20. Wheelchair Accessibility of Your Practice

Actionable Nuggets for SCI (3rd ed., 2016)

The Problem:Man hand on wheelchair

The first concern in providing good care to a patient with a spinal cord injury is the accessibility of the office and examining space.  Recent research shows that 80-90% of primary care settings are compliant with accessibility requirements.

 

Actionable Nugget

Conduct an accessibility audit of your office space and procedures using attached Primary Care Accessibility Checklist.

 

Link to: Primary Care Accessibility Checklist

Evidence-based Best Practice:

You may think that your office is accessible, but in fact, only half the doctors who think they have accessible offices actually do – 45% of patients with spinal cord injuries report difficulty accessing their doctor’s office, and 5% can’t access it at all, due to stairs or other major barriers.

The most common barriers encountered once inside the practice include non-adjustable exam tables, lack of transfer or lifting equipment, the need to bring someone to assist with transfers or dressing/undressing.  Patients routinely report being examined in their wheelchairs, not being weighed, and missing out on routine screening and prevention.

The addition of an adjustable examining table and ceiling-track lift in one examining room benefits not only SCI patients, but many other patients in the practice as well. In most jurisdictions, accessibility is now the law, and there are published guidelines for accessibility of family physician’s offices, based on systematic reviews of literature and principles of universal design.

Key reference:

    Stillman, M. D., Frost, K. L., Smalley, C., Bertocci, G., & Williams, S. (2014). Health care utilization and barriers experienced by individuals with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 95(6), 1114–1126. http://doi.org/10.1016/j.apmr.2014.02.005

Additional References (chronological order):

    Milligan, J., Lee, J., Milligan, J., & Lee, J. (2016). Enhancing primary care for persons with spinal cord injury : More than improving physical accessibility Enhancing primary care for persons with spinal cord injury : More than improving physical accessibility, 0268(August). http://doi.org/10.1179/2045772315Y.0000000041
    Stillman, M., Williams, S., Stillman, M., & Williams, S. (2016). interdisciplinary primary care clinic for patients with spinal cord injury A more perfect union : Reports from an interdisciplinary primary care clinic for patients with spinal cord injury, 0268(September), 1–3. http://doi.org/10.1179/2045772313Y.0000000189
    Frost, K. L., Bertocci, G., Stillman, M. D., Smalley, C., & Williams, S. (2015). Pilot study, 52(6), 653- 662.
    Popplewell, N. T. A., Rechel, B. P. D., & Abel, G. A. (2014). How do adults with physical disability experience primary care ? A nationwide cross-sectional survey of access among patients in England, 1–9. http://doi.org/10.1136/bmjopen-2013-004714
    Bombardier, C.H., Fann, J.R., Tate, D.G., Richards, J.S., Wilson, C.S., Warren, A.M., Temkin, N.R., et al. (2012). An exploration of modifiable risk factors for depression after spinal cord injury: Which factors should we target? Archives of Physical Medicine & Rehabilitation, 93(5), 775-81.
    Bommbardier, C.H., Kalpakjian, C.Z., Graves, D.E., Dyer, J.R., Tate, D.G., & Fann, J.R. (2012). Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation. Archives of Physical Medicine & Rehabilitation, 93(10), 1838-45.
    Bonanno, G.A., Kennedy, P., Galatzer-Levy, I.R., Lude, P., & Elfstrom, M.L. (2012). Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabilitation Psychology, 57(3), 236-47.
    Hagen, E.M., Grimstad, K.E., Bovim, L., & Gronning, M. (2012). Patients with traumatic spinal cord injuries and their satisfaction with their general practitioner. Spinal Cord, 50, 527-32.
    Orenczuk, S., Silvinski, J., Mehta, S., & Teasell, R.W. (2012). Depression following spinal cord injury. Spinal Cord Injury Rehabilitation Evidence, Version 4.0, 1-32.
    Saunders, L.L., Krause, J.S., & Focht, K.L. (2012). A longitudinal study of depression in survivors of spinal cord injury. Spinal Cord, 50(1), 72-7.
    Wolfe, D.L., Legassic, M., McIntyre, A., Cheung, K., Goettl, T., Walia, S., Loh, E., et al. (2012). Bladder health and function following spinal cord injury. Spinal Cord Injury Rehabilitation Evidence, Version 4.0: 1-143.
    Hoffman, J.M., Bombardier, C.H., Graves, D.E., Kalpakjian, C.Z., & Krause, J.S. (2011). A longitudinal study of depression from 1 to 5 years after spinal cord injury. Archives of Physical Medicine & Rehabilitation, 92(3), 411-8.
    Kalpakjian, C.Z., Houlihan, B., Meade, M.A., Karana-Zebari, D., Heinemann, A.W., Dijkers, M.P., Wierbicky, J., et al. (2011). Marital status, marital transitions, well-being, and spinal cord injury: An examination of the effects of sex and time. Archives of Physical Medicine & Rehabilitation, 92(3), 433-40.
    Krause, J.S., Saunders, L.L., Bombardier, C., & Kalpakjian, C. (2011). Confirmatory factor analysis of the Patient Health Questionnaire-9: A study of the participants from the spinal cord injury model systems. Archives of Physical Medicine and Rehabilitation, 3(6), 533-40; quiz 540.
    Kennedy, P., Sherlock, O., McClelland, M., Short, D., Royle, J., & Wilson, C. (2010). A multi-centre study of the community needs of people with spinal cord injuries: The first 18 months. Spinal Cord, 48(1), 15-20.
    Arrol, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., Falloon, K., et al. (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine, 8(4), 348-53.
    Burns, S.M., Boyd, B.L., Hill, J., & Hough, S. (2010). Psychosocial predictors of employment status among men living with spinal cord injury. Rehabilitation Psychology, 55(1), 81-90.
    Craig, A., Tran, Y., & Middleton, J. (2009). Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord, 47(2), 108-14.
    Migliorini, C.E., New, P.W., & Tonge, B.J. (2009). Comparison of depression, anxiety and stress in persons with traumatic and non-traumatic post-acute spinal cord injury. Spinal Cord, 47(11), 783-8.
    Migliorini, C., & Tonge, B. (2009). Reflecting on subjective well-being and spinal cord injury. Journal of Rehabilitation Medicine, 41(6), 445-50.
    Pang, M.Y., Eng, J.J., Lin, K.H., Tang, P.F., Hung, C., & Wang, Y.H. (2009). Association of depression and pain interference with disease-management self-efficacy in community-dwelling individuals with spinal cord injury. Journal of Rehabilitation Medicine, 41(13), 1068-73.
    Sakakibara, B.M., et al. (2009). A systematic review of depression and anxiety measures used with individuals with spinal cord injury. Spinal Cord, 47(12), 841-51.
    Graves, D.E. & Bombardier, C.H. (2008). Improving the efficiency of screening for major depression in people with spinal cord injury. Journal of Spinal Cord Medicine, 31(2), 177-84. http://www.ncbi.nlm.nih.gov/pubmed/18581665
    Migliorini, C., Tonge, B., & Taleporos, G. (2008). Spinal cord injury and mental health. Australian and New Zealand Journal of Psychiatry, 42(4), 309-14.
    McDermott, S., Moran, R., Platt, T., Issac, T. Wood, H., & Dasari, S. (2005). Depression in adults with disabilities, in primary care. Disability Rehabilitation, 27(3), 117-23.
    Bombardier, C.H., et al. (2004). Symptoms of major depression in people with spinal cord injury: implications for screening. Archives of Physical Medicine & Rehabilitation, 85(11), 1749-56. http://dx.doi.org/10.1016/j.apmr.2004.07.348
    Kroenke, K., Spitzer, R.L., & Williams, J.B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-13. http://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x
    Krause, J.S., Kemp, B., & Coker, J. (2000). Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators. Archives of Physical Medicine & Rehabilitation, 81(8), 1099-109. http://dx.doi.org/10.1053/apmr.2000.7167
    Consortium for Spinal Cord Medicine. (1998). Depression following spinal cord injury: A clinical practice guideline for primary care physicians. Paralyzed Veterans of America, Washington DC. http://www.pva.org/site/News2?page=NewsArticle&id=7649
    Hartkopp, A., et al. (1998). Suicide in a spinal cord injured population: its relation to functional status. Archives of Physical Medicine & Rehabilitation, 79(11), 1356-61. http://dx.doi.org/10.1016/S0003-9993(98)90227-1
    DeVivo, M.J., et al. (1991). Suicide following spinal cord injury. Paraplegia, 29(9), 620-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1787986