A systematic review on the pros and cons of using a pushrim-activated power-assisted wheelchair

Objective: To determine the (dis)advantages of transition to a power-assisted wheelchair, and derive the clinical implications for its use or prescription. Data sources: Relevant articles published prior to May 2012 were identified using PubMed, Cochrane Library, REHABDATA, CIRRIE and CINAHL databases. Review methods: Clinical or (randomized) controlled trials, published in a peer-reviewed journal, comparing power-assisted wheelchair use and hand-rim or powered wheelchair use were eligible. Data quality and validity were assessed by two reviewers independently using the Checklist for Measuring Quality developed by Downs and Black. Results: A systematic search yielded 15 cross-over trails with repeated measurement design and one qualitative interview. Methodological quality scored between 9 and 15 points out of the maximum score of 32. Ten studies measuring body function and structure reported reduced strain on the arm and cardiovascular system during power-assisted propulsion compared to hand-rim propulsion. Twelve studies measuring activities and social participation reported precision tasks easier to perform with a hand-rim wheelchair and tasks which require more torque were easier with a power-assisted wheelchair. Social participation was not altered significantly by the use of a hand-rim, powered or power-assisted wheelchair. Conclusion: Power-assisted propulsion might be beneficial for subjects in whom independent hand-rim wheelchair propulsion is endangered by arm injury, insufficient arm strength or low cardiopulmonary reserves. Also, subjects who have difficulty propelling a wheelchair in a challenging environment can benefit from power-assisted wheelchair use. Caution is warranted for the additional width and weight in relation to the usual mode of transportation and access to the home environment.