Wheelchair use by residents of nursing homes: effectiveness in meeting positioning and mobility needs

The purpose of this study was to assess the effectiveness of wheelchairs purchased by Nebraska Medicaid for residents of nursing homes. Effectiveness was defined as (a) meeting therapist goals, (b) matching the request form wheelchair specifications, (c) conforming to accepted physical or occupational therapy practices for positioning and mobility, and (d) degree of user satisfaction. The authors completed a 16-item evaluation form for each of 42 subjects. Competent subjects completed a satisfaction questionnaire. Changing postural alignment (67% of subjects), mobility (43%), risk for pressure ulcers (38%), and comfort status (31%) were most frequently included in therapist goals. For 21 subjects, one or more therapist goals for wheelchair use were not met. The most frequently unmet goal was independent propulsion for a specified distance or destination within the facility (15 out of 18 subjects having that goal). Ninety-three instances of inadequate wheelchair equipment were discovered. Twenty subjects were at increased risk for pressure ulcers. Frame or seating dimensions did not match those of 19 subjects in one or more ways. Seat frames (27 subjects), seat cushions (24), and trunk supports (22) were most frequently inadequate. For 67% of the subjects, all wheelchair frames and components were of the same type or style as those specified on request forms, and when they were not, the deviations from request specifications were minor. Twenty-six percent of the subjects owned wheelchair components purchased by Medicaid that were not in use, but in only one instance was this an actual wheelchair frame. Eighty-six percent of the subjects who completed the questionnaire were mostly satisfied with their wheelchairs. Overall, the wheelchairs were meeting many subject needs and therapist goals. Lack of adequate follow-up and follow-along services may have contributed to the frequency of problems discovered.