What is the most effective assessment for determining disability and requirement for a wheelchair (Mobility Aid)?

From the Guidelines

The most effective assessment for determining disability and requirement for a wheelchair is a comprehensive functional mobility assessment conducted by a physical therapist or occupational therapist, as recommended by the American Heart Association/American Stroke Association guidelines 1. This assessment should include:

• Evaluation of the person's ability to walk, stand, and transfer independently
• Assessment of balance, strength, and endurance
• Analysis of posture and gait
• Review of medical history and underlying conditions
• Consideration of home and community environment The therapist will use standardized tests like the Timed Up and Go (TUG) test, 6-minute walk test, or Berg Balance Scale as part of the evaluation, as these tests have been shown to be effective in assessing mobility and balance in stroke patients 1. To implement this, the individual should request a referral from their primary care physician to a physical or occupational therapist specializing in mobility assessments. The evaluation typically takes 1-2 hours and may require multiple sessions. This comprehensive approach is considered best practice because it provides an objective, multifaceted assessment of the person's mobility needs, taking into account both physical capabilities and environmental factors, which is in line with the recommendations for managing adult stroke rehabilitation care 1. It helps ensure that a wheelchair is prescribed only when truly necessary and that the most appropriate type of mobility aid is recommended, ultimately improving the patient's quality of life and reducing the risk of falls and other mobility-related complications 1.

From the Research

Assessment for Determining Disability and Requirement for a Wheelchair

The most effective assessment for determining disability and requirement for a wheelchair (Mobility Aid) can be evaluated through various physical-performance tests.

• The timed "up and go" test (TUG) is a simple and widely used clinical performance-based measure of lower extremity function, mobility, and fall risk 2.
• The 5-min walk and timed 5-step test can best separate the "able" from the "decreased," whereas the 50-ft-walk-test can best differentiate the "decreased" from the "disabled" 3.
• The TUG, Six-Minute Walk Test (6MWT), and gait speed are reliable outcome measures for use with people with Alzheimer's disease, with high test-retest reliability values and calculated minimal detectable change scores 4.
• A cut-off point for normal mobility can be identified using the timed 'up and go' test, with community-dwelling elderly women able to perform the test in 12 seconds or less 5.
• The L Test of Functional Mobility, a modified version of the timed "up & go" test, demonstrates excellent measurement properties for people with lower-limb amputations 6.

Key Findings

• The TUG is an appropriate tool for clinical assessment of functional mobility, even in healthy older adults, and is related to executive function 2.
• The 5-min walk, 5-step, and 50-ft-walk tests can be used to guide intervention or prevention programs for community-mobility function in older adults 3.
• Minimal detectable change scores for the TUG, 6MWT, and gait speed can be used to assess change in performance over time and the impact of treatment in people with Alzheimer's disease 4.
• Residential and mobility status are significant predictors of timed up and go test performance, and the test can be used as a screening tool to determine the need for in-depth mobility assessment and early intervention 5.
• The L Test is a reliable and valid measure of basic mobility skills for people with lower-limb amputations, with excellent interrater and intrarater reliability and minimal bias upon retesting 6.