SP-1a: Transportation Safety Survey of Wheelchair Users

Task leaders: Thomas J. Songer, PhD and Shirley Fitzgerald, PhD

Co-investigator: Patricia Karg, MS

Other participants: Human Engineering Research LaboratoryCenter for Assistive TechnologyUniversity of Pittsburgh Wheeled Mobility RERC, University of Pittsburgh Medical Center Rehabilitation Hospital and Childrens Institute, AC Transit, Hampton Roads TransitPATransitWashtenaw Intermediate School DistrictEaster Seals/Project ActionUnited Cerebral Palsy, and the Paralyzed Veterans of America

Duration/staging of task: This project will be 36 months in duration and begin in Year 1.


Study Participant Information | Progress Report May 1, 2003 | Progress Report May 1, 2004 | Progress Report May 1, 2005


Responsiveness to priority

This project is one of three proposed activities that address the priority to “investigate and report on the incidence, extent, and nature of injury of wheelchair riders due to motor vehicle accidents…” It will identify the incidence of injury among wheelchair occupants involved in motor vehicle accidents through a self-report survey completed by a sample of 300 wheelchair users. Identified injuries will be investigated to determine cause and related circumstances (e.g., vehicle involved, cause of accident, type of seat, type of disability) by obtaining associated medical records and police accident reports. (Note: “type of seat” refers to either a wheelchair or motor-vehicle seat.)

This survey and document approach overcomes the limitations inherent in other crash data sources, which have difficulty in identifying wheelchair users. Further, it builds upon the investigators previous experience in survey research in motor-vehicle accidents. As a result, this project will provide information to address several fundamental questions in wheelchair transportation safety, including:

  • What is the risk for injury to wheelchair users during motor vehicle transport?
  • What are the characteristics of the individuals who are injured in transport?
  • What are the characteristics of the crashes that lead to injury?
  • How do injuries and injury risk differ between private and public transportation?
  • How frequently do individuals transfer to a vehicle seat for transportation?
  • How frequently do they remain seated in their wheelchair during transportation?
  • What are the characteristics of those who remain seated in their wheelchair?
  • What is the injury risk to wheelchair-seated travelers?
  • How does this differ from those seated in a vehicle seat?

The results will provide a consumer-oriented, public-health perspective on the issue of wheelchair transportation safety in different types of vehicles and transportation. It has the broad goal of identifying the relative magnitude of the problem and is expected to be the first in-depth wheelchair user survey on this issue. The results will thereby supplement existing and proposed research on the engineering and biomechanics of wheelchair failure during crashes by examining the frequency of injury incidence to individual wheelchair users, and thereby documenting the exposure to vehicle transportation risks. This information is expected to lay the foundation for future, larger longitudinal studies to investigate safety for wheelchair users, and to help develop mitigation strategies and safety policies for reducing the transportation risks of wheelchair users.

Research objectives

The goal of the proposed study is to identify the frequency of injury to wheelchair users during motor vehicle transport. This project seeks to identify and describe the epidemiology of injuries from motor vehicle transportation and clarify transportation safety issues from the user perspective. It will provide one of the first detailed estimates of the level of risk associated with the motor vehicle transportation of wheelchair users. More specifically, it will:

  1. Describe the exposure to transportation, the frequency and severity of motor vehicle accidents, and the frequency of injuries among wheelchair users who are motor vehicle drivers.
  2. Describe the exposure to transportation, the frequency and severity of motor vehicle crashes, and the frequency of injuries among wheelchair users who are motor vehicle passengers.

The project will examine transportation risks to drivers and passengers, as the safety messages for these individuals may differ. It will also examine:

  • if injury events differ by public or private transportation,
  • the safety risk for riders seated in wheelchairs, as opposed to those seated in vehicle seats,
  • if injury frequency differs by type of vehicle, and
  • the frequency of injury during emergency maneuvers and crashes, respectively.

Anticipated outcomes

This project will provide some of the first comprehensive data on the transportation risks of wheelchair users. Results from the study will be published in peer-reviewed journals. A graduate student will also be involved and trained in the data collection and analysis phase of the project. We anticipate that this individual will complete a thesis on the basis of this work. The study outcomes will allow for the development of more refined (better informed) prevention strategies in wheelchair transportation safety. Further, the work in this project will allow for secondary research benefits that will aid subsequent studies, such as the identification of appropriate sample sizes and appropriate population sources.


Wheelchair Use and Injury Risk in Transportation Accidents Study Participant Information

The Americans with Disabilities Act has led to several more opportunities in travel and transportation for individuals using wheelchairs. With new possibilities may lie new concerns to wheelchair riders in motor vehicle transportation. For motor vehicle accidents represent one of the leading causes of death and injury in the United States. How this affects persons in wheelchairs is not clearly understood at this time.

Investigators at the University of Pittsburgh are conducting a new research study under a grant from the National Institute on Disability and Rehabilitation Research to identify the frequency and nature of injuries to wheelchair riders involved in motor vehicle accidents. Persons who use wheelchairs as their primary means of mobility are eligible to participate.

The investigators will survey over 300 wheelchair users about their transportation experiences. The survey will include questions on basic information such as age, gender, and design of the wheelchair, as well as questions on the types of transportation used, any involvement in motor vehicle accidents, and any resulting injuries. Identified injuries will be investigated further to examine the related circumstances (e.g., vehicle involved, cause of accident, type of seating).

The study will provide a consumer-oriented perspective on the issue of wheelchair transportation safety and will be the first in-depth wheelchair user survey on this issue. The results will lay the foundation for future efforts to improve transportation safety for wheelchair users.

If you are interested in participating, please contact either:

Dr. Thomas Songer
at the Center for Injury Research and Control
Phone: 412-648-9296
E-mail: tjs@pitt.edu

or

Dr. Shirley Fitzgerald
at the Rehabilitation Engineering Research Center
Phone: 412-383-6603
E-mail: sgf9@pitt.edu


References

National Highway Traffic Safety Administration. Wheelchair Users Injuries and Deaths Associated with Motor Vehicle Related Incidents. Research Note. September 1997. http://www.nhtsa.dot.gov/people/ncsa/wheelchr.html

Shaw G. Wheelchair rider risk in motor vehicles; a technical note. Journal of Rehabilitation Research and Develop 37(1):89-100, 2000.

ECRI. Positioning and securing riders with disabilities and their mobility aids in transit vehicles; designing an evaluation program. Project Action, Washington, DC, 1994.

Richardson HA. Wheelchair occupants injury in motor vehicle-related accidents. National Center for Statistics and Analysis Mathematical Analysis Division, US Dept. of Transportation, Washington, DC, 1991.

Bertocci GE. Computer simulation and sled test validation of a powerbase wheelchair and occupant subjected to frontal crash conditions. IEEE Transactions on Rehabilitation Engineering 7(2):234, 1999.

National Highway Traffic Safety Administration. Safety Issues for Vehicles Adapted for Use by Persons with Disabilities. Research Note. April 1998. http://www.nhtsa.dot.gov/

Songer TJ, LaPorte RE, Dorman JS, Orchard TJ, Cruickshanks KJ, Becker DJ, Drash AL. Motor Vehicle Accidents and IDDM. Diabetes Care 11(9):701-707, 1988.

LaPorte RE, Songer TJ, Gower IF, Lave LB, Ekoe JM. "Review of 49 CFR 391.41(b)(3) Regarding Diabetic Commercial Motor Vehicle Drivers," Final Report No. FHWA/MC- 92/004, Washington, DC, Federal Highway Administration, Dept. of Transportation, May 1992

Songer TJ, Lave LB, LaPorte RE. The Risks of Licensing Persons with Diabetes to Drive Trucks. Risk Analysis 13(3):319-326, 1993.

Lave LB, Songer TJ, LaPorte RE. Should Persons with Diabetes be Licensed to Drive Trucks? -- Risk Management. Risk Analysis 13(3):327-334, 1993.

Songer TJ, LaPorte RE, Palmer CV, Lave LB, Talbott E, Gibson J, Austin L, Chastain P. "Hearing Disorders and Commercial Motor Vehicle Drivers," Washington, DC, Federal Highway Administration, Department of Transportation, March 1993.


Progress Report May 1, 2003

Objectives

Same as before

Target Population

The target population for the project is 300 person who use wheelchairs as their primary means of mobility. It will include individuals with disabilities arising from various medical diagnoses. We will recruit Study subjects from several sources to reduce potential bias in the study population and to permit a mix of public and private transportation users.

Progress to Date

This project is examining the incidence of injury among wheelchair occupants involved in motor vehicle accidents through a self-report survey completed by a sample of 300 persons. Injuries and crashes will be investigated to determine cause and related circumstances by obtaining associated medical records and police accident reports.

To date, we have contacted over 500 agencies and organizations to advertise the study. We have spoken with 270 individuals to determine their eligibility for the study. Eligibility criteria include that the individual uses a wheelchair as the primary means of mobility and that they remain seated in their wheelchair when using either public or private transportation. Of the 270 individuals contacted, 192 were eligible for study, and a questionnaire was mailed to each person. At this time, 140 surveys have been returned. The study has obtained 46.7% of the goal of 300 surveys. Eighteen months remain on the study.

Information on transportation use obtained from the study to date has been presented in preliminary form at the International Seating Symposium in Minneapolis, MN and the RESNA conference in Atlanta, GA.

Our goals in the next year include continued recruitment and survey collection to meet the target. We will focus, in particular, on identifying participants from rehabilitation hospitals and the VA Healthcare System.


Progress Report May 1, 2004

This study’s goals are to describe exposure to transportation, motor vehicle accidents, and related injuries among wheelchair users. Specifically:

  • Transportation type (private or public)
  • Mode of Travel (driver or passenger)
  • Transportation seating
  • Injury circumstance (moving or stationary)
  • Seat belt use (yes or no)
  • Wheelchair securement (presence and type).

As of this time, recruitment for the study is complete. Six hundred subjects were screened for eligibility, 428 were eligible and 336 returned the questionnaires. All data has been cleaned. We have obtained medical reports and police records from all subjects who agreed to have their records obtained regarding the accidents and occurrence of injuries. We are in the process completing data analysis for several full-length manuscripts which we expect will be complete by the fall of 2004.


Progress Report May 1, 2005

Reecruitment and data analysis for the study is now complete. Six hundred subjects were screened for eligibility, 428 were eligible and 336 returned the questionnaires. All data has been cleaned. We have obtained medical reports and police records from all subjects who agreed to have their records obtained regarding the accidents and occurrence of injuries. Ashley Rotko wrote up her Master's thesis on the data collected for this project. We have provided below the abstracts from the award winning paper (RESNA) and from Ms. Rotko's thesis, which will be written into a full paper this summer. We are currently in process of finishing the main paper resulting from this project.

Injury to Wheelchair Users as a Result of Loading and Unloading from a Motor Vehicle

Little is known about the injury risk to wheelchair users who use motor vehicle transportation. This study was designed to quantify the injury risk to wheelchair users while loading and unloading from a motor vehicle. To identify this information, a 12-page survey was completed by 336 wheelchair users. The results showed that most loading and unloading injuries occurred while the subject was using a lift and a private vehicle. In addition, it was shown that these events had higher injury rates, when compared to the injury rates of both crash and non-crash incidents. These findings suggest that research and training efforts focused on private vehicle and lift use may be beneficial.

Wheelchair Securement and Occupant Restraints: A Cross-Sectional Analysis Of Use And Effect On Motor Vehicle Related Injuries

Objective

The goal of this project was to describe the characteristics of how wheelchair users, who must remain in their wheelchair while in the vehicle, use motor vehicle transportation; in addition, to how these individuals utilize occupant restraint and wheelchair securement devices. Also, the study was aimed to investigate the epidemiology of motor vehicle related injuries, and report on the relationship between these injuries and the identified use of occupant restraint and wheelchair securement systems.

Methods

A 12-page survey was completed, via mail, by 336 wheelchair users, who self-reported that they remain seated in their wheelchair at least some point in their transportation use. These individuals were recruited through various nationwide disability related service and advocacy organizations, as well as through disability related internet message boards. Descriptive, chi-square and t-test analysis was completed using SPSS statistical software.

Results

The results of this study show that traveling as a private vehicle passenger is the most used form of motor vehicle transportation, with 70.2% of the sample population reporting to using this mode within the past month and 50.0% reporting this mode as their primary means of transportation. Limited significant difference existed in regard to subject's gender, age, disability or wheelchair type and the reported use of either an occupant restraint device or a wheelchair securement system. There were also limited significant findings seen in regard to the use of either an occupant restraint device or wheelchair securement system and the occurrence/severity of a motor vehicle crash, or non-crash related injury. Finally, in regard to motor vehicle related adverse events that resulted in an injury, descriptive statistics showed that there were limited events (crash: n = 15, non-crash: n = 71), with even less resulting in an injury requiring the need to seek medical attention (crash: n = 10, non-crash: n = 9).

Conclusion

This study is one of the first efforts to describe the real-world transportation characteristics of wheelchair-seated passengers, as well as an examination of the relationship between the use of occupant restraint and wheelchair securement devices and the occurrence of motor vehicle related injuries. These data demonstrate that private vehicles are the most widely used form of motor vehicle transportation, suggesting that research focused in this area may be beneficial. Also, limited significant findings were seen in regard to the relationships between the use of either an occupant restraints or wheelchair securement and the occurrence of motor vehicle related injuries, both crash and non-crash incidents. These results may be interpreted in two ways 1) that these safety systems are not being used effectively, and that use of an occupant restraint and wheelchair securement independent of one another does not reduce injury risk in a motor vehicle crash or non-crash incident. It should also be noted that based on descriptive statistics alone, it is evident that for those individuals who were injured severely enough in a non-crash incident to require medical attention, there was limited reported usage of wheelchair securement and occupant restraints. These findings may suggest that the use of such devices may decrease the number of severe non-crash related injuries. Based on the limitations of this study and trends seen within the descriptive statistics, more research in this area is required to develop more inferential findings between the use of these devices and the occurrence of injuries related to motor vehicle transportation.

Last updated: August 30, 2005

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