Overview

Large datasets and registries are essential elements for the consideration of accountable and value-based healthcare and associated policy. The field of CRT is relatively new to using large datasets and registries, and therefore policies surrounding CRT have not necessarily been based on research with standardized outcome measures, uniform datasets, or other similar strategies.

The study involves analysis of several large datasets that will be made available through data use agreements. The datasets contain information about people (e.g. basic demographics and health outcomes) and devices they use (e.g. wheelchairs). We will be conducting descriptive analyses of the data to better understand the characteristics of the devices being used to answer questions such as, “how long do devices last before they need to be repaired,” “how much do repairs cost?”, and “do people using certain kinds of devices have health outcomes like pressure ulcers?”  The overall goal of the study is to use the information obtained to draft a new policy for insurance coverage of devices including wheelchairs.

The outcome of this project will be a large Uniform Dataset merged from multiple independent sources that includes variables of interest that can be used to inform a new value-based policy model for CRT. Specifically, knowing the average reasonable useful life (RUL) and overall cost of operating various types of CRT devices can assist in informing a payment strategy. For example, knowing mileage over time with associated service messages will be the first of its kind type analysis in the CRT industry to further inform expected RUL and maintenance routines. The comprehensive data set can also be leveraged beyond the purpose of this proposal for further investigations. Stakeholder groups and researchers may be interested to know how different variables are correlated to model predictive outcomes associated across types of devices, users, and their situation which can further promote levels of research evidence in the field of CRT.

Update

As of May 1, 2025

Regular meetings are scheduled with our collaborating stakeholders along with a weekly ‘Fun with Data’ meeting with our internal data team to explore and review data analyses and questions/topics. The current 5 datasets include:

Dataset 1: Functional Mobility Assessment and Uniform Dataset Registry (FMA/UDS) – The FMA/UDS is a person-reported outcomes registry related to satisfaction in performing Mobility Related Activities of Daily Living (MRADLs) and other factors of interest including health, function, and participation that are related to various types of Complex Rehabilitation Technology (CRT). The FMA/UDS is managed through a sponsored research agreement between the University of Pittsburgh and the Van G. Miller Group’s US Rehab subsidiary (VGM/US Rehab).

Dataset 2: Labor Tracker Wheelchair Repair Registry (WRR) – Within the existing RERC Project on Wheelchair Standards, Pitt investigators have developed a Wheelchair Repair Registry (WRR) to obtain a large dataset in order to better understand the type and frequency of failures across types of devices for research and development purposes. This project is also a collaboration between Pitt and VGM/US Rehab, who maintains Labor Tracker, which is a strategy for its members to document, track and manage wheelchair repairs that also includes procedures for insurance claims.

Dataset 3: Business Operations Data from National Seating and Mobility (NSM) – NSM is one of the largest suppliers of CRT, with over 240 branches nationwide. Due to the size and scope of the company, they maintain their own business operations data infrastructure. They maintain electronic records on all CRT cases, which includes information about the device and history of repairs.

Dataset 4: Permobil Connected Wheelchair (PCW) – Permobil is a global manufacturer of high-end powered wheelchairs. There is a feature called Permobil Connect that is able to collect and transmit information about the use and performance of the device, including battery health, frequency of battery charges, hours of use, distance traveled, utilization of power functions such as seat elevation and service messages (including device errors). Permobil is working with Pitt investigators on a subset of the data to be aggregated, de-identified, and shared.

Dataset 5: UPMC Health Plan Claims Dataset (UPMC-HP) – The University of Pittsburgh Medical Center Health Plan (UPMC-HP) is a Managed Care Organization (MCO) within, but independent of, the UPMC Health System, which is an Accountable Care Organization (ACO) serving over 3.7 million lives throughout Pennsylvania and neighboring states. The HP offers several health insurance products including commercial plans as well as Medicare and Medicaid managed care plans. The Health Plan routinely collaborates with investigators to share and analyze claims data to investigate utilization and the effectiveness of various treatments and services.

Ongoing projects include the following:

Repair Variables: Distribution frequency of type and incidence will be compared across datasets containing that information (i.e. WRR, UPMC-HP Claims data, and NSM operations data)

• Published by Kim et al., (see full citation below), the research team investigated the lifespan of power wheelchair electronics, aiming to estimate time until repair or replacement and identify contributing factors to variability in lifespan. A retrospective analysis using the WRR data yielded 1,268 group 2 PWCs. Using a Kaplan–Meier’s survival analysis and Cox proportional hazards models the team found that 29.2% of PWCs experienced electronics-related repairs, with a median survival of 32.2 months. Significant predictors of reduced electronics survival included device type (group 3 hazard ratio (HR), 1.58; p = .003), distribution year in 2017 (HR, 1.82; p < .001) and distribution year in 2018 (HR, 4.08; p < .001). Manufacturer D was a marginally significant factor in reduced survival (HR, 1.66, p = .070). These findings underscore the importance of proper maintenance and design in enhancing PWC reliability and user quality of life.  

Health Factors: Distribution frequency of falls, pressure sores, and hospital readmissions will be compared across datasets containing that information (FMA/UDS and UPMC Claims Data).

• Published by Morrow et al., (see full citation below), the research team (1) summarized the personal and clinical characteristics of persons with disabilities (PwDs) in the US who were evaluated for mobility assistive equipment (MAE) in the functional mobility assessment and uniform dataset (FMA/UDS) and (2) stratify subpopulations of PwD who reported falling versus those who do not report a fall. Using a retrospective, descriptive cohort analysis of adults with disabilities using the FMA/UDS, there were 11,084 PwDs with thirty-one different primary diagnoses. During their new mobility device evaluation, 52.2% of PwDs reported at least one fall in the last 3 months. For those who reported a fall, 46.6% of PwDs were using a walking aid or no device at all before the new mobility device evaluation. Additionally, persons with progressively acquired disabilities (i.e., Parkinson’s disease, osteoarthritis, and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida). These findings will influence future studies comparing different types of devices and their influence on falls and user satisfaction. A follow-up paper examining associations of wheelchair service provision with patient falls 1-year post delivery of a new seating intervention is being investigated and a manuscript to be submitted before the end date of the grant.

A second question investigated from Aim 3 included stakeholders perceived access tomaintenance and repair services. This work was done in collaboration with another University of Pittsburgh NIDILRR-funded award, RERC Wheelchair Standards. 

• Published by Hiles et al. (see full citation below), this study aimed to amplify wheelchair users’ opinions and experiences related to their perceived access to crucial wheelchair maintenance and repair services. The research team conducted semi-structured interviews with four full-time wheelchair users using five semi-structured interview questions. The collected data was analyzed using a reflexive thematic analysis approach. Six interconnected themes were detailed: “improving accessibility and efficiency: service delivery,” “access challenges: diversifying repair options and locations,” “systemic challenges: the role of policy,” “design, durability, and dependability: meeting the user’s needs,” “empowering accessibility: bridging the knowledge gap,” and “The system Itself: a call for change.” The findings suggest that wheelchair users prioritize not only the revision of existing barriers to access but also the implementation of preventative measures to minimize repair needs. Practical implications include adjusting current policies, establishing best practice guidelines, and enacting preventative measures to facilitate improved user access to maintenance and repair services and optimize related outcomes. 
• A manuscript in preparation (i.e. Access to Maintenance and Repair Services for Wheelchairs: A Qualitative Study of Multi-Stakeholder Perspectives) followed Hiles et al. research strategy examining the perspectives of multiple stakeholders, including consumers, manufacturers, suppliers, clinicians, payors, and industry representatives, to identify barriers and opportunities for improving service accessibility. Through the same semi-structured interviews, twenty-one stakeholders in the Complex Rehabilitation Technology (CRT) sector were interviewed. Reflexive Thematic Analysis (RTA) was applied, with AI-assisted initial coding refined through researcher-led thematic discussions to ensure rigor and depth in theme development. Similarly, six key themes emerged: service inefficiencies and delays, technician shortages and training gaps, supply chain disruptions and part availability, underutilization of preventive maintenance, policy and reimbursement constraints, and stakeholder misalignment in service delivery. Participants emphasized the need for structured training programs, policy adjustments, and improved collaboration to enhance repair accessibility.

A third topic investigated from Aim 4 includes: what was the mean daily distance that individuals travelled in their power wheelchairs in 2022, is this distance different between regions, and is this distance different between power wheelchair models. All of these questions are being analyzed in collaboration with Permobil and the Permobil Connected Wheelchair Data.

• The ‘Distance Traveled by People Using Permobil Power Wheelchairs based on Large Data Analytics’ is still in review with the journal. The team has responded and submitted a second round of revisions and awaiting a decision. A follow-up article has been written using Permobil data from a 2-year period however will await a final decision on the first article before submitting this follow-up manuscript.

Dissemination Activities

Published Manuscripts

Kim, M., Pramana, G., Schein, R. M., & Schmeler, M.R. (2025). Estimating power wheelchair electronics lifespan based on real-world data. Disability and Rehabilitation. Assistive Technology, 1–7. Advance online publication. https://doi.org/10.1080/17483107.2025.2458727

Hiles, K.M., Schein, R.M., Pramana, G., & Schmeler, M.R. (2024). Wheelchair user’s perceived access to maintenance and repair services: a qualitative study. Disability and Rehabilitation. Assistive technology, 1–9. Advance online publication. https://doi.org/10.1080/17483107.2024.2442713

• a publication from a previous NIDILRR-funded award with content area related to this current award, that was published during the current reporting period.

Morrow, C., Schein, R.M, Pramana, G., McDonough, C., & Schmeler, M.R. (2024). Falls in people with mobility limitations: a cross-sectional analysis of a US registry of assistive device users. Disability and Rehabilitation: Assistive Technology, 1–7. https://doi.org/10.1080/17483107.2024.2369654

Ruffing, J. J., Schmeler, M. R., Schein, R. M., & Mhatre, A. (2024). A cross-sectional descriptive analysis of complex rehabilitation technology (CRT) supplier opinions on the current state of wheelchair repair services. Disability and rehabilitation. Assistive technology, 19(3), 739–744. https://doi.org/10.1080/17483107.2022.2121007

Mesoros, M. J., Schein, R. M., Pramana, G., Schiappa, V. J., Schmeler, M. R., & Dicianno, B. E. (2023). Functional mobility, employment and safety benefits of seat elevating devices. Assistive technology : the official journal of RESNA, 35(6), 471–476. https://doi.org/10.1080/10400435.2022.2124469

Cuppett, M., Schein, R. M., Pramana, G., Dicianno, B. E., & Schmeler, M. R. (2023). Investigation of factors from assistive technology professionals that impact timeliness of wheelchair service delivery: a cross-sectional study. Disability and rehabilitation. Assistive technology, 18(8), 1522–1526. https://doi.org/10.1080/17483107.2022.2048099

Nieto, A., Pramana, G., Schein, R. M., & Schmeler, M. R. (2023). Estimating power wheelchair battery lifespan based on real-world data. Disability and rehabilitation. Assistive technology, 18(2), 140–144. https://doi.org/10.1080/17483107.2022.2133182 

• a publication from a previous NIDILRR-funded award with content area related to this current award, that was published during the current reporting period

Schein, R. M., Yang, A., McKernan, G. P., Mesoros, M., Pramana, G., Schmeler, M. R., & Dicianno, B. E. (2021). Effect of the Assistive Technology Professional on the Provision of Mobility Assistive Equipment. Archives of physical medicine and rehabilitation, 102(10), 1895–1901. https://doi.org/10.1016/j .apmr.2021.03.024

Manuscripts in Review

Zhu, H., Schein, R.M., Pramana, G., Nooijen, C., Leire, K., Dicianno, B.E. & Schmeler, M.R. (Under Review in Assistive Technology). Distance Traveled by People Using Permobil Power Wheelchairs based on Large Data Analytics.

Manuscripts in Preparation

• Distance Travelled by Permobil Power Wheelchair Uses Across Regions and Models
• Access to Maintenance and Repair Services for Wheelchairs: A Qualitative Study of Multi-Stakeholder Perspectives
• Falls and Functional Mobility Assessment Scores post 1-Year Follow of a New Wheelchair Intervention

Abstracts in Review

Gerontological Society of America (2025). Abstract submitted titled, “Age-related Increases in Seating and Mobility-related Adverse Events in New Mobility Device Users”

Oceanic Seating Symposium (2025). Abstract submitted titled, “Towards an Evidence-Based Approach to Wheelchair Maintenance & Repair”

Other Project Dissemination Activities

**Schmeler, M.R., Schein, R.M. DiGiovine, C., Pramana, G., Busquets, M.P., Zhu, H., & Dicianno, B. (2025). Elements of a Value-Based Approach to Complex Rehabilitation Technology Service, Policy, and Payment. Instructional Course Presented at the 39^th International Seating Symposium. Assistive Technology, 37:sup2, S25, https://doi.org/10.1080/10400435.2025.2463822

Zhu, H., Schein, R.M., Mesoros, M., Dicianno, B.E., Nooijen, C., & Schmeler, M.R. (2025). How Far on Average Power Wheelchairs Travel? Short Course Presented at the 39^th International Seating Symposium. Assistive Technology, 37:sup2, S29, https://doi.org/10.1080/10400435.2025.2463822

Muriel, M.O., Schein, R.M., Schmeler, M.R., & Pramana, G. (2025). Access to Maintenance and Repair Services for Wheelchairs: A Qualitative Study of Multi-Stakeholder. Paper Session Presented at the 39^th International Seating Symposium. Assistive Technology, 37:sup2, S22, https://doi.org/10.1080/10400435.2025.2463822

• a publication from a previous NIDILRR-funded award with content area related to this current award, that was published during the current reporting period.

Kim. M., Schein, R.M., Pramana, G., & Schmeler, M.R. (2025). Estimating Power Wheelchair Electronics Lifespan Based on Real-World Data. Paper Session Presented at the 39^th International Seating Symposium. Assistive Technology, 37:sup2, S22, https://doi.org/10.1080/10400435.2025.2463822

Morrow, C., Schein, R.M., Schmeler, M.R., & Pramana, G. (2025). Five-year Medicare costs and replacement parts for complex rehabilitation technology. Instructional Course Presented at the 39^th International Seating Symposium. Assistive Technology, 37:sup2, S26, https://doi.org/10.1080/10400435.2025.2463822

** Schmeler, M.R., Schein, R.M.., & Morrow, C. (2024, June). Estimating the Reasonable Useful Life Cost of Complex Wheelchairs Using Real-World Datasets. Instructional Course presented at European Seating Symposium, Dublin, Ireland. 

**Schmeler, M.R., Morrow, C. Schein, R.M. (2024, June). Estimating Life-Cost of Complex Rehabilitation Technology Using Real-World Data. Instructional Course Presented at VGM Heartland Conference. Waterloo, Iowa.

Zhu, H., Schein, R.M., Pramana, G., Dicianno, B.E., & Schmeler, M.R. (2024). Distance Traveled by People Using Permobil Power Wheelchairs Based on Large Data Analytics. Paper Presented virtually at the Rehabilitation Engineering and Assistive Technology Society of North America annual conference

• 2024 RESNA Student Scientific Paper Runner-Up Award Winner

Worobey, L., Schein, R.M., &  Bennewith, A. (2024, September). The cost of wheelchair breakdown and who is to blame. Platform presentation at the Academy of Spinal Cord Injury Professionals (ASCIP). Chicago, Illinois. 

Schmeler, M.R., Morrow, C. Schein, R.M. (2024, June). Estimating Life-Cost of Complex Rehabilitation Technology Using Real-World Data. Instructional Course Presented at VGM Heartland Conference. Waterloo, Iowa. 

Hiles, K., Schein, R.M., Pramana, G., Schmeler, M.R., & Allegretti, A. (2024, May 22). Wheelchair User’s Perceived Access to Maintenance and Repair Services: A Qualitative Study. Poster Presented at the 20th Annual Rehabilitation Institute Research Day.

• Download Poster

Zhu, H., Schein, R.M., Pramana, G., Dicianno, B.E., & Schmeler, M.R. (2024, May 22). Distance Traveled by People Using Permobil Power Wheelchairs Based on Large Data Analytics. Poster Presented at the 20th Annual Rehabilitation Institute Research Day.

• Download Poster

Wilson, B., Schein, R.M., Pramana, G., Schmeler, M.R., & Masselink, C. (2024, May 22). Wheelchair Repair and Maintenance 一 Encounters During the First Year of Ownership. Poster Presented at the 20th Annual Rehabilitation Institute Research Day.

• Download Poster

Morrow, C. (2024, February). Falls in People with Mobility Limitations: A Cross-Sectional Analysis of a National Registry of Mobility Assistance Device Users. Paper Presented at the South Carolina Occupational Therapy Association. Columbia, South Carolina.

Data Driven Change. January 25, 2024 – https://www.nsm-seating.com/journal/data-driven-change/

Leire, K. Schmeler, M.R. Zhu, H., & Schein, R.M. (2023, November). Big Data as an Enabler-How to Make (the most) Out of It. Paper Presented at the Oceania Seating Symposium. Melbourne, Australia

**Schmeler, M.R. & Hibbs, R. (2023, September). Development of an Equitable Coverage Policy for Complex Wheelchair Seating and Mobility Devices. Paper Presented at the Academy of Spinal Cord Injury Professionals (ASCIP).

Borin, J., Schein, R.M., Schmeler, M.R., & Pramana, G. (2023, July). Preliminary Case Series Description of Power Standing Wheelchair Users. Paper Presented at the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). https://www.resna.org/sites/default/files/conference/2023/SeatingandMobility/77_Borin.html

• 2023 RESNA Student Scientific Paper Runner-Up Award Winner

**Schein, R., Schmeler, M.R., DiGiovine, C.P., & Hibbs, R. (2023, July). Steps Taken into the Assessment and Investigation of an Equitable Wheelchair Coverage Policy. Paper Presented at the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). https://www.resna.org/Events/RESNA-2023-Annual-Conference/Program-by-Track/SM-Seating-and-Mobility-including-CRT/323-steps-taken-into-the-assessment-and-investigation-of-an-equitable-wheelchair-coverage-policy

**Schmeler, M.R., DiGiovine, C.P., & Schein, R.M. (2023, June). Assessment and Investigation of an Equitable Wheelchair Coverage Policy. Instructional Course Presented at VGM Heartland Conference. Solving the Problem: Dr. Mark Schmeler on the important role data can play in proving effectiveness of assistive technology and establishing best practices and policies. March 29, 2023. https://www.nsm-seating.com/journal/solving-the-problem/

McKernan, G., Schein, R.M., Schmeler, M.R., Pramana, G. Mesoros, M. & Dicianno, B.E. (2022, February). Impact of the Assistive Technology Professional in the Provision of Mobility Assistive Equipment. International Seating Symposium (ISS). https://www.seatingsymposium.us/2022/event-schedule/event/3

Dicianno BE. Archives of PM&R podcast to a follow-up on the manuscript, ‘Effect of the Assistive Technology Professional on the Provision of Mobility Assistive Equipment’ – https://podcasts.apple.com/us/podcast/frailty-fighting-home-the-role-of-atps/id1215343605?i=1000576498474

• scroll to about 16 min 50 seconds for Dr. Dicianno’s part

Mesoros MJ, Schein RM, Pramana G, Schiappa VJ, Schmeler MR, Dicianno BE. (2022). Functional Mobility, Employment and Safety Benefits of Power Adjustable Seat Height. UPMC Rehabilitation Institute Research Day.

• Download Poster

Schmeler, M.R., Dicianno, B., Schein, R.M., & Pramana, G. (2023, April 14). Datasets & Registries Related to Complex Rehabilitation Technology. International Seating Symposium (ISS).

**  above dissemination activities were paper presentations at conference/symposia in collaboration with other project updates