Fall management among full time wheelchair users

Falls are a common health issue among full-time wheelchair users, however there is a lack of evidenced-based fall prevention and management strategies for wheelchair users. The main objective of this dissertation is to develop a fall management program for full-time wheelchair users. To develop a fall management program, a sequential exploratory mixed methods research study was implemented. The first phase of the study (Chapter 4) explored the circumstances surrounding falls, aftermath of falls, and fall recovery strategies among full-time wheelchair users. In phase 1, the qualitative interview data from 38 wheelchair users was analyzed. The results of phase 1 revealed many underlying factors associated with falls and potential fall prevention and recovery strategies including exercises to enhance sitting balance, wheelchair/transfer skill training, education on management of a variety of environmental hazards, education on wheelchair set-up/maintenance and the development of comprehensive fall recovery plans. In phase 2 (Chapter 5), a multifactorial fall management program, entitled Individualized Reduction of FaLLs (iROLL), was developed for full-time wheelchair and scooter users living with multiple sclerosis (MS) based on data obtained from phase 1 and previous literature. To examine the feasibility and preliminary efficacy of the intervention, participants underwent assessments to examine fear of falling, knowledge of fall prevention and recovery strategies, quality of transfer and wheelchair skills, and sitting balance before and after the 6-week intervention program. 13 wheelchair/scooter users living with MS (age: 59.2 10.3 years, 10 female) completed the post-intervention assessment following the 6-week intervention. The results revealed that fear of falling, which was evaluated by the spinal cord injury-fall concern scale, significantly decreased (p=0.022). Knowledge of fall prevention and recovery strategies, indexed by the fall management scale (p=0.008) and the fall prevention and management questionnaire (p=0.010), significantly improved. Finally, quality of transfer skills, evaluated with the transfer assessment instrument (p=0.034), improved significantly. No significant changes were found in wheelchair skills, as measured by the wheelchair skill test (p=0.551) or in sitting balance, evaluated with the function in sitting test (p=0.249). These preliminary results indicate that the iROLL program is effective in decreasing fear of falling, increasing knowledge of fall prevention and recovery, and improving quality of transfer skills. Future research is needed to examine the long-term impact of the program and the influence on fall frequency

Mobility on Demand (MOD) Sandbox Demonstration: Pierce Transit Limited Access Connections, Evaluation Report

This report presents the results of an independent evaluation of the Pierce Transit Limited Access Connections Demonstration project, part of the Federal Transit Administration (FTA) Mobility on Demand (MOD) Sandbox program. In this MOD Sandbox project, Pierce County Public Transportation Benefit Area Corporation (Pierce Transit), in partnership with Sound Transit and Lyft, implemented a first/last-mile system to provide access to rail stations and other destinations of interest within the Tacoma, Washington, metropolitan region. The one-year demonstration period began May 2018 and was extended seven months to the end of 2019, delivering 10,825 trips to 330 different users. The project increased transit use among users and reduced net vehicle miles traveled (VMT); however, it did not result in increased transit ridership overall. The service reduced parking lot use and travel and wait times for users. In addition, the project provided service to a local college, Pierce College Puyallup, which improved the perception of transit service quality and enabled greater mobility security through a guaranteed ride home. It also produced a number of lessons learned related to deployment regarding approaches to marketing, contracting, and cost management and operator negotiation