Understanding Quality and Equity in Wheelchairs for Veterans

NCT01236170 | Completed Results DMC

• 1 other identifier: B7148-I
• Study Type: observational
• Target: 497
• Locations: 1 country
• Sites: 5

Brief Summary

The Department of Veterans Affairs (VA) provides wheelchairs to about 42,000 Veterans with SCI and more than 40,000 Veterans with amputated limbs (AL). Despite VA's efforts to remove financial and other barriers to the provision of wheelchairs to all Veterans who need them, preliminary evidence suggests that disparities exist in the quality of wheelchairs prescribed to racial minorities and low income Veterans with SCI or AL. The proposed project will provide important information to the VA about the quality and equity of wheelchairs provided to Veterans with SCI or AL, and it will identify the patient and provider factors associated with wheelchair provision. Because Veterans with SCI and AL are considered special disability populations, identifying and understanding these factors is a critical first step to developing interventions to increase the quality and equity of wheelchairs provided to all disabled Veterans.

Conditions

Spinal Cord Injuries; Amputees

Keywords

Amputees; spinal cord injuries; quality of life; satisfaction; healthcare disparities; wheelchairs

Outcome Measures

Primary Outcomes (1)

• Quality of Life Assessed With the Veterans RAND 12 Item Health Survey (VR-12)

  The investigators will assess QOL with the Veterans RAND 12 Item Health Survey (VR-12) and two additional physical function items designed for patients with SCI. Eight QOL domains are assessed, including physical functioning, vitality, role limitations due to physical problems, role limitations due to emotional problems, bodily pain, general health, social functioning, and mental health. The VR-12 has been used extensively with Veterans in a variety of health domains and has shown to be reliable and valid in ambulatory care populations (Cronbach's alpha= .83-.85). The additional two items were added because previous research demonstrated that existing measures of physical function in the VR12 are not appropriate to patients with SCI and are not able to reveal differences in physical function among SCI patients. The investigators assessed physical QOL and mental QOL, both scales range from 0 (worst possible outcome) to 100 (best possible outcome).

  Measured at baseline

Secondary Outcomes (4)

• Satisfaction With Wheelchair Service Delivery

  one time use, at baseline

• Satisfaction With Prescribed Wheelchair

  one time use, at baseline

• Participation in Society

  Measured at baseline

• Wheelchair Activity

  over a two week period following baseline

Study Arms (1)

Group 1

Veterans with spinal cord injury or amputated limbs who use a wheelchair as their primary source of mobility

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Participants will be recruited from the following four VA Medical Centers: the Philadelphia VA Medical Center in Philadelphia, PA; the Louis Stokes VA Medical Center in Cleveland, OH; The Hunter Holmes McGuire VA Medical Center in Richmond, VA; and the James J. Peters VA Medical Center in Bronx, NY. Recruitment will occur at SCI clinics, amputee clinics, wheelchair clinics, and patient registries.

You may qualify if:

• Veterans
• age \>18 years
• must have SCI with discernible neurological impairments or an amputated lower limb which results in the use of a wheelchair
• must be in power or manual wheelchair \>1 year and treated at the participating VAMC
• participants must use a manual or power wheelchair as their primary means of mobility (e.g., use wheelchair \> 40 hours/week
• and be non-ambulatory except for exercise purposes

You may not qualify if:

• In wheelchair less than 1 year
• Able to ambulate without the use of a wheelchair
• Other disorders requiring the use of a wheelchair (e.g., MS)

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (5)

James A. Haley Veterans' Hospital, Tampa, FL

Tampa, Florida, 33612, United States

Location

James J. Peters VA Medical Center, Bronx, NY

The Bronx, New York, 10468, United States

Location

Louis Stokes VA Medical Center, Cleveland, OH

Cleveland, Ohio, 44106, United States

Location

Center for Health Equity Research and Promotion

Pittsburgh, Pennsylvania, 15206, United States

Location

Hunter Holmes McGuire VA Medical Center, Richmond, VA

Richmond, Virginia, 23249, United States

Location

Related Publications (3)

• Hart-Hughes S, Highsmith MJ, Phillips SL, Groer S. A review of clinical outcome assessment instruments for gait, balance, and fall rish in persons with lower level extremity amputation. Topics in Geriatric Rehabilitation. 2014 Mar 31; 30(1):70-76.

  RESULT

• Myaskovsky L, Gao S, Hausmann LRM, Bornemann KR, Burkitt KH, Switzer GE, Fine MJ, Phillips SL, Gater D, Spungen AM, Boninger ML. How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury? Arch Phys Med Rehabil. 2017 Sep;98(9):1812-1820.e3. doi: 10.1016/j.apmr.2016.12.015. Epub 2017 Jan 25.

  PMID: 28130083 DERIVED

• Myaskovsky L, Gao S, Hausmann LRM, Bornemann KR, Burkitt KH, Switzer GE, Fine MJ, Phillips SL, Gater D, Spungen AM, Worobey L, Boninger ML. Quality and Equity in Wheelchairs Used by Veterans. Arch Phys Med Rehabil. 2017 Mar;98(3):442-449. doi: 10.1016/j.apmr.2016.09.116. Epub 2016 Oct 3.

  PMID: 27713075 DERIVED

MeSH Terms

Conditions

Spinal Cord Injuries; Personal Satisfaction

Condition Hierarchy (Ancestors)

Spinal Cord Diseases; Central Nervous System Diseases; Nervous System Diseases; Trauma, Nervous System; Wounds and Injuries; Behavior

Results Point of Contact

• Title: Dr. Larissa Myaskovsky
• Organization: VA Pittsburgh Healthcare System

Larissa.Myaskovsky@va.gov

4123602241

Study Officials

• Larissa Myaskovsky, PhD

  Center for Health Equity Research and Promotion

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 4, 2010
• First Posted: November 8, 2010
• Study Start: March 1, 2011
• Primary Completion: August 1, 2013
• Study Completion: September 1, 2013
• Last Updated: June 27, 2019
• Results First Posted: December 31, 2014

Record last verified: 2019-06

Locations

US (5)