Independent Wheelchair Transfers in the Built Environment: How Transfer Setup Impacts Performance Phase 2: Final Report

Two Step Transfer Evaluation

The evaluation of two-step transfers has never been studied before and was evaluated in this phase. The two-step transfers consisted of an adjacent transfer (no gap between two steps) and a ramped transfer over a constant 8 inch gap between two steps. It should be noted that for this evaluation not all study participants are included in the two-step analysis. Not all participants attempted the two-step transfers as they were given the choice to not make the transfer. Additionally, the study participants who made the two-step transfers appear more able on these transfers when comparing the heights achieved during the two-step transfers to the heights achieved from the WMD to and from the first platform (Table 9).  Transferring to and from a WMD is different than transferring between two surfaces.  It's also possible that more able or skilled WMD users completed the two step transfers.

In this study, participants who attempted the two-step transfers transferred from one step to a second step that was higher and lower than first one. The results of our study suggest that transfer steps of any height differential that currently exist in the built environment would exclude about 15.2% of adult community dwelling WMD users who independently transfer (11 out of 72 participants; 8 of which wouldn’t attempt it at all and 3 of which attempted it but failed in the process).  The addition of a ramp to bridge the two steps did not improve the situation and there were additional failed transfer attempts when the ramp was used to go up a step compared to when the ramp wasn’t used.  It’s possible that more failed attempts occurred because it was ‘new’ and a very different type of transfer than what these individuals were used to.  These types of transfers are not currently part of the standard training that patients receive during a typical rehabilitation stay.  Performance may improve with training and practice. 

Results from the questionnaire asking for participants’ opinion on these transfers reflect a mixed review of the ease and practicality of two-step transfers. Comments on the two-step transfers varied from thinking they were fun, easy, and safe to impractical, difficult, and uncomfortable. Both types of transfers received relatively equal responses for the number of people who said they would or would not perform the transfer in a ‘real-world’ situation. Participants who attempted and were successful with the two-step transfers performed at a high level on average.  The 50th percentile for the adjacent and ramp transfer attained a height of 7.0 inches, only 1 inch below the maximum allowable transition for this transfer (8.0 inches). A lower step height (about 2.0 in) would be needed to accommodate the 5th percentile of users who would attempt this type of transfer.