title: A clinical trial of a rehabilitation expert clinician versus usual care for providing manual wheelchairs.
abstract: OBJECTIVE
  To determine the effect of differing methods of dispensing wheelchairs.
  
  
  METHODS
  Quasi-experimental by day of week.
  
  
  METHODS
  Department of Veterans Affairs Medical Center.
  
  
  METHODS
  Eighty-four community-dwelling, cognitively intact patients prescribed a standard manual wheelchair.
  
  
  METHODS
  A multifactorial intervention consisting of an expert physical/occupational therapist who used a scripted evaluation that included an evaluation based on medical record review and self-reported and physical performance measures; individualization of the wheelchair and initiation of orders for additional occupational/physical therapy, equipment, or home modifications as needed; multimodal patient education; and telephone follow-up at 3 and 6 weeks.
  
  
  METHODS
  The primary outcome was amount of wheelchair use. Secondary outcomes were shoulder pain, wheelchair comfort and confidence, and home modifications.
  
  
  RESULTS
  The intervention group had significantly greater wheelchair use than usual care at 2 weeks, 3 months, and 6 months (P=.01). Wheelchair use declined monotonically over time for the entire study sample (P<.001). There were no significant differences between the two groups in shoulder pain, wheelchair comfort or confidence, or home modifications.
  
  
  CONCLUSIONS
  New wheelchair owners used the wheelchair more often if they received it from an expert therapist using a multifactorial intervention.
authors.affiliation: Physical Medicine and Rehabilitation Service, Duke University Medical Center, Durham, North Carolina, USA. hoeni001@acpub.duke.edu
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Landerman
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Shipp
authors.forename: Carl
authors.initials: C
authors.lastname: Pieper
authors.forename: Carl
authors.initials: C
authors.lastname: Pieper
authors.forename: Margaret
authors.initials: M
authors.lastname: Richardson
authors.forename: Nancy
authors.initials: N
authors.lastname: Pahel
authors.forename: Linda
authors.initials: L
authors.lastname: George
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D002908:Chronic Disease / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009657:North Carolina; D009788:Occupational Therapy; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D011361:Professional Competence; D012044:Regression Analysis; D020069:Shoulder Pain / Q000453:epidemiology; D014910:Wheelchairs / Q000706:statistics & numerical data*