Understanding independent wheelchair transfers. Perspectives from stakeholders
PURPOSE: Transferring to and from the wheelchair is among the most important routine tasks for many wheelchair users. Transfers are also greatly affected by many personal and external factors. The purpose of this study is to investigate personal experiences, needs and concerns of wheelchair users in relation to wheelchair transfers performed in their everyday lives. METHODS: A series of focus groups and interviews were carried out with 11 wheelchair users and 4 occupational therapists. Data were analysed using a hybrid deductive and inductive approach of thematic analysis. RESULTS: The seven themes identified emphasize the importance and complexity of wheelchair transfers. Transfers were described as gateways to independence that grant access to life opportunities, and community participation. Nonetheless, transferring skills are difficult to acquire and the concept of correct technique, although really important, is often poorly defined. Wheelchair transfers can be further complicated by the characteristics of the individual, the presence of upper limb pain, fear of falling or the characteristics of the environment. Despite the importance of transfer training to improve safety and reduce the risk of overload injuries, only a few people receive dedicated advice from health professionals. Currently available assistive technologies were perceived as only partially successful in providing support to wheelchair users during the execution of transfers, especially when environmental constraints make the transfer more challenging. CONCLUSION: Due to their multifactorial nature, creating effective solutions to improve any aspect of wheelchair transfers will require a collaborative effort from users, clinicians, designers and other professionals. Implications for rehabilitation The ability to transfer independently is extremely important for many wheelchair users and can affect not only their personal and social lives, but also the way they perceive themselves and are perceived by others. The use of a correct transferring technique plays an important role in reducing the effort required to complete a transfer and decreases the risk factors for both falls and upper limb injury development. Unfortunately, few wheelchair users have access to in-person training to develop transferring skills. The remaining people rely on a combination of peer observation, personal research and simple trial and error to figure out the movement strategies that better suit their needs. Currently available assistive technologies are perceived by wheelchair users as only partially successful in providing support during the execution of transfers. Transfer boards and other devices are often described as only useful for basic transfers and for individuals with reduced, but still sufficient, upper limb function.