The Impact of Transfer Setup on the Performance of Independent Transfers: Phase I Final Report

Expert opinion on the current knowledge

Our review of the literature revealed a small number of studies that directly relate to the influence of transfer setup on performing independent transfers and thus points to a critical need for more studies in this area. All the studies identified also involved small groups of subjects and all of them included either subjects with SCI or unimpaired subjects except for one study (8) and thus a vast majority of them would not be generalizable to other populations who do independent transfers.  There is not enough evidence in the literature or studies at the present time to determine the limits of setup that would make transfers in the built environment accessible to a majority of wheelchair users. 

Transfer boards are a common aid used to facilitate transfers for those who have limited arm strength and/or situations where the height differential between the initial and target seats or gap difference is too large for them to negotiate without assistance.  As the latter is a function of environment, we hoped to find studies that addressed the use of transfer boards or other similar technologies for circumventing environmental barriers. 

In addition to transfer aids, experts also felt none of the original research studies were relevant to the issue of constrained space available for transfers.  This item was geared to identifying issues concerning transfers into/out of an airplane seat, amusement park ride, or motor vehicle, by which the individual has a limited space to position the feet or legs when moving over to or from the target surface.

All the studies were conducted in laboratory settings versus ‘real-world’ environments with experimental setups that appeared free from any barriers that would limit leg/foot placement.  Proper positioning of the feet is believed clinically to be a very important consideration for setting up for a safe and efficient transfer (9, 10) and thus may be critical for space planning in public areas where transfers are expected.

Physical obstacles and barriers are commonly observed for transfers to and from airline seats (e.g. arm rest is fixed) and amusement park rides (e.g. ride side rail/guard is fixed).  Boats, kayaks, and other sorts of recreational equipment pose a similar barrier to transfers.  None of the research identified described how well individuals are able to overcome physical barriers in between the wheelchair and target surfaces.  In our own observations we see individuals going around or over the top of obstacles (e.g. transferring onto the obstacle first and then down into the seat/surface).  The later is an example of a scenario that was scored separately for the item ‘number of transfers to go from the initial location to the final destination’ which was another aspect of setup reviewers identified as lacking evidence.  There is no evidence suggesting how large (e.g. how high, tall and wide) an obstacle can be and still be accessible to a majority of wheelchair users. 

Another area lacking sufficient evidence concerns the location and characteristics of effective supports to aid with transferring.  This item encompassed for example the use of handholds, grab bars, or other environmental fixtures designed to facilitate a transfer to a target surface.