Evaluating the Impact of Wheelchair Type on Mobility and Physical Independence in Spinal Cord Injury Patients

Introduction: Spinal cord injury (SCI) significantly impacts motor function and independence, leading many individuals to rely on wheelchairs for mobility. This study aims to compare the effectiveness of manual versus motorized wheelchairs on mobility and independence outcomes one-year post-injury.

Methods: We analyzed 1,445 adult patients from the National Spinal Cord Injury Model Systems (SCIMS) Database from 2011 to 2021 who used a wheelchair one-year post-SCI. Propensity score matching was employed to control for potential confounding variables, including age, race, sex, body mass index (BMI), American Spinal Injury Association (ASIA) motor score at discharge, Functional Independence Measure (FIM) motor score at discharge, history of spine surgery, presence of vertebral injuries, and any other associated injuries. The outcomes measured included the Craig Handicap Assessment and Reporting Technique (CHART) mobility score, CHART independence score, and ASIA motor score at one-year post-discharge.

Results: After propensity score matching, a total of 452 patients were included in the analysis, with 226 using manual wheelchairs and 226 using motorized wheelchairs. The average age of the cohort was 40.6 and 79.0% of the cohort was male. Motor vehicle accidents (n=172, 38.1%), and falls (n=136, 30.1%) accounted for the majority of injury etiologies. At discharge, the average ASIA motor score was 41.8 (STD: 19.6), and the average FIM motor score was 41.4 (STD: 16.7) indicating significant motor deficits. At one-year follow-up, there were no significant differences in CHART mobility scores (β: -2.64, p = 0.243; 95% confidence interval [CI]: [-7.06, 1.79]) between the two groups. Additionally, no significant differences were observed in CHART independence scores (β: 4.89, p = 0.123; 95% CI: [-1.33, 11.1]). The analysis of ASIA motor scores revealed no significant difference (β: 1.07, p = 0.275; 95% CI: [-0.85, 2.99]).

Conclusion : Our findings suggest that there is no significant difference in mobility and independence outcomes at one-year post-injury between users of manual and motorized wheelchairs. This indicates that individual preferences should guide wheelchair selection in the rehabilitation process for patients with spinal cord injury.