1. Differences in Participation by Diagnostic or Mobility Device Group Stephanie J. Hayes, OTS April 6, 2006

2. The Problem: Low Levels of Participation More people with serious impairments are surviving as a result of improvements in health care People with mobility impairments participate less frequently than people without mobility impairments Unknown whether: People with different diagnostic conditions and prognoses show similar patterns of participation Different mobility device users report comparable patterns of participation Study of group differences in participation may provide insight into the factors that are important to consider in developing rehabilitation interventions and community based activities

3. Participation Framework International Classification of Functioning, Disability, and Health (ICF) A revolutionary framework with a new focus on participation and environment Participation: “the involvement in life situations, which include being autonomous… or being able to control one’s own life” Few studies examine people with mobility impairments, in part, because measures of participation have only recently been developed (Perenboom, R. J. M., & Chorus, A. M. J. 2003).

4. Current Participation Measures Craig Handicap Assessment and Reporting Technique (CHART) (Whiteneck, G. G. Charlifue, S. W., Gerhart, K. A., Overholser, J. D., & Richardson, G. N. 1992) Participation Survey/ Mobility (PARTS/M) (Gray, D. B., Hollingsworth, H. H., Stark, S. L., & Morgan, K. A. 2005) Community Participation and Perceived Receptivity Survey (CPPRS) (Gray, D. B., Hollingsworth, H. H., & Morgan, K. A. submitted)

5. Comparison of CHART, PARTS/M, and CPPRS CHART defines participation in broad categories; PARTS/M uses major life activities; and CPPRS uses specific sites of participation The PARTS/M and CPPRS look at the person’s participation in relation to the environment, while the CHART deducts points for personal assistance and inaccessibility of the environment The PARTS/M and the CPPRS ask about the person’s choice, satisfaction, and importance of an activity or site

6. Participation by Diagnostic Group: Using the CHART Two studies examined differences in participation between diagnostic groups using the CHART The multiple sclerosis group had the highest overall participation score The stroke group had a significantly lower total participation score than all other diagnoses The spinal cord injury group was in the middle on all domains Participants with post-polio have greater overall participation than participants with spinal cord injury The cerebral palsy group has a higher participation than people with stroke (Walker, N., Mellick, D., Brooks, C. A., Whiteneck, G. G. 2003; Kumakura, N., Takayanagi, M., Hasegawa, T., Ihara, K., Yano, H., & Kimizuka, M. 2002)

7. People with Mobility Impairments and Participation Over 6.8 million people use a mobility device Cane users are the largest mobility device group Manual wheelchairs are used by nine times more people than power wheelchairs People who use scooters and wheelchairs report greater activity limitations than people who use ambulatory aids (C; C; W) Transportation is reported by mobility device users to be the greatest limitation for accessing the community (Kaye, H. S., Kang, T. & LaPlante, M. P. 2000)

8. Mobility Device and Quality of Participation using PARTS/M A cross-sectional study found a relationship between type of mobility device used and quality of participation using the PARTS/M Overall, scooter users reported the highest quality of participation, except in community activities Powered wheelchair users had the highest participation score for community activities In addition, a person’s diagnosis did not influence quality of participation (Davinroy, J. L., Hollingsworth, H. H., & Gray, D. B., 2004)

9. Community Participation and Perceived Receptivity Survey (CPPRS) Measures participation through performance in the person’s current community environment Focus on the specific places in the community where the person participates Self-report questionnaire 5 most important monthly places 5 most important yearly places Components of Participation: personal assistance, assistive technology, temporal, evaluative quality of participation, features, and person (effects of pain / fatigue)

10. Current Study: Measuring Participation Using the CPPRS Variables Examined Evaluative Quality of Participation (EQOP) Value computed from choice of participation at a site, satisfaction at that site, and importance of going to that site Mean monthly and yearly scores are computed from the important sites the participant chooses Range: 1 - 5 for each site Temporal (Frequency) Number of times the participant visits a particular site Scored: In days per month or days per year

11. Research Questions: Evaluative Quality of Participation 1. Do people who use mobility devices have a higher EQOP for monthly or yearly activities? 2. Is there a difference in EQOP by diagnosis? 3. Is there a difference in EQOP by device group?

12. Research Questions: Frequency & Correlations with EQOP 4. Are there differences in frequency of participation by device group? 5. Are there differences in frequency of participation by diagnostic group? 6. Is there a correlation between frequency of visiting sites and the EQOP for those sites?

13. Hypotheses Null hypotheses No difference in EQOP will be found for diagnostic groups No difference in EQOP will be found for device groups No differences in diagnostic groups will be found in the frequency of going to community sites No differences between device groups will be found in the frequency of going to community sites.

14. Methods: Recruitment Through disability organizations, support groups, newsletters, independent living centers, in- service trainings, or from previous studies Sample compiled from two previous studies 99 participants from validity and reliability study of the CPPRS assessment (54.7%) Participants located nationwide 82 participants through NIDRR study examining the benefits of exercise (45.3%) Participants located locally

15. Methods: Inclusion Criteria Mobility limited and use a mobility device: cane, crutches, walker, manual wheelchair, powered wheelchair, or scooter One of 5 selected diagnoses: Spinal Cord Injury (SCI), Multiple Sclerosis (MS), Cerebral Palsy (CP), Polio, or Stroke Over 18 years of age Answer survey questions independently Currently living in the community Post-rehabilitation at least one year

16. Results: Demographics of Participants (n = 181) Age 47.6 +/- 13.63 Gender 80 (44.2%): Male 101 (55.8%): Female Ethnicity128 (70.7%): Caucasian 41 (22.8%): African American 8 (4.4%): Hispanic/ Latino 2 (1.1%): American Indian Education Level 1 (0.6%): Never entered school 9 (5.0%): Grades 1-11 34 (18.7%): High School Graduate/ GED 59 (32.6%): College 1-3 years 78 (43.1%): College 4 or more years Personal Annual Income 61 (33.7%): $0 - $14,999 52 (28.7%): $15,000 - $34,999 24 (13.3%): $35,000 - $54,999 14 (7.7%): $55,000 - $74,000 14 (7.7%): over $75,000

17. Results: Diagnosis and Device Groups of Participants (n = 181) Primary Diagnosis Number Spinal Cord Injury 75 (44.1%) Multiple Sclerosis 27 (14.9%) Cerebral Palsy31 (17.1%) Polio31 (17.1%) Stroke17 (9.4%) Primary DeviceNumber Cane; Crutches; Walker 40 (22.1%) Scooter28 (15.5%) Manual Wheelchair 53 (29.3%) Powered Wheelchair 60 (33.1%)

18. Results: Do people who use mobility devices have a higher EQOP for monthly or yearly activities? Overall monthly EQOP is significantly higher than the overall yearly EQOP for all participants Monthly3.80 Yearly3.09 t - test-7.02*** *** significant to.001 level

19. Results: Is there a difference in EQOP by diagnosis? No significant differences in EQOP between diagnostic groups SCIMSCPPolioStrokeANOVA Monthly 3.87 3.58 4.01 3.92 3.26 1.21 Yearly 3.20 2.75 3.31 2.93 2.98.95

20. Results: Is there a difference in EQOP by diagnosis? Significant differences between monthly and yearly EQOP existed within all groups except stroke SCIMSCPPolioStroke Monthly 3.87 3.58 4.01 3.92 3.26 Yearly 3.20 2.75 3.31 2.93 2.98 t - test-4.12***-3.23**-2.85**-5.12***-.64 ** significant to.01 level; *** significant to.001 level

21. Results: Is there a difference in EQOP by device group? No significant differences in EQOP existed between device groups Cane; Crutches; Walker ScooterManual Wheelchair Powered Wheelchair ANOVA Monthly 4.17 3.45 3.69 3.18 1.94 Yearly 2.95 2.63 3.31 3.82 1.91

22. Results: Is there a difference in EQOP by device group? However, significant differences existed in participation within a device group Cane; Crutches; Walker ScooterManual Wheelchair Powered Wheelchair Monthly 4.17 3.45 3.69 3.18 Yearly 2.95 2.63 3.31 3.82 t - test-6.09***-3.62***-1.89-3.56*** *** significant to.001 level

23. Results: Are there differences in monthly frequency of participation by diagnostic group? * significant difference in means to.05 level * * * *

24. Results: Are there differences in yearly frequency of participation by diagnostic group *

25. Results: Are there differences in monthly frequency of participation by device group? * * * * * * significant difference in means to.05 level

26. Results: Are there differences in yearly frequency of participation by device group?

27. Results: Is there a correlation between frequency of visiting sites and the EQOP for those sites? CategoriesCorrelationStrength of Correlation Monthly to Yearly Frequency.51***Moderate Monthly Frequency to Monthly EQOP.25***Weak Yearly Frequency to Yearly EQOP.18***Weak Monthly EQOP to Yearly EQOP.46***Moderate *** significant to.001 level

28. Discussion Participants evaluated their quality of participation for monthly sites higher than yearly sites No difference in EQOP based on diagnostic or device group Powered wheelchair group was the one to consider quality of participation higher for yearly sites over monthly sites Appeared to be large variability between groups for frequency of participation; yet, only monthly sites showed significance A high monthly participator is likely to be a high yearly participator and visa versa Similarly, if participants has a high EQOP for monthly sites; they will probably have a high EQOP for yearly sites

29. Clinical Implications Working in direct care Establish goals for therapy based on the sites the client finds important Determine the appropriate mobility device for the client Advocate for clients at community sites Working as a consultant Educate sites on how they can accommodate people with mobility impairments Educate workers about what people with mobility impairments need to participate in the community

30. Acknowledgements David Gray, PhD- A Wonderful Mentor Holly Hollingsworth, PhD- “King of SPSS” Kerri Morgan, MS OTR/ L- “Queen of Assistive Technology” Denise Curl- “Master of Data” The GrayLab Staff GrayLab MSOT and OTD Students My Parents James My Friends THANK YOU!! GO GRAYLAB!!