given a copy of the FEW, Beta Version 2.0 to self-administer 4-7 days later. Data collection consisted of the initial (response to concepts) and self-administrations (personal responses, test-retest reliability) of the FEW, Beta Version 2.0.

Beta Version 2.0 Final Test-Retest Reliability Results:

Forty participants were recruited, and 37 participants completed both the initial and self-administrations of the FEW, Beta Version 2.0. A typical participant was a 36 year old (range 18–72) male power wheelchair user, who used a wheelchair for 11.5 years (4 months – 30 years). The test-retest reliability results yielded an ICC (2,k) = 0.85, [CI = 0.70, 0.93; p < 0.001]. The FEW, Beta Version 2.0 was highly stable in its measurement of seating-mobility goals for Phase III participants over a one-week interval.

Phase 4: in progress

Non-randomized Clinical Trial
Two parallel forms of the FEW have been developed for use by clinicians and researchers in a “standardized” or clinic environment (FEW–Capacity/FEW–C) and in the home/community environment (FEW–Performance/FEW–P). The consumer-based self-report version of the FEW and the two performance-based instruments, FEW–C and FEW–P, will be tested in a non-randomized clinical trial to quantify functional outcomes following acquisition of a new seating-mobility device. We will recruit a maximum of 50 individuals with non-progressive conditions, who are 18 years of age and older and existing manual/power wheelchair or scooter users. The three instruments will be administered before and after consumer receipt of a new wheelchair/scooter in the clinic and home/community environments.

Expected Outcomes

Valid and reliable tools that:

• Enable consumers to obtain quantitative information about the effectiveness of their seating technology interventions.
• Provide functional measures for documenting the outcomes of assistive technology seating interventions.
• Provide clinicians and researchers with a means to objectively measure the effectiveness of wheelchair seating interventions.

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Awards

Tamara Mills, Awarded the Jewish Healthcare Foundation/Coro Center for Civic Leadership Pittsburgh Health Sciences Fellowship, June 2002.

Margo B. Holm, Academy of Research Award from the American Occupational Therapy Foundation (AOTF), April 2001. An induction to the AOTF, Academy of Research is the highest recognition awarded for excellence in research.

Tamara Mills, Award of Honorable Mention, “Public Opinion of Universal Design in Housing,” Rehabilitation Engineering and Assistive Technology Society of North America Student Scientific Paper Competition sponsored by the Whitaker Foundation, April 2001. Proceedings of the Rehabilitation Engineering and Assistive Technology Society of North America 24th International Conference, USA, 112-114.

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Peer-Reviewed Journal Publications

Mills, T., Holm, M. B., Trefler, E., Schmeler, M., Fitzgerald, S., & Boninger, M. (2002).
Development and consumer validation of the Functional Evaluation in a Wheelchair (FEW) instrument. Disability and Rehabilitation, 24, 38-46.

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Conference Proceedings

Mills, T., Holm, M. B., Schmeler, M., Trefler, E., Fitzgerald, S., Boninger, M., Buning, M. E., & Shapcott, N. (2002). The Functional Evaluation in a Wheelchair (FEW) instrument: Test-retest reliability and cross-validation with consumer goals. Proceedings of the Rehabilitation Engineering and Assistive Technology Society of North America 25th International Conference, USA, 245-247.

Mills, T., Holm, M. B., Schmeler, M., Trefler, E., Fitzgerald, S., Boninger, M., Buning, M. E., & Shapcott, N. (2002). Cross-validation of the Functional Evaluation in a Wheelchair (FEW) instrument with consumer goals. Proceedings of the 18th International Seating Symposium, BC, Canada, 237-241.

Mills, T., Holm, M. B., Trefler, E., Schmeler, M., Fitzgerald, S., & Boninger, M. (2001). Development of an outcome measure tool for wheelchair seating and mobility interventions: A work in progress. Proceedings of the Rehabilitation Engineering and Assistive Technology Society of North America 24th International Conference, USA, 245-247.

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Peer-Reviewed Research Presentations

Mills, T., Holm, M. B., Schmeler, M., Trefler, E., Fitzgerald, S., Boninger, M., Buning, M. E., & Shapcott, N. (2002, July). The Functional Evaluation in a Wheelchair (FEW) instrument: Test-retest reliability and cross-validation with consumer goals. Poster session presented at the Rehabilitation Engineering and Assistive Technology Society of North America 25th International Conference, Minneapolis, MN.

Mills, T., Holm, M. B., Trefler, E., & Schmeler, M. (2002, May). Consumer validation of a seating-mobility outcome measurement tool. American Occupational Therapy Association Annual Conference, Miami, FL.

Mills, T., Holm, M. B., Schmeler, M., Trefler, E., Fitzgerald, S., Boninger, M., Buning, M. E., & Shapcott, N. (2002, March). Cross-validation of the Functional Evaluation in a Wheelchair (FEW) instrument with consumer goals. Paper presented at the 18th International Seating Symposium, Vancouver, BC, Canada.

Trefler, E., Holm, M. B., Mills, T., Schmeler, M., Fitzgerald, S., & Boninger, M. (2001, October). Development and consumer validation of the Functional Evaluation in a Wheelchair (FEW) instrument: A preliminary report. Nordiskt Sittsymposium, Stockholm, Sweden.

Mills, T., Holm, M. B., Trefler, E., Schmeler, M., Fitzgerald, S., & Boninger, M. (2001, June). Development of an outcome measure tool for wheelchair seating and mobility interventions: A work in progress. Paper presented at the Rehabilitation Engineering and Assistive Technology Society of North America 24th International Conference, Reno, NV.

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Workshop Submission

Mills, T., Schmeler, M., & Holm, M. B. (June, 2003). Development & validation of the Functioning Everyday with a Wheelchair (FEW) outcome measures. Rehabilitation Engineering and Assistive Technology Society of North America 26th International Conference, Atlanta, GA (1.15 hours).

Mills, T., Desai, K., Schmeler, M., & Holm, M. B. (October, 2003 – accepted workshop). Wheelchair seating and mobility interventions: An evidence-based practice perspective. 26th Annual Pennsylvania Occupational Therapy Association Conference, Pittsburgh, PA (4 hours).

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Contact Person: Margo B. Holm