The research community has traditionally concentrated on studying falls among ambulatory individuals suffering from ailments like multiple sclerosis or Parkinson’s disease. However, the incidence of falls among those who utilise wheelchairs or motorised scooters has been relatively underexplored, according to a recent publication in the journal Disability and Rehabilitation. This new study highlights the vulnerabilities that full-time users of these mobility aids face, including frequent falls, associated injuries, and persistent fear of subsequent falls.
The U.S. Census Bureau reports that approximately 5.5 million Americans depend on wheelchairs or motorised scooters for mobility. These individuals, particularly those using these aids for 40 or more hours a week, often face physical barriers that impede their movement and pose significant risks of falls. This insight comes from the work of Laura A. Rice, a professor of health and kinesiology at the University of Illinois Urbana-Champaign. Rice, alongside University of Illinois graduate student Sahel Moein and Elizabeth W. Peterson, a clinical professor of occupational therapy at the University of Illinois Chicago, has led this groundbreaking study.
Peterson explains that the factors contributing to falls among wheelchair and scooter users are multifaceted, encompassing physical, behavioural, environmental, and psychological elements. For instance, manoeuvring over uneven terrain, transitioning between different surfaces, or reaching beyond one’s stable base can significantly increase the risk of a fall. The repercussions of these falls vary, ranging from minor abrasions and bruises to more severe injuries like fractures. For those with reduced sensation, even minor injuries can escalate into significant complications, adds Rice.
This team of researchers revisited data from an earlier investigation involving 156 full-time wheelchair or scooter users who had reported at least one fall within the past three years. Through an online survey, participants provided detailed information regarding their demographic profiles, as well as their mental health status, including levels of anxiety and depression. The survey further explored the history and extent of their wheelchair or scooter usage, their experience with fall-prevention training, and the frequency of falls within the last year. Notably, a significant majority of respondents, 96% in fact, reported experiencing at least one fall in the preceding year, with 74% sustaining injuries and over 94% living with the fear of falling again.
The findings of this study underscore the complexity of the issues at hand. While falls are commonly associated with the elderly in the general population, this study found that younger wheelchair and scooter users reported a higher incidence of injuries, suggesting that riskier behaviours might be more prevalent in younger demographics. Peterson notes that while the study does not establish causation, there is an evident correlation between fear of falling and reduced physical activity, which can lead to a decline in physical capabilities and increased vulnerability to falls— a cycle she describes as a ‘disuse disability cycle’.
In response to these challenges, the researchers advocate for specific interventions to reduce the risk of falls among wheelchair and scooter users. These interventions should include an assessment of fall risk and comprehensive safety training. The team is currently piloting a targeted intervention designed to address these needs. The intervention employs self-management strategies, such as problem-solving and resource utilisation, physical exercises, transfer techniques, and wheelchair-handling skills, delivered by occupational or physical therapists. Participants also learn to develop proactive plans to manage falls should they occur.
As the findings of this study gain broader recognition, the hope is that caregivers and healthcare providers will become more attuned to the risks of falls in this demographic. Rice criticises a common misconception among healthcare providers who believe that merely providing a wheelchair or scooter is sufficient to prevent falls. She stresses the necessity for comprehensive training in using these devices and strategies to manage the accompanying challenges, highlighting the need for a paradigm shift in how mobility aids are integrated into those who rely on them. This research not only sheds light on the overlooked aspects of wheelchair and scooter use but also sets the stage for more informed, effective interventions that can enhance the safety and quality of life for millions of users.
More information: Sahel Moein et al, Factors associated with fear of falling and fall-related injuries among people who use wheelchairs and motorized mobility scooters: a cross-sectional study, Disability and Rehabilitation. DOI: 10.1080/09638288.2024.2365984
Journal information: Disability and Rehabilitation Provided by University of Illinois at Urbana-Champaign, News Bureau
