Throughout my early years in clinical research, I was fortunate to work with highly experienced researchers from the Medical Research Council and so I didn’t have to think too much about research methodology. When I was sked to support the introduction of an Electric Powered Indoor/outdoor Wheelchair (EPIOC) Service I had to think about how the service can be best supported through acquiring good data about it.

It was clear from the beginning that demand for EPIOCs would greatly outstrip supply and so I was afraid that funding might be transferred to other services that might be perceived as having a greater impact e.g. it was clear that, at that time in early 1999, the cost of an average EPIOC was about the same as that of an elective hip replacement which gives one of the highest changes to the quality of life of any health intervention.

At our team meeting it was agreed that we must be able to demonstrate that the service users (hereafter referred to as ‘users’) were happy with the service that were provided. In addition, other team members wanted to ensure that the EPIOC provided was not giving rise to pain or discomfort; whilst other team members wanted to ensure that the EPIOC functioned well with no breakdowns etc.
In terms of ‘User satisfaction’, we asked a very simple question – without giving it too much thought – Did the service we provided meet your expectations in the following areas? Please answer yes or no [1]. We were happy with the result of 83 (52-99) % satisfaction from the 120 users contacted, but two other factors proved the value of such basic information

1. Two questions related to the waiting time for clinic appointments and wheelchair delivery. These two had a mean satisfaction rate of 63%. This compared with a 89% satisfaction with the clinical services. I.e. there was poor satisfaction with those elements which were outside the team’s control. The team did however point out that the waiting time for the delivery of the chair was partly influenced by our staffing levels and this enabled us to obtain funding for an increase in staffing levels.

2. A separate question asked whether ‘you were satisfied with the approved repairer…’. The range of answers enabled the team to award the next annual contract for approved repairers to one company only – the results of the audit clearly confirming the clinical impressions formed by our engineers.

Another situation in which straightforward yes/no answers can be extremely useful is in the area of equipment provision. If the NHS or any other service provides equipment of any kind – e.g. from walking sticks to environmental control units – then it is reasonable to ensure that the equipment is being used as intended. Our very simple telephone questionnaire showed that this is not always the case. Following on the successful initial pilot audit [1], the audit was continued and further aspects of the data collected were reviewed and the results of the telephone interview approximately 4 months after delivery of the EPIOC reported [2]. We found that only 71% of users were actually using their EPIOC outdoors. Our review did not explore the reasons for this, but they would have included:-

• Changing clinical condition of the user
• Advice that a further part or adaptation of the EPIOC was needed and for some reason this did not materialise
  o Manufacturer did not supply it and the team did not chase it up
  o Manufacturer delivered the part but it was ‘shelved’ for some reason and not allocated to the user
• The EPIOC was not comfortable
• Concerns about safety so didn’t go out alone [3].

Conclusions

Useful information can be gained by asking very simple questions, but some questions may not be so simple to ask, and thus to answer and I will try and explore this next month using return to work as an example.
The provision of any form of equipment, other than cheap and disposable, should be checked to ensure that it is in use and functional.

I am happy to discuss any of the issues raised in these reflections with colleagues who can email me via the VRA and head the email VRA – professional reflections.

Andrew Frank
Trustee and Past-Chair, VRA

1. Ward, J., The set-up and audit of a regional EPIOC service. Posture and Mobility, 1999. 9(Spring): p. 5-11.
2. Frank, A., et al., Introduction of the new NHS Electric Powered Indoor/outdoor Chair (EPIOC) service: benefits, risks and implications for prescribers. Clin Rehabil, 2000. 14(December): p. 665-673.
3. Evans, S., et al., Young people’s experiences using electric powered indoor-outdoor wheelchairs (EPIOCs): potential for enhancing users’ development? Disabil Rehabil, 2007. 19(16): p. 1281-1294.