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European Journal of Physical and Rehabilitation Medicine 2020 April;56(2):160-8

DOI: 10.23736/S1973-9087.19.05920-3


language: English

Compliance with prescriptions for wheelchairs, walking aids, orthotics, and pressure-relieving devices in patients with traumatic spinal cord injury

Justyna FRASUŃSKA 1, 2, 3 , Piotr TEDERKO 1, 2, Piotr WOJDASIEWICZ 2, 4, Jerzy MYCIELSKI 5, Paweł TURCZYN 1, 2, Beata TARNACKA 1, 2

1 Department of Rehabilitation, First Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; 2 Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; 3 Department of Rehabilitation, Mazovian Rehabilitation Center (STOCER), Konstancin-Jeziorna, Poland; 4 Department of General and Experimental Pathology, Center for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland; 5 Department of Economics, University of Warsaw, Warsaw, Poland

BACKGROUND: The use of adaptive equipment (AE) is the basic indication for patients with spinal cord injury (SCI). Inappropriate decisions concerning the use of AE imply treatment results, patient confidence, and patient and state costs. The present study is the first analysis of the causes of non-compliance conducted in Europe with the provision of AE in SCI patients using Wielandt and Strong’s classification.
AIM: The aim of this study is to analyze of the causes of non-compliance in the process of providing AE to SCI patients.
DESIGN: Retrospective observational study.
SETTING: “STOCER” Masovian Rehabilitation Centre, Konstancin-Jeziorna, Poland.
POPULATION: Seventy-two patients with traumatic SCI 10 months after the completion of the acute and post-acute phases of inpatient rehabilitation.
METHODS: Wielandt and Strong’s classification was used to determine the causes of non-compliance with AE provisions and the present authors’ questionnaire with the World Health Organisation Quality of Life (WHOQOL-BREF) were used to identify the risk factors of non-compliance with AE provisions.
RESULTS: Non-compliance with prescribed AE provisions was reported in 34 (49.3%) of 69 study participants. Non-compliance was due to medical-related factors in 44.1%, client-related factors in 20.6%, equipment-related factors in 11.8%, and unspecific factors in 17.8% of cases. Non-compliance with AE provisions correlated with complete neurological deficit, preserved ability to walk (in case of wheelchairs), the presence of bedsores (in cases of lower extremity devices), low financial status, and lost ability to walk (in cases of AE for standing and walking). The highest percentage of non-compliance was noted for the provision of knee-ankle-foot orthosis (50%).
CONCLUSIONS: The most common causes of non-compliance with AE provisions include health status improvement in the patient and high cost of the device.
CLINICAL REHABILITATION IMPACT: These results can be helpful for more effective treatment planning and the avoidance of unnecessary reimbursement costs covered by the state and users.

KEY WORDS: Equipment and supplies; Compliance; Spinal cord injuries; Quality of life; Rehabilitation

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