Effectiveness of postural intervention via manual wheelchair change: feasibility of teleconsultation delivery
Hastings, Jennifer Dee
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This study tested the following hypotheses: (1) Wheelchair configuration changes will change seated postural alignment, (2) Health outcome measures will improve after postural change and (3) Successful seating interventions are possible via a distance medicine model.Prospective repeated measures design with subjects randomized at enrollment to either in-person intervention by the investigator or teleconsultation mediated intervention. Data were collected at baseline, post intervention and 3-months. Outcome Measures: Seated Height (SH), Wheelchair Users Shoulder Pain Index (WUSPI), Postural Scale for Wheelchair Users (PSWU), Satisfaction with Life Scale (SWLS)*, Pain Visual Analog Scale (VAS) and Pain Interference (*baseline and 3 months only). The primary comparison was between pre and post intervention scores on the outcome measures (within subject analysis) examining the effect of the intervention. The between group comparison explored the effectiveness of the teleconsultation intervention in relation to the gold standard of a hands-on clinic. A convenience sample of 13 subjects was enrolled across two investigative sites with analysis on 11 subjects who completed the study. Inclusion: SCI with ASIA Impairment Scale scores of A or B, motor level T1-T10 inclusive, age 18 or greater, one year or more post SCI, with non-specific musculoskeletal pain or discomfort in their wheelchair, who are full-time users of manual wheelchairs. Intervention: custom specified wheelchair configuration change; generally decreasing inside seat to back angle via changes to seat plane or backrest alignment. Post intervention results: Increase in SH (postural alignment) was significant (p=.03), mean change of 1.01 inches; 95% confidence interval 0.13 to 1.9. Mean improvement (-9.6) on the WUSPI was significant (p=.03); 95% confidence interval -18.34 to -0.87. Decrease in worst pain intensity (-1.18) was significant (p=.04); 95% confidence interval -2.3 to -0.4. Remaining outcomes did not show significant change post intervention. The intervention effect was not maintained at 3-month follow up (n=9).Clinical Relevance. Wheelchair configuration can alter seated posture, and improved postural alignment appears to improve health outcomes as measured by the WUSPI and Pain VAS. Feasibility of successful postural intervention via teleconsultation was supported by this preliminary study. Further work is needed on maintenance of the intervention effect.
- Nursing - Seattle