*Corresponding author: Hassan Izzeddin Sarsak (PhD, OT), Batterjee Medical College, PO Box 6231 Jeddah 21442 KSA, Saudi Arabia, E-mail: hassan.sarsak@bmc.edu.sa; sarsakhassan@gmail.com Citation: Sarsak HI (2019) Factors Associated with Change in Functional Per- formance among Wheelchair Users. J Phys Med Rehabil Disabil 4: 028. Received: October 25, 2018; Accepted: December 28, 2018; Published: January 11, 2019 Copyright: © 2019 Sarsak HI. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestrict- ed use, distribution, and reproduction in any medium, provided the original author and source are credited. Background While performing the wheelchair evaluation process (functional assessment, wheelchair ftting and delivery, training, and follow-up), clinicians (i.e., occupational therapists, physical therapists) need to take various factors into consideration. These factors include (1) the client’s profle (medical and physical status, personality, attitude, tem- perament, and socio-cultural relations), (2) wheelchair characteristics (wheelchair design, brakes, frames, seat, seat functions, back height, footrests and armrests, positioning devices [i.e., cushions, seatbelts, lateral, head and back supports], propulsion techniques, etc.), (3) the environment (physical and socio-cultural environments), and (4) the daily activities and social roles that the client performs [1]. To ensure the accuracy of wheelchair prescription, all these factors need to be evaluated to help clinicians make the best possible ft between the cli- ent’s needs, goals, and social roles and the wheelchair selected [1,2]. A properly ftted and correctly prescribed wheelchair benefts both client and caregiver [3,4]. Clients use their wheelchairs more often if they receive them from an expert clinician who uses a multifactorial assessment-intervention process. Hoenig et al., described this process as a thorough evaluation that takes into account all the factors and is based on medical record review and self-reported and physical perfor- mance measures, individualization and modifcations/adjustments of the wheelchair, home modifcations as needed, client education, and follow-up [5]. To aid in provision of the best quality wheelchairs and service delivery programs, Karmarkar et al., suggested that assess- ment of wheelchair ft is a continuous process requiring re-assessment of wheelchair ft as user’s age and their functional conditions change [6]. Specifc wheelchair characteristics (i.e., wheelchair type and de- sign) are considered essential factors that can play a vital role in the wheelchair evaluation process. Differences in wheelchair type and design can lead to differences in a client’s performance of function- al mobility skills. Choice of wheelchair may affect a client’s ability to be independent in a community setting. Research has shown that changes in the design of a wheelchair can result in positive chang- es in energy cost, joint kinematics and propulsion biomechanics [7]. For example, the high degree of adjustability of the Ultra-light HSOA Journal of Physical Medicine, Rehabilitation & Disabilities Research Article Hassan Izzeddin Sarsak* Department of Occupational Therapy, Batterjee Medical College, Saudi Arabia Factors Associated with Change in Functional Performance among Wheelchair Users Abstract Objective: The main objective of this study was to explore demo- graphics, wheelchair characteristics, and functional status indicators associated with changes in perceptions and functional performance of wheelchair users. Method: Nineteen wheelchair users were selected for this explorato- ry study. Utilizing Exhaustive Chi-Squared Automatic Interaction De- tector (CHAID) analysis, seven models were generated to examine specifc demographics, wheelchair characteristics, and functional status indicators associated with pretest to posttest change scores in perceptions and performance of everyday tasks over time of three target variables. Validation of the models generated by Exhaustive CHAID analyses was conducted through the n-fold cross-validation procedure. The Functioning Everyday with a Wheelchair (FEW), the FEW-Capacity (FEW-C), and the FEW-Performance (FEW-P) were the measures used in this study. Results: The means for the change score were larger for the FEW (1.08 ± 0.59) followed by the FEW-C (0.69 ± 0.63), and then the FEW-P (0.33 ± 0.45). Most of the factors identifed in each model were derived from the pretest. Our study explored factors that were signifcantly associated with change scores of the FEW tools. In- dependence, number of physical assists, safety, and tasks related to Outdoor Mobility at pretest were the functional status indicators found to be of greatest importance and signifcantly associated with changes in perceptions and performance of everyday tasks over time in our models. For all analyses, the values of the Risk Estimate for the Risk Statistics and Cross-validation were close with relatively small differences, suggesting strong and reasonable confdence in the validity of the seven models. Conclusion: This study may suggest specifc focus areas for as- sessment and intervention and may highlight the importance of some factors that infuence changes in functional performance among cli- ents who have been referred for, and prescribed, a wheeled mobility device. Keywords: Factors; FEW; Functional performance; Wheelchair us- ers Sarsak HI, J Phys Med Rehabil Disabil 2019, 4: 028 DOI: 10.24966/PMRD-8670/100028