Authors: Loretta LIU Kit-ling, Walter POON Chun-wah, Jenny CHAN Shuk-wai, Kenneth TAI Chi-ming

Abstract

Adaptive seating aims to maintain proper body alignment and enhance one's ability to function in sitting. One of the major clienteles in need of adaptive seating are wheelchair users who spend most of the time in a sitting posture. For nearly two decades, the Spastics Association of Hong Kong has provided custom-made adaptive seating service to wheelchair bound children and adults.

The current trend of assistive technology is to achieve optimum outcomes for its end-users. Emphasis has been directed to the establishment of an evidence-based practice in assistive technology. In adaptive seating, evidence-based practice is founded on the objective outcome measures conducted by specialists together with the level of satisfaction as presented by its end-users.

A pilot trial of evidence-based practice was conducted in our seating centre. In a focus group interview with a team of experienced specialists in adaptive seating (including 2 physiotherapists, 2 occupational therapists and a prothetist-and-orthotist), the 'Seated Postural Control Measure' (SPCM) was selected as the "tool" for the objective outcome measure. The SPCM was used for evaluating changes on a 4-point scale across 22 items of alignment and 12 items of function before and after the prescription of adaptive seating. In addition, the 'Quebec User Evaluation of Satisfaction with Assistive Technology' (QUEST) was selected by the focus group for evaluating the satisfaction level (5-point scale) of the end-users on 12 items that are also weighted by the end-users in list of importance. A Chinese version of QUEST was developed and was administered to individual subjects through a semi-structured interview. All customers who had received a full set of adaptive seating during the 5-month period of the study were recruited as subjects for the objective outcome measure with the SPCM. Among these subjects, those with normal intelligence or mild grade mental retardation were recruited for the administration of the Chinese version of QUEST.

Twenty-eight subjects (18 males, 10 females, mean age = 34.0 ± 13.6) participated in the SPCM and 18 of them also completed the QUEST. The SPCM revealed significant improvements in both the 'Total Alignment Score' and the 'Total Function Score' after positioning the subject in the custom made adaptive seating (p<0.01, paired t-test). However, a greater amount of improvement was observed in the alignment than that in function (mean improvement in the 'Total Alignment Score' among the 28 subjects = 5.9 while that in the 'Total Function Score' = 0.82). Thus, an improvement in alignment did not necessarily lead to an improvement in function. Special considerations in compromising these two aspects are needed in the design of adaptive seating to achieve an optimum outcome.

Among the 12 items in QUEST, 'Comfort' was weighted by the end-users as the most important single factor in determining their overall satisfaction. It was interesting to find that the mean score in this factor was one of the two highest mean score in their comments to our products (mean score in 'Comfort' = 3.94 while the average mean scores = 3.56 ± 0.34). In addition, 'comfort' was also one of the two highest percentages among the 12 items This indicated that our seating products had adequately met the most important concern of our customers. On the other hand, 'Service Delivery' was the item that scored the lowest (mean score in 'Service Delivery' = 2.88). A number of subjects criticized on the long fabrication period between assessment and product delivery.

The preliminary findings revealed that the use of 'SPCM' together with a Chinese version of 'QUEST' can be employed as tools for establishing an evidence-based practice in adaptive seating.

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The paper has been submitted and presented in the Occupational Therapy Symposium 2002 organised by Hong Kong Occupational Therapy Association.