OBJECTIVE: To identify the outcomes of power mobility devices for middle-aged and older adult users, and to critically appraise the research evidence.
DESIGN: Systematic review of primary source studies involving adults aged 50 and over using power mobility devices (1996-2007). Articles were (i) mapped to the Taxonomy of Assistive Technology Device Outcomes, which describes categories of impact of assistive devices from the vantages of effectiveness, social significance, and subjective well-being; and (ii) appraised using the Grading of Recommendations, Assessment, Development, and Evaluation criteria.
RESULTS: This review retained 19 studies and identified 52 different categories of impacts of power mobility devices spanning the three vantages of the taxonomy. The coverage of outcome dimensions was not as extensive for adults age 50 and over as it was for mixed-age groups. Most of the research designs were assigned very low evidence grades. Three studies were low to moderate in quality of evidence, among which one was a randomized trial.
CONCLUSIONS: A vast array of potential impacts of powered mobility devices have been described in the last decade. The level of quality of this evidence is improving, but most of these studies were not designed to verify causal relationships, and this is largely responsible for the absence of unequivocal evidence for directly attributing benefits to devices themselves and for quantifying relationships between power mobility device intervention and outcome. To raise the level of evidence about power mobility device interventions in older adults, studies are needed that use prospective designs, better-defined user groups, and well-grounded conceptual frameworks for measuring interventions and outcomes.
Auger, Claudine and Louise Demers, Isabelle Gelinas, Jeffery Jutai, Marcus J. Fuhrer, Frank DeRuyter
Disease Category: Health care of older people
Disease Name: N/A
Age Range: 50 - 100
Sex: Either
Nature of Intervention: Device
- None
- Systematic review of outcomes measured in trials
- Systematic review
Inclusion Criteria
The present review considered studies with a variety of research designs, ranging from randomized control trials to case studies, without any restriction for measurement methods. Inclusion criteria were (i) primary source studies, (ii) at least one adult age 50 and over who used a PMD, and (iii) a separate description of outcome results for PMD users. Studies that covered multiple device types were retained if outcomes were separately described. Studies that focused on experimental PMD prototypes or employing dummies were excluded.
Search Methods for Identifying Studies
Using three Web data bases (Embase, PsycINFO, and Medline), the search was limited to articles published in French or English between 1996 and June 2007. The search strategy relied on iterative strategies because no specific key words were available for PMDs throughout the period covered. For each database, a core set of key words were identified on the basis of a few eligible articles. For example, Medline key words were: *selfhelp devices/or wheelchairs/or dependent ambulation or mobility limitation. Because there is no specific key word for electric wheelchairs or scooters in this database, these results were combined with electric power supplies/or electricity. To capture any references to PMDs, titles and abstracts were also searched with the natural terms power$ wheelchair$ or power$ mobility or motor$ wheelchair$ or (electric and wheelchair$) or (scooter$ and (electric$ or motor$ or power$)). The search strategy located 445 references. After screening, 50 full articles were obtained and read independently by two reviewers to finalize the selection process. The two reviewers discussed their results and came to a consensus to determine which studies to keep for analysis.
Appraisal of the Evidence
Selected studies were evaluated and graded according to the methods set out by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) working group. Data were extracted using a standard form (available on request from the authors). The appraisal of the quality of the evidence was performed by one reviewer for multiple case studies and cross-sectional descriptive studies. Both reviewers assessed studies that involved group comparison across time (e.g., using a pre/post design) or with controls (e.g., a randomized trial). For studies reporting more than one primary outcome, the outcome with the highest level of evidence was considered, as suggested by the GRADE group. Discrepant judgments between the two reviewers were discussed and resolved.
A total of 19 studies involving qualitative, mixed methods, and quantitative approaches were kept for analysis.