A Qualitative Investigation of Arm Use Ergonomic Factors During Daily Activities of Manual Wheelchair Users

Research Objectives: To identify daily activities of manual wheelchair users (MWC) with spinal cord injury (SCI) that involve ergonomic factors1,2 which put the shoulder at risk of musculoskeletal pathology3-6.

Design: Semi-structured interviews, qualitative data analysis.

Setting: Tertiary medical center researchers performed video-based interviews.

Participants: Five adult MWC users with spinal cord injury (SCI) (4 men, 1 woman) aged 29-42 years with 3-19 years of MWC use. Participants were a volunteer sample from a larger longitudinal study who receive annual shoulder imaging and provide wearable sensor data during free-living. Participants for larger study were recruited from regional clinic patient lists.

Interventions: Not Applicable.

Main Outcome Measures: Participants were asked to describe in detail their daily activities with probing questions to identify activities requiring awkward postures, working with arms away from their bodies, loading, and repetition. Participants rated activity level of difficulty on an analog scale (1-10). Interviews were recorded and reviewed to identify themes.

Results: Arm use with awkward postures and loading were reported as frequent, routine activities. Repetitive loading occurred seasonally (shoveling/gardening). Repetitive household chores (vacuuming/yard) often required completion across multiple sessions due to high level of difficulty. High level of difficulty tasks also included transferring off low soft furniture, transferring to vehicles with a large seat-to-seat gap (plows/lawn mowers), cooking, dressing/undressing while in MWC, and propulsion on loose rock/uneven grass. Broken or inefficient assistive technology devices went unused, resulting in missed opportunities to reduce arm loading. Participants reported performing tasks with different techniques than they learned in acute care rehabilitation.

Conclusions: Data acquired was used to create an in-home biomechanical data collection protocol with high content validity. Findings highlight the importance of collecting data in the real-world to better understand daily demands and investigate ways to manage load and reduce awkward postures with training, technology, and health care policy.

Author(s) Disclosures: National Institutes of Health Funding (grant no. R01 HD84423)