Perception of autonomy among people who use wheeled mobility assistive devices: dependence on environment and contextual factors

Abstract

Purpose

To evaluate and compare the perceived autonomy of people using wheeled mobility assistive devices (WMADs) in five community-based environments. To evaluate how personal, environmental, and assistive device-related factors impact the perceived autonomy of WMAD users.

Method

A study-specific questionnaire was used to evaluate perceived satisfaction of WMAD users with their autonomy in five environments: the Home Environment, Buildings Outside of the Home Environment, Outdoor Built Environment, Outdoor Natural Environment, and Transportation. For each environment, participants rated their satisfaction with autonomy about 15 personal, environmental, and assistive device-related factors. Qualitative perceptions were also collected with open-ended questions.

Results

Participants included 123 full- and part-time community-dwelling WMAD users. Participants’ overall satisfaction with autonomy in the Outdoor Natural Environment was statistically significantly lower compared to the other four environments (p < 0.05). In all environments, the top factor respondents were most satisfied with was WMAD ease of use. Their least satisfaction was when negotiating stairs, curbs, or obstacles in the Home, Buildings Outside of the Home, and the Outdoor Built Environments. In the Outdoor Natural Environment, the most dissatisfaction was with manoeuvring on different terrains. Responses to open-ended questions supported the quantitative findings and highlighted the effects of various factors on autonomy (e.g., subject-environment familiarity).

Conclusions

WMAD users reported the greatest restriction to their autonomy in outdoor environments. Different context-specific factors were found to impact autonomy in different environments. Understanding how environment-specific contextual factors contribute to overall perception of autonomy may inform the development of future strategies to overcome identified limitations and challenges.

Implications for Rehabilitation

• Wheeled mobility assistive device (WMAD) users experienced the highest autonomy in their home environments, specifically, when having access to home modification services.

• WMAD users had the lowest autonomy in the outdoor natural environment, with manoeuvrability on different terrains being the main predictor of the overall satisfaction with autonomy in this environment.

• Environment-specific contextual factors with significant impacts on perceived autonomy were identified that can inform the design and development of future WMADs (e.g., distance travelled, safety).

Keywords:

• Personal autonomy
• community participation
• mobility limitation
• wheelchairs
• environment
• user satisfaction

Disclosure statement

All the authors confirm that they have no conflict of interest, financial or otherwise.

Additional information

Funding

This work was supported by a Partnership Grant from the Social Sciences and Humanities Research Council of Canada [grant # 895-2013-1021] for the Canadian Disability Participation Project www.cdpp.ca, Canadian Institutes of Health Research [Grant # New Investigator Award], Canada Research Chair in Rehabilitation Engineering Design,Natural Sciences and Engineering Research Council of Canada [Grant # RGPIN-2019-05458], Canadian Institutes of Health Research [Grant # New Investigator Award].