The WhOM The Wheelchair Outcome Measure Table of contents 1. Introduction (description and applications).....................2 2. Development of the WhOM.........................................3 3. Administering the WhOM..........................................4 4. Scoring.........................................................5 5. Frequently asked questions (FAQs)...............................6 6. Research.......................................................10 7. Using the WhOM - examples......................................12 8. The WhOM.......................................................26 Acknowledgements Funding for the development and testing of the WhOM was provided by the following organizations: * *BC Medical Services Foundation WhOM Manual Version 7 December 8 2015 1
Transcript
The WhOM
The Wheelchair Outcome Measure
Table of contents
1. Introduction (description and applications)................................................................................2
2. Development of the WhOM..........................................................................................................3
3. Administering the WhOM............................................................................................................4
7. Using the WhOM - examples......................................................................................................12
8. The WhOM...................................................................................................................................26
Acknowledgements
Funding for the development and testing of the WhOM was provided by the following organizations:
*
*BC Medical Services Foundation
WhOM Manual Version 7 December 8 2015 1
1. Introduction (description and applications)
Provision of a wheelchair has immediate intuitive benefits, however, it can be difficult to evaluate which wheelchair and seating components best meet an individual’s needs. As well, funding agencies now prefer evidence of outcome and therefore measurement upon prescription of a wheelchair or its components is essential to demonstrate the efficacy of intervention. As no existing tool provides individualized goal oriented measure of outcome after wheelchair prescription occupational therapists and researchers have created the Wheelchair Outcome Measure (WhOM). The WhOM is a client-specific wheelchair intervention measurement tool. It is designed to primarily identify desired outcomes at a participation level, but also acknowledges concerns about body structure and function.
The Client-Centred Approach
Typical of many rehabilitation measures, most wheelchair related body function and activity outcome tools reflect clinicians’ concerns (Kramer, 1997) rather than determining whether the individual goals of wheelchair users are being met. An ideal method of determining what clients want or want to do is to ask them (Wright, et al, 1994). Identification and evaluation of client-specific outcomes is a relatively recent trend in outcome measurement. It provides a relevant and personalized approach to determine the success of an intervention based on a client’s specific needs. This flexible format enables the instrument to cover a wide range of disorders or physical impairments (Law et al, 1990) and ensures that only the most relevant questions or domains are included (Streiner & Norman, 1995).
It has been suggested that goal oriented measures are required to provide a comprehensive approach to outcome measurement in the field of assistive technology (Day, et al, 2002). Studies have also shown that a client-centred approach can provide a reliable, valid and responsive measure of outcome after intervention (Carpenter, et al, 2001; McColl, et al, 2000; Tugwell et al., 1987). This approach is so appealing to clinicians and researchers that many have used or modified existing client-centred instruments such as the Canadian Occupational Performance Measure (COPM) (Barlow, 1998; Miller Polgar, et al, 2000; Mills et al, 2001; Reid, et al, 1999) or the Goal Attainment Scale (GAS) (Barlow, 2000; Kirby & Smith, 2001) to assess the needs of wheelchair users. However, clinical experience and published evidence (Barlow, 1998) suggest that these instruments are not specific enough to capture information that is important to wheelchair prescription and can take too long to use.
The importance of ‘participation’ outcomes
Although there are a number of assessment tools that evaluate body function and structure issues, there is no wheelchair outcome measure that focuses on participation concerns, which represents the pinnacle of the World Health Organization’s International Classification of Function (ICF) (WHO, 2001). The WhOM enables therapists and their clients to identify participation-oriented goals related to wheelchair use. The outcomes, in turn, can be used to guide intervention and to determine the success of intervention.
A recent review (Mortenson et al. 2008) on outcome measures for wheelchair users determined that there were 11 measures that looked at participation level outcomes. The WhOM was found the only instrument that uses items nominated and weighted by the client. As such, it could potentially, but not necessarily, include items from all participation domains, because the rater solicits information that is participation focused. In addition, the WhOM belongs to a unique category, because it captures the satisfaction with performance of activities or participation when using a wheelchair.
WhOM Manual Version 7 December 8 2015 2
Wheelchair funding
Data from this tool can be presented to funding agencies as evidence to support therapists in justifying prescription of appropriate, often expensive, wheelchair systems. Given the cost of wheelchair equipment, this tool can facilitate prescription of the right device at the right time. The result is an improvement in the users’ ability to participate and a containment of costs incurred by abandonment of inappropriate equipment.
Who can this tool be used with?
This tool can be used with any new or existing wheelchair user receiving the following wheelchair seating interventions:
Education Wheelchair setup Cushion or other add-on device New or different wheelchair components
2. Development of the WhOM
The WhOM was developed using in-depth qualitative interviews with a heterogeneous sample of adult wheelchair users (N=16), family members of wheelchair users (N=5) and an international group of occupational and physical therapists (N=7) with experience prescribing wheelchairs and seating systems. These knowledgeable informants were selected because they were articulate and known for their ability to reflect upon their own experience. The wheelchair informants came from a broad range of age, diagnostic, and disability groupings.
All informants participate in at least 2 interviews. The initial 90-minute interview focused on what the wheelchair user did in their chairs, how their activities would be altered if they did not have a wheelchair system or if the system did not fit correctly. Questions explored the environmental context of activity participation. Additional questions exploring the order of content, structure and format of the tool were included for the clinician informants. After initial interviews and data analysis the informants were contacted a second time in order to establish data credibility of the interpretations and conclusions of the analyses. A third interview was conducted withed selected informants in order to refine the final version of the tool.
The data from the first interviews were coded using techniques consisting of open, axial and selective coding and a conditional matrix consisting of amalgamated codes was generated. The study team identified and created individual items and/or categories of items based on the domain of interest identified. A pool of items was generated and an ‘initial instrument’ was constructed.
Analyses revealed that; body response to the chair (pain/discomfort/skin condition), as well as activity and participation were considered essential. This suggests a tool structured using World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) conceptual model was useful in framing the questionnaire. Another prominent theme, “At home” versus “In the community” activities, was also revealed.
In a recent study (Auger et al. 2010) the WhOM was adapted and translated into French in order to conduct telephone interviews with middle-aged and older adults. Since reliability and validity are context- and population-specific attributes, the translation of a measurement tool and the modification of the assessment
WhOM Manual Version 7 December 8 2015 3
format required additional psychometric testing to verify the equivalence of the measure. The objective of the study was to examine the properties of the French version of the WhOM in relation to reliability and applicability for telephone administration, as well as the construct validity of the WhOM for French- and English-speaking middle-aged and older Power mobility device users (PMD).
The authors recruited two independent cohorts: (i) a prospective cohort (n = 40) to estimate test-retest reliability and to determine the applicability of the telephone format, and (ii) a cross-sectional cohort to examine construct validity with 3 groups: (a) people waiting for a first power mobility device (n = 44); (b) initial users (n = 35; 1–6 months); and (c) long-term users (n = 39; 12–18 months). The authors found that the WhOM is a stable, valid and applicable measure for telephone administration with older power mobility device users. It is moderately linked to satisfaction with the device and to the psychosocial impact of the device, and therefore complements rather than replaces those measures.
3. Administering the WhOM
The WhOM is a two part questionnaire which can be administered by a therapist in under 30 minutes. The first part consists of a semi-structured interview and the second part consists of structured questions.
In Part I, the client’s concerns are validated and the therapist and client then collaborate to express them as goals.
In Part II, the client answers some questions about their comfort, satisfaction with positioning and skin breakdown.
a. Establishing participation outcomes
Process:
In part I, the client identifies participation goals both in the home (question 1) and in the community (or outside the home) (question 2). The client then rates perceived ‘importance’ of this goal and ‘satisfaction’ with their current performance of this activity. In part II, the client answers three questions and the results are recorded on the scoring sheet. Intervention planning can then proceed based on the outcomes established with the WhOM. Possible interventions could include changes to the wheelchair, wheelchair seating, the environment or client/care giver education. Following intervention, the WhOM is re-administered. By comparing pre and post scores, an outcome score can be calculated.
b. Suggested administration Script
To ensure the client has understood the importance scoring system the therapist may wish to follow up with these questions.
(The therapist can verify the number selected by the participant with the following sentences: 0: You chose 0; does that mean it is not important at all?1-3: You chose 2; does that mean it is not very important?4-6: You chose 5; does that mean it is more or less important?7-9: You chose 8; does that mean it is quite important?10: You chose 10; does that mean it is extremely important?)
WhOM Manual Version 7 December 8 2015 4
On a scale ranging from 0 to 10, 0 meaning not satisfied at all and 10 meaning extremely satisfied, how satisfied are you with your current level of performance of this activity?
To ensure the client has understood the satisfaction scoring system the therapist may wish to follow up with these questions.
(The therapist can verify the number selected by the participant with the following sentences:0: You chose 0; does that mean you are not satisfied at all?1-3: You chose 2; does that mean you are not very satisfied?4-6: You chose 5; does that mean you are more or less satisfied?7-9: You chose 8; does that mean you are quite satisfied?10: You chose 10; does that mean you are extremely satisfied?)
c. Re-administering the WhOMWhen an intervention is provided, it is important to allow a trial period to allow the individual to accommodate to the intervention prior to re-administration of the WhOM. When using the WhOM clinically we recommend that the clients see their previous scores, if applicable. There is evidence that informed response (previous response available) and blind response (previous response not available) decreases the sample size needed to detect changes in clinical trials. Guyatt and colleagues (1985) conducted a research using a quality of life questionnaire in two groups of clients. The participants included 43 stable subjects with chronic cardiorespiratory disease, and 13 patients with chronic lung disease. Large improvements in dyspnea, fatigue, and emotional function were seen in patients which was significantly different between blind and informed groups. It is important to note that this method (informed response) is applicable for clinical trials but showing the previous score might make bias if we are evaluating the intervention in a research.
4. ScoringThere are several ways to score the WhOM. Each method provides slightly different information and there are advantages and disadvantages to each. Different ways of scoring include:
Mean satisfaction = the sum of all satisfaction scores ÷ number of goals. Total satisfaction = the sum of all satisfaction scores for each goal
Mean satisfaction × importance = the sum of the individual importance x satisfaction of all goals ÷ number of goals.Total satisfaction × importance = the sum of the individuals importance x satisfaction scores of all goals
Method Advantages DisadvantagesMean satisfaction Simple to calculate. Easy to understand. On a
standardized scale (0-10) Allows comparison of people with different numbers of goals.
Omits the weighting of importance (but just by bringing up a goal it has some importance)Regression to the mean. Extremes of satisfaction with goals are obscuredMight miss change in individual items
Total satisfaction Not losing the contribution of information related to individual goals
If used for research purposes the number of goals has to be set at a standard number.
Mean satisfaction × importance
On a standard scale from 0-100. Allows comparison of people with different numbers of goals. It is weighted by the importance score, which guides decisions regarding device or set up changes.For research purposes, should have a better distribution of scores.
Regression to the mean. Extremes of satisfaction with goals are obscuredMight miss change in individual items
WhOM Manual Version 7 December 8 2015 5
Total satisfaction × importance
Not losing the contribution of information related to individual importance, satisfaction of individual goals.
If used for research purposes the number of goals has to be set at a standard number.
The WhOM allows the therapist to obtain a numerical value representing a change in the client’s satisfaction following intervention.
Process:
In part I, the importance and satisfaction scores are multiplied. This score is then added to the scores obtained for all of the other activities to obtain a total baseline score.
In part II, these scores are stand-alone values; the single item 0-10 rankings are used to assess change for each of the comfort, positioning and skin breakdown items. The score for Q1 from time point 1 will be compared to Q1 in time point 2 with the equation:
This will be done for Q1, Q2 and Q3a. Scores for questions Q1, Q2 and Q3a are not totalled.
Intervention planning can then proceed under the guidance of the WhOM.
Following intervention, the WhOM should be re-administered. An outcome score is calculated by comparing pre and post-intervention scores.
Interpretation:
In part I, the results can be interpreted as total of importance x satisfaction (T2) – total of importance x satisfaction (T1). If this value is a positive integer, the client has experienced an increase in satisfaction with their use of the wheelchair in their home or community.
In part II, the results can be interpreted as:Q1 and Q2: Change in scores from T2 – T1. If this value is a positive integer, then the client has experienced an increase in their satisfaction with either their comfort (Q1) and/or body positioning (Q2). Q3a: Change in scores from T2 – T1. If this value is a positive integer, then the client has experienced an increase in severity of skin breakdown. The desired outcome for Q3a is a negative integer, that is, a decrease from T1 to T2.
5. Frequently Asked Questions
Question:
1. How do I administer the WhOM on someone who has not previously owned a wheelchair?
Response:
It is possible to administer the WhOM on someone who has never had a wheelchair. In fact, it is a useful tool for determining the type of wheelchair a new user will require based on their participation outcomes (see the following scenarios).
WhOM Manual Version 7 December 8 2015 6
To administer part I, questions 1 and 2:
The question becomes:
1. Some people use their wheelchairs because they want to participate in activities in or around their home, such as preparing meals, watching TV, or gardening. What activities in your home will you use your wheelchair to perform?
(Do the same substitution for part 1, question 2)
To administer part II:
The questions become:
1. If you are not presently using a wheelchair, how would you rate your comfort while seated on your normal seating surface (defined as the surface you sit on for the greatest part of an average day)?
2. If you are not presently using a wheelchair, how satisfied are you with the way your body is positioned on your normal seating surface (defined as the surface you sit on for the greatest part of an average day)??
Question 3 remains the same.
Question:
2. How do I deal with someone who has multiple wheelchairs (or has the potential to have multiple wheelchairs) to meet their desired outcomes?
Response:
With the WhOM outcome scores can be calculated for each chair individually. This will allow some comparison between chairs, but ultimately the client and therapist will need to discuss how each chair could best be used taking into account the need to transport each chair, ease of transfer between them, and environment in which each chair will be used. For example, a power chair might really be great at meeting some community participation outcomes, but might not be able to be transported, which would interfere with others. As well, a client may be unable to transfer independently between the chairs and will need to rely on assistance, which is not always readily available.
Question:
3. How do I handle environmental issues?
Response:
The WhOM is designed to be responsive to any intervention (as noted in scenario three) and interventions do not have to be restricted to the wheelchair or wheelchair seating. Sometimes adding a ramp or widening a door can drastically alter the outcome result without any modification to the wheelchair.
Sometimes if the physical environment cannot be altered intervention choices will be curtailed.
WhOM Manual Version 7 December 8 2015 7
Question:
4. When should the WhOM be administered?
Response:
The WhOM should be administered initially as part of an evidenced-based wheelchair prescription process. The WhOM should be generally be re-administered once the intervention is completed. This may mean that if an intervention takes a long time to implement (home modification for example) there may be a considerable space between pre and post measures. For ongoing interventions, such as client or associate education, the measure could be re-administered on a number of occasions, as there is no learning effect associated with this tool.
As the instrument is sensitive to changes in the environment, outcomes achieved within a facility or hospital setting, may change when the person is in the community. Ideally, therefore, administration of the WhOM should occur in the setting where the client will use the wheelchair.
Question:
5. How can the WhOM be administered to someone who has aphasia or is unable to comprehend the questions?
Response:
In accordance with the principles of client-centred practice, a surrogate decision maker can be involved in the outcome identification and or/scoring, while every attempt should be made to engage the client as much as possible in the prescription process. To act as a proxy for a resident who was not able to provide their own response, the individual had to be in contact at least once a week with the resident and be able to speak English well enough to answer the WhOM questions. If the surrogate decision maker met these criteria, that person was the first individual who was invited act as a proxy. If neither that person nor another family member was able to act as a proxy, we approached staff members who worked with the residents on a regular basis. The WhOM has been used as a proxy measure in group home setting with individuals with developmental delay and in nursing home residential care settings (White et al. 2008).
Question:
6. If funding is limited should I curtail the equipment I trial?
Response:
There are two sides to this debate. Some prescribers argue that it is not fair to trial equipment that a client will unlikely be able to receive.
Some prescribers on the other hand advocate trialling the equipment that they think best meets the client's needs and then examining the outcomes this equipment can achieve. During the research a number of prescribers indicated they had been successful getting equipment that was not normally funded by pursuing the latter course, and sometimes other sources of funding could become available, because the funding inadequacy had been formally identified.
Question:
WhOM Manual Version 7 December 8 2015 8
7. What should happen if the client's outcomes conflict with the prescriber’s ideas?
Response:
The WhOM is a client-centred, rather than client driven tool. In this respect outcomes identified are negotiated between the user and prescriber rather than dictated by the client. In this respect, the prescriber can fulfil their ethical responsibility to allow the client to make an informed decision (especially in regard to safety issues, such as skin breakdown or unsafe power mobility driving). By focusing on participation oriented outcomes however, many conflicts can be avoided as both parties would generally be in agreement about improving participation as a long term goal, but may need to negotiate how to achieve these outcomes long-term in light of body-function and structure issues. For example, if a client indicates that their goal is to obtain a scooter, the therapist would explore what participation outcomes will be facilitated with this device. Then, if it is discovered that a client is unsafe with power mobility, the mutually agreed upon outcomes would remain the same and alternate solutions could be considered.
Question:
8. What should I do when a client is having trouble identifying participation outcomes?
Response:
As the outcome measure is semi-structured rather than scripted it is permissible to ask other prompts to illicit participation outcomes. Perhaps even starting with body function and structure concerns and probing to discover the participation implications of these.
Question:
9. What should I do if an activity identified initially is no longer important to the client when the WhOM is re-administered?
Response:
It is important that the importance scores do not change between initial and re-administration of the WhOM to provide a value that truly represents change resulting from intervention. If the importance scores have changed the WhOM could be re-administered to accurately reflect the client’s new priorities.
Question:
10. What should I do if the client identifies a new activity at the time of reassessment?
Response:
It is important that the activities identified at the initial and re-administration of the WhOM are the same in order to provide a value that truly represents change resulting from intervention. Therefore the client must not identify any new activities on re-administration. If they have further needs that have not been addressed by the intervention, the WhOM needs to be administered again.
Question:
11. Should I allow the client to see their initial answers when re-administering the WhOM?
WhOM Manual Version 7 December 8 2015 9
Response:
It is recommended that participants be allowed to see their previous responses as suggested by Guyatt, Berman, Townsend, and Taylor (1985). In clinical trials of the instrument it was noted that respondents would often report improvement with outcomes, but were unable to recall their previous rating scores. Thus, when blinded, respondent's scores did not always reflect the improvement or problems that respondents indicated qualitatively.
Question:
12. How do I administer the WhOM with those who live in residential care?
Response:
To administer part I, question 1:
The question becomes:
1) Some people use their wheelchairs because they want to participate in activities in or around their facility, such as preparing meals, watching TV, or gardening. What activities in your facility would you use your wheelchair to perform?
The remainder of the WhOM can be used without amendment.
Question:
13. Isn’t a measure like the WhOM biased with its scoring? Some people believe that if the therapist who provides the intervention, tries to evaluate the success of the intervention clients will tend to report positive outcomes because of the social relationship that exists.
Response:Satisfaction with participation is a subjective construct. Therefore, it is subject to the internal interpretations of the individual. If you are worried about social desirability bias (the presence of the therapist influencing scoring), the WhOM could be administered by a neutral third party after intervention.
6. Research
This new tool also provides a vital and unique contribution to wheelchair research. The WhOM is a form of measurement that is complimentary to existing tools, thereby facilitating a more comprehensive approach to assessment of wheelchair satisfaction. As an example, the new tool potentially enables description, evaluation and comparison in trials of the efficacy and effectiveness of new wheelchair systems that are introduced into the marketplace. Using the WhOM can have a profound and essential influence on the measurement of outcome after wheelchair prescription. Ultimately, ensuring that client goals are being successfully met enables clinicians to maximize client participation in activities they value, a major determinant of quality of life.
WhOM Manual Version 7 December 8 2015 10
To date in addition to the original research for the WhOM consisting of the development of the tool itself (covered on page 3 ‘Development of the WhOM’)1, there are some studies to demonstrate its validity and reliability. Reliability is the repeatability of a measurement, or the degree to which an instrument measures the same way each time it is used under the same condition with the same subjects. Validity is the extent to which a test measures what it claims to measure. The WhOM reliability and validity was confirmed through current research. The following table present a summary of the WhOM reliability and validity studies.
There is support that validity and reliability scores across populations are varied. The ICC scores is ranged from 0.83 (0.72 - 0.90) for Mean Sat to 0.92 (0.84–0.96) for Total IMP × SAT. Also, the validity scores considering the WhOM correlation with other measures are ranged from r = (0.31–0.43) for the Psychosocial Impact of Assistive Devices Scale to r = (0.16- 0.62) for scores on the LIFE-H.
Study Authors Population ICC ValidityMeasurement properties of the Wheelchair Outcome Measure in individuals with spinal cord injury.
Miller et al. (2011)2
Individuals with spinal cord injury n=50(M=84% & F=16%)
Mean Sat: 0.83 (0.72 - 0.90) Mean Imp× Sat scores: 0.88 (0.79 - 0.93)
Moderate and positive correlated with scores on the LIFE-H.r= (0.62- 0.16)
Reliability and Validity of Telephone Administration of the Wheelchair Outcome Measure for Middle-Aged and Older Users of Power Mobility Devices.
Moderate correlations with the Quebec User Evaluation of Satisfaction with assistive Technology (r = 0.36–0.45) and the Psychosocial Impact of Assistive Devices Scale(r = 0.31–0.43)
Validating the Wheelchair Outcome Measure in individuals who reside in long-term care
Proxy group (n=17)Moderate and positive correlated with scores on the LLDI Frequency(r = 0.46) and LLDI Frquency × Limtation(r= 0.47).
WhOM Manual Version 7 December 8 2015 11
Translation and validation of the Farsi version of the Wheelchair Outcome Measure (WhOM-Farsi) in individuals with spinal cord injury
Alimohammad et al. (2015)5
Farsi speakers with spinal cord injury N= 75
Mean age was 31.9 (SD 5 9.5) years
Mean duration of injury was 59.8(SD 5 60.8) months.
References:1. Mortenson WB, Miller WC, Miller-Polgar J. Measuring wheelchair intervention outcomes: Development of
the wheelchair outcome measure. Disabil Rehabil. 2007;2:275-285.2. Miller WC. Measurement properties of the Wheelchair Outcome Measure in individuals with spinal cord
injury. Advance online release Spinal Cord May 17, 20113. Auger C, Demers L, Gélinas I, Routhier F, Mortenson WB, Miller WC. Reliability and validity of the
telephone administration of the wheelchair outcome measure (WhOM) for middle-aged and older users of power mobility devices. J Rehabil Med. 2010;42:574-581.
4. Parvaneh S, Mortenson WB, Miller WC. Validation of the Wheelchair Outcome Measure in residents of long-term care. Disability & Rehabilitation: Assistive Technology 2014 May;9(3):209-12.
5. Alimohammad S, Parvaneh S, Ghahari S, Saberi H, Yekaninejad MS, Miller WC. Translation and validation of the Farsi version of the Wheelchair Outcome Measure (WhOM-Farsi) in individuals with spinal cord injury. Disabil Health J. 2015 Oct 8; pii: S1936-6574(15)00158-2.
Other Publications that feature the WhOM
Auger C, Demers L, Gélinas I, Miller WC, Jutai J, Noreau L, Depa M. Life-space mobility of middle-aged and older adults at various stages of usage of power mobility devices. Archives of Physical Medicine and Rehabilitation, 2010;91:765-73. DOI:10.1016/j.apmr.2010.01.018.
Rushton PW, Miller WC, Mortenson WB, Garden J. What do individuals with spinal cord injury do in their wheelchairs and how satisfied are they with their participation: a cross-sectional study. Spinal Cord 2010;48:691-6.DOI:10.1038/sc.2009.197.
WhOM Manual Version 7 December 8 2015 12
7. Using the WhOM - examples
1. Sally
Sally is a fifty-four year old woman with Multiple Sclerosis who has used a wheelchair for 3 years. She is currently using an eight year old power wheelchair without any additional features and a Jay cushion of similar age. She has impaired sensation in her gluteal area and her care-giver noted recently that she was in the early stages of skin breakdown. This is the reason Sally has come to see you.
Sally’s concerns
When administering the WhOM, Sally states her goal is to get rid of the ulcer. While acknowledging this concern, you help her frame her goal so as to address activity or participation loss. You ask what the ischial wound is preventing her from doing.
Sally tells you that because of the wound she is on bed rest, can’t make a meal and is unable to go watch her son play football. Based on discussion with Sally you identify the following indoor and community goals, for which she gives the scores shown below.
Initial assessment Date: Aug 9 2004Participation goals: Importance Satisfaction 1
Eg. Making a meal Watching favourite TV show
How important is this activity to you?
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
i. Watch son play a full game of football 8 0 0
ii. Making a meal 7 1 7
WhOM Manual Version 7 December 8 2015 13
Initial assessmentDate: Aug 9 2004
Reassessment Date:
Questions Time 1 Time 2
1. How would you rate your comfort while sitting in your wheelchair? (0 – 10)
0 = Not at all comfortable 10 = Extremely comfortable
2
2. How satisfied you are with the way your body is positioned in your wheelchair? (0 – 10)
0 = Not at all satisfied 10 = Extremely satisfied
7
3. Over the past month have you had any episodes of skin breakdown on your bottom? (Please circle)
Y N Y N
3a. If yes, in your opinion, how severe has your skin breakdown been? (0 - 10)
0 = Not at all severe 10 = Extremely severe
6
Change in scores Q1 T2_____ - T1_____ = _____
Change in scores Q2 T2_____ - T1_____ = _____
Change in scores Q3a T2_____ - T1_____ = _____
Intervention
You provide Sally with a power tilt wheelchair and a temperature-sucking cushion which will help heal her skin ulcer, enable her to sit for longer periods and decrease the risk of skin breakdown in the future. Part of your intervention includes educating Sally about how and when to use the power tilt system.
WhOM Manual Version 7 December 8 2015 14
Re-administration
You re-administer the WhOM and obtain the following results.
Initial assessment Date: Aug 9 2004 Reassessment Date: Aug 24 2004Participation goals: Importance Satisfaction 1 Satisfaction 2
Eg. Making a meal Watching favourite TV show
How important is this activity to you?
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
How satisfied are you with your current level of
performance of this activity?
(0 – 10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 2
i. Watch son play a full game of football 8 0 0 8 64
Jim is a sixty-five year old man who sustained a spinal cord injury at the level of C6 at the age of twenty-eight. He is currently using a light-weight manual wheelchair.
Jim’s concerns
Jim has experienced increased shoulder pain and fatigue when propelling his manual wheelchair. Further enquiry reveals that, as a result of his shoulder problems, Jim is having trouble getting to and from work and having difficulty getting his wheelchair in and out of his car. In discussion with Jim you identify the following participation goals, for which he gives the scores shown below.
Initial assessment Date: Aug 10 2004Participation goals: Importance Satisfaction 1
Eg. Making a meal Watching favourite TV show
How important is this activity to you?
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
i. Getting wheelchair in and out of car 8 4 32
ii. Get easily to and from work 9 3 27
Interventions
You and Jim to trial two different wheelchair options:1) Power assist wheels and 2) A power chair
You also explore how he can transport both of these chairs using a trunk lift.
WhOM Manual Version 7 December 8 2015 17
Re-administration
You re-administer the WhOM for the two options and obtain the following results:
1) Power assist wheels
Initial assessment Date: Aug 10 2004 Reassessment Date: Aug 25 2004Participation goals: Importance Satisfaction 1 Satisfaction 2
Eg. Making a meal Watching favourite TV show
How important is this activity to you?
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
How satisfied are you with your current level of
performance of this activity?
(0 – 10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 2
i. Getting wheelchair in and out of car8 4 32 4 32
Based on achieving a higher change score with the power assist wheels than with the power chair, you and Jim decide to install power assist wheels.
WhOM Manual Version 7 December 8 2015 19
3. Yvette
Yvette is a twenty-eight year old woman with cerebral palsy. Her cerebral palsy affects her upper and lower extremities and she has used a wheelchair most of her life. Because of her physical and cognitive abilities she is unable to use a power wheelchair and is unable to answer questions regarding any wheelchair outcomes she would like to achieve. Yvette’s mother is her primary care-giver and advocate. She is currently in an 18 wide manual wheelchair.
Yvette’s concerns
In discussing Yvette’s current wheelchair seating with her mother she indicates that Yvette is grimacing and moving around more than usual when seated in her chair and is concerned that her chair has become uncomfortable. She thinks that the chair has become too small for Yvette as a result of her recent weight gain. She also notes that the wheelchair has become very hard to push. Despite your best efforts to identify goals at a participation level, Yvette’s mother is only willing to acknowledge goals at the activity level and the two of you negotiate and score the following goals.
Initial assessment Date: Aug 11 2004Participation goals: Importance Satisfaction 1
Eg. Making a meal Watching favourite TV show
How important is this activity to you?
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
i. Be able to sit comfortably for as long as I like 10 3 30
ii. Be able to move around the house freely9 5 45
WhOM Manual Version 7 December 8 2015 20
Intervention 1
You allow Yvette to trial a wide barriatric wheelchair, which enables her to sit comfortably and is much easier to propel. Yvette’s mother remarks that she no longer notices Yvette grimacing or moving around. However, she also informs you that the chair now does not fit through the doorway linking Yvette’s bedroom and her ensuite bathroom. You re-administer the WhOM and obtain the following results.
Re-administration 1
Initial assessment Date: Aug 11 2004 Reassessment Date: Aug 26 2004Participation goals: Importance Satisfaction 1 Satisfaction 2
Eg. Making a meal Watching favourite TV show
How important is this activity to you?
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
How satisfied are you with your current level of
performance of this activity?
(0 – 10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 2
i. Be able to sit comfortably for as long as I like 10 3 30 9 90
ii. Be able to move around the house freely9 5 45 6 54
As her mother is still not satisfied with Yvette’s ability to move around the house you review options to modify the environment with her which include taking the door off its hinges or putting in a wider a door. Yvette’s mother selects the latter and once this work has been completed you re-administer the WhOM to achieve the following results, indicating successful resolution of both issues.
Joanne is a 30 year old woman who has had MS for the last five years, and has been using canes to help her with ambulation.
Joanne’s concerns
Recently she has found that she is only able to walk short distances and when she does so she becomes extremely fatigued. She is worried that she might have more problems if her MS progresses.
Initial assessment Date: Aug 12 2004Participation goals: Importance Satisfaction 1
Eg. Making a meal Watching favourite TV show
How important is this activity to you?
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
i. Shopping 8 3 24
ii. Getting to and from work 10 4 40
WhOM Manual Version 7 December 8 2015 23
Initial assessmentDate: Aug 12 2004
Reassessment Date:
Questions Time 1 Time 2
1. How would you rate your comfort while sitting in your wheelchair? (0 – 10)
0 = Not at all comfortable 10 = Extremely comfortable
5
2. How satisfied you are with the way your body is positioned in your wheelchair? (0 – 10)
0 = Not at all satisfied 10 = Extremely satisfied
8
3. Over the past month have you had any episodes of skin breakdown on your bottom? (Please circle)
Y N Y N
3a. If yes, in your opinion, how severe has your skin breakdown been? (0 - 10)
0 = Not at all severe 10 = Extremely severe
Change in scores Q1 T2 - T1 = ___
Change in scores Q2 T2 - T1 = ___ Change in scores Q3a T2 - T1 = ___
Intervention
You provide Joanne with a mid wheeldrive power chair with a pressure relieving cushion and personal back.
WhOM Manual Version 7 December 8 2015 24
Re-administration
You re-administer the WhOM and obtain the following results.
Initial assessment Date: Aug 12 2004 Reassessment Date: Aug 27 2004Participation goals: Importance Satisfaction 1 Satisfaction 2
Eg. Making a meal Watching favourite TV show
How important is this activity to you?
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
How satisfied are you with your current level of
performance of this activity?
(0 – 10) 0 = Not satisfied at all10 = Extremely satisfied
1. How would you rate your comfort while sitting in your wheelchair? (0 – 10)
0 = Not at all comfortable 10 = Extremely comfortable
5 8
2. How satisfied you are with the way your body is positioned in your wheelchair? (0 – 10)
0 = Not at all satisfied 10 = Extremely satisfied
8 9
3. Over the past month have you had any episodes of skin breakdown on your bottom? (Please circle)
Y N Y N
3a. If yes, in your opinion, how severe has your skin breakdown been? (0 - 10)
0 = Not at all severe 10 = Extremely severe
Change in scores Q1 T2 8 - T1 5 = 3
Change in scores Q2 T2 9 - T1 8 = 1 Change in scores Q3a T2 Not applicable - T1 Not applicable = Not applicable
WhOM Manual Version 7 December 8 2015 26
Name / ID #:_____________________________ THE WhOMPart I: PARTICIPATIONInstructions for Administration:Ask the client to identify activities they perform in their wheelchair that are important to them by asking the two questions outlined below. Have the client score the importance of these activities and then ask them to rate their current level of satisfaction in performing these activities. If the client has scored their satisfaction with an activity ≤ 7, determine the underlying conditions (wheelchair/seating device or environmental barriers) that impair performance of this activity to assist with intervention planning.
1) Some people use their wheelchairs because they want to participate in activities in or around their home, such as preparing meals, watching TV, or gardening. What activities in your home would you use your wheelchair to perform?
Use this numerical scale to help fill in the table:0 1 2 3 4 5 6 7 8 9 10
(0 - 10) 0 = Not at all important10 = Extremely important
How satisfied are you with your current level of
performance of this activity?
(0 –10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 1
How satisfied are you with your current level of
performance of this activity?
(0 – 10) 0 = Not satisfied at all10 = Extremely satisfied
Importance x
Satisfaction 2
i.
ii.
iii.
iv.
v.
Total of importance x satisfaction 1 scores =
Score 1 Total of importance x satisfaction 2 scores =
Score 2
Change in satisfaction = Score 2 – Score 1 =
Version #1: May 6 2004; Version #2: June 11, 2004
Name / ID #:_____________________________ THE WhOM
2. Some people use their wheelchairs because they want to participate in activities outside of their home such as dog walking, going for coffee, to work or to the park. What activities outside of your home or in your community would you use your wheelchair to perform?
Use this numerical scale to help fill in the table:0 1 2 3 4 5 6 7 8 9 10
![Woosh - University of British Columbiamed-fom-clone-pt.sites.olt.ubc.ca/files/2012/05/... · [FF] If you are planning on working for five weeks in a row this year, you can take a](https://static.documents.pub/doc/80x56/5fc08d5a48446b4a3943d450/woosh-university-of-british-columbiamed-fom-clone-ptsitesoltubccafiles201205.jpg)