Differences in Wheelchair Satisfaction of Veterans by Body Mass Index

Eun-Kyoung Hong, B.S1,2; Diane M. Collins, PhD OTR/L1,2; Amol M. Karmarkar, MS 1,2; and Rory A. Cooper, PhD1,2
1 Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA
2 Department of Rehabilitation Science and Technology, University of Pittsburgh


Manual wheelchairs are designed for people of average weight and height. Therefore, people not of average weight or height would be anticipated to report their wheelchairs do not fit properly. Thus, wheelchair comfortable, ease of use, and safety would be reduced for these larger- or smaller-than-average persons. Study participants who used wheelchairs identified ease of use, comfort, and safety as vital to wheelchair selection. The purpose of this study was to examine how individuals with higher body mass indices rated their satisfaction with their wheelchairs. A slight, but insignificant, difference in satisfaction scores was found as participants with lower body mass had slightly higher wheelchair satisfaction scores than participants with higher body mass.


BMI; nursing home, manual wheelchairs; PIADS; QUEST, satisfaction


World-wide, approximately 100-130 million people use wheelchairs for their mobility. In the U.S., about 2.2 million Americans report using wheelchairs for their daily mobility [1]. More than 191,000 veterans use wheeled mobility devices, and 79% of these devices are manual wheelchairs [2]. Standard manual wheelchairs are designed for an average person 6 feet tall and 18 inches wide. Thus, people who are not of average size and do not have custom fit wheelchairs might have difficulty with their wheelchair fit, such as falling, sliding out, or component failures. Individualized wheelchair seating is selected to match the body shape and range of motion of a specific person; further, the seating is chosen offer comfort and function [3].

Differences in body mass result in differing wheelchair and seating needs. To select a wheelchair that fits appropriately, several measurements including body height and weight must be considered. The waist and pelvic widths and body component lengths are important to selecting arrange armrests and side guards. People who use wheelchairs have difficulty placing their arms in forward flexion to reach the pushrims when the seat is too wide or too long [4]. People with higher BMI may be less satisfied with their wheelchairs. Therefore, people with higher body mass may feel crammed into standard wheelchairs. On the other hand, people with low body mass who use wheelchairs may feel the armrests are too far apart or the standard seat leads to pressure ulcers [5]. As a result, we explored differences in wheelchair satisfaction based on calculated body mass indices (BMI).


Study participants were recruited using group presentations and IRB-approved flyers at a VA-affiliated nursing home in the Pittsburgh area. The data of 25 veterans who used manual wheelchairs (MWC’s) were analyzed this study. Based on their BMI, they were divided into two groups based on the median BMI value: Group 1 had a BMI of 24.3 or less; Group 2 had a BMI of 24.4 or more. The Psychosocial Impact of Assistive Devices Scale (PIADS) is a 26-item, self rating questionnaire for measuring individual perceptions of how assistive devices influence quality of their lives. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) is a 12-item, ordinal scale used to measure users’ satisfaction about device and service. Based on the QUEST 2.0 and PIADS, two questionnaire scores represented MWC satisfaction.


Twenty-five veterans who used MWC’s and resided in a nursing home participated in the study, with 12 participants in Group 1 (<24.3 BMI) and 13 in Group 2 (≥24.4 BMI). Participants in both groups were most likely to be male (84%), Caucasian (80%), and veterans (88%). Overall QUEST 2.0 satisfaction scores were slightly higher for Group 1 than Group 2. Mean satisfaction score of Group 1 score was 3.97 out of 5, and mean satisfaction score for Group 2 was 3.79. However, overall satisfaction of using wheelchairs was not significantly different (p=0.94). Satisfactions with device mean scores were 3.86 for Group 1 and 3.80 for Group 2. The two groups did not differ significantly (p=0.22). Ease of use and level of comfort are the most important MWC characteristics for 17 of the 25 participants (68%). Feeling safe and secure was the second most important MWC characteristics for 11 participants (44%).

Table 1. Consideration of Importance in Wheelchairs
  Group 1
(Lower BMI)
Group 2
(Higher BMI)
Easy to use
Repairs Servicing
Service Delivery
Professional service
Follow-up service
    Totals Percentage
The graph indicates differences in QUEST score between Group 1 (lower BMI) and Group 2 (higher BMI). The graph plots categories of QUEST on the horizontal axis and means of satisfaction scale on vertical axis. It shows scale of Group 1 is higher than Group 2 on satisfaction of dimension, weight, and safety. The rest of categories, which are adjustment, durability, easy to use, and comfort, show Group 2 participants are satisfied more.  Content for class "floatpicright" id "Fig1" Goes Here (Click for larger view)

Durability was important for 25% of Group 1 compared to only 7.7% of Group 2. Group 1 participants were more satisfied with the dimensions of their MWC’s (mean=4.1), weight (mean=3.8), safety (mean=4.0), compared to Group 2 participants. Group 2 participants were satisfied with ease in adjusting the wheelchair (mean=4.0), durability (mean=4.0), ease of use (mean=3.8), comfortable (mean=3.8) more than Group 1. However, both groups were most likely to use Invacare 9000 XT MWC’s.

The PIADS Scale is provides three subscale ratings as follows: competence, adaptability and self-esteem. Overall, Group 2 participants were more satisfied with their MWC’s than those in Group 1. Group 2 participants felt increasing of competence (mean=1.36), adaptability (mean=1.04), and self-esteem (mean=1.07). A point of differences is competence (0.4), adaptability (0.29), and self-esteem (0.54). 

Table 2. Comparison of PIADS scores by three categories





Group 1




Group 2





Twenty-five veteran participants who used MWC’s considered ease of use and comfort as the most important characteristics. The participants were > 60 years old and were ambulatory prior to moving to the nursing home. Using a MWC can be challenging for novice users, especially those with disabilities related to aging. Therefore, the ease of use of a wheelchair is vital. Comfort is also essential to those who use MWC’s, in part because transferring into and out of wheelchairs can be difficult for some.

Older age alone is enough to contribute to secondary problems such as pressure sores from sitting for long periods of time. Feeling safe and secure was the second most important factor to participants. These participants would not be mobile without their MWC’s. Falls do not only result in injury, but also have serious consequences. Physical injury and fear of falling cause those to who wheelchairs to participate in fewer activities. In turn, loss of strength, flexibility and mobility result, making physical injury and fear of falling more likely[6]. Most participants used the same MWC make and model - the Invacare 9000 XT. Because most of the chairs did not allow backrest angle or axle position adjustments, most participants did not have custom-fit wheelchairs.

Satisfaction with MWC dimensions, weight, and safety tended to be higher for Group 1, than Group 2. The larger the wheelchair frames, the safer the participants felt. Group 1 participants were more satisfied with MWC size compared to those in Group 2. Group2 participants are more satisfied with durability, ease of use, and comfort. Group 2 participants felt comfortable and easily used wheelchairs because of the size. The result of the PIADS is supported by QUEST. Group 2 participants had more positive Self-esteem, Competence and Adaptability scores than Group 1 though Group 1 in general felt more satisfied with their MWC’s. According to considering of all participants’ importance, Group 2 participants are more satisfied with their MWC’s. Limitation of this study was insufficient subjects to compare the individual answers of the QUEST 2.0 and PIADS for wheelchairs satisfaction. No significant differences were found between two groups. Future study should use a larger participate sample completing the QUEST 2.0 and PIADS to permit more detailed results about specific wheelchair characteristic satisfaction ratings.


  1. Cooper, R.A. (2004). VA Testimony of Rory Cooper, PhD before Congress.  September 5, 2006 [cited 2006 October 20]Available from: http://www.va.gov/OCA/testimony/hvac/040722RC.asp.
  2. Hubbard, S.L., Fitzgerald, S.G., Reker, D.M., Boninger, M.L., Cooper, R.A., Kazis, L.E. . (2006). Characterization of Veterans Prescribed Wheelchairs and Scooters by the VHA.   [cited 2006 October 23]Available from: http://www.hsrd.research.va.gov/meetings/2005/display_abstract.cfm? RecordID=416.
  3. Rader, J., Jones, D., Miller, L. L. (1999). Individualized wheelchair seating: reducing restraints and improving comfort and function.Topics in Geriatric Rehabilitation, 15 (2), 34-47.
  4. Cooper, R.A. (1998) Wheelchair Measurement in Wheelchair selection and configuration.New York, New York):R.A. Cooper
  5. Kernozek, T.W., et al. (2002). The effects of body mass index on peak seat-interface pressure of institutionalized elderly.Archives of Physical Medicine & Rehabilitation, 83 (6), 868-871.
  6. Kirchhoff, M., et al. (2002). Prevention of falls among the elderly.Ugeskrift for Laeger, 164 (44), 5137-5139.


The study is funded by Competitive Pilot Project fund (CPPF) Human Engineering Research Laboratories (Grant # H0001).

Eun-kyoung Hong,
7180 Highland Drive building 4,
2nd floor, East Wing, 151R-1
Pittsburgh, PA, 15206.


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