2023-11-15 12:30:23
If the adequate configuration and adjustment of the wheelchair and its seating system are important issues for people with neuromuscular diseases who depend on them, there are few recommendations to guide the health professionals who accompany them. A study carried out since 2021 collected the opinions of those concerned and provided initial insight.
Different pathologies, similar needs
The study was carried out using the Delphi method, a survey technique aimed at obtaining a consensus of experts on a specific subject, via successive anonymous questionnaires which are enriched as responses are provided. It thus gradually allows a common opinion to emerge.
A total of 74 participants answered four sets of questions on the criteria they consider important: 31 health professionals including occupational therapists, MPR doctors and orthopedic surgeons, and 21 electric wheelchair users with proximal spinal muscular atrophy type 2 and 22 with Duchenne muscular dystrophy.
Analysis of the responses showed that the needs were generally similar between these two groups of patients, thus making it possible to apply the same recommendations to adults with neuromuscular diseases.
Six common key criteria identified
Throughout the interviews, six key criteria reached consensus between the two groups of users and health professionals:
Comfort : the choice of the various elements from the seat to the shock absorbers of the chair is decisive in guaranteeing a comfortable sitting position over long daily periods.Joystick access : it is logical to have the right joystick in the right place to be able to drive, but the participants insist on having access to it whatever the position of the user in their chair (when tilting the seat, the inclination of the backrest etc.).Pain prevention : it is necessary to prevent them by avoiding any configuration of the seat causing fatigue or discomfort and to regularly question the pain linked to the chair.Stability : benefit from a seat that stabilizes the pelvis and trunk to encourage the use of the upper limbs as well as to secure outdoor movements.Pressure management (on the support points): have a seating system that allows pressure points to be distributed and immersed and be able to regularly change position with the chair to avoid bedsores.Electrical functions of the chair : have on your chair, all the electric seat functions, such as the electric tilt of the backrest, the seat tilt, etc., allowing you to mobilize for various health and everyday reasons.
Although most of the criteria achieved consensus among patients and professionals, the “electrical functions of the chair” criterion ultimately proved more controversial. In fact, patients attach much more importance to it than health professionals. This gap might be explained by cost constraints when prescribing equipment which would be taken more into account by professionals.
Source
Identification of wheelchair seating criteria in adults with neuromuscular diseases: A Delphi study
E. Dupitier, M. Voisin, C. Stalens et al.
PLoS One. 2023 Sep 8 ;18(9) :e0290627
1700052263
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