Recommendations on Standards for the Design of Medical Diagnostic Equipment for Adults with Disabilities, Advisory Committee Final Report

8.4 Improving Data Sources and Research

As described in Section 3, to inform their deliberations, MDE Advisory Committee members sought as much information as possible, including anthropometric data, information about wheelchair and scooter dimensions, standards from previous rulemaking, and findings about how users approach transfers and other movements relevant to medical diagnostic equipment. Although Committee members did find helpful data, many gaps remained leaving Committee members to make recommendations based on experience and judgments of experienced clinicians and technical personnel. These experienced practitioners offer valuable perspectives, but they may not produce results that generalize broadly to the entire population of persons with disabilities.

MDE Advisory Committee members struggled in particular with applying the anthropometric data that were available for wheelchair and scooter users. The sample sizes for these data were small and not always representative of all wheelchair and scooter users. Another critical shortcoming was the lack of “functional” anthropometric data. For example, the Committee was making recommendations about standards for transfer surfaces of certain sizes. It is not clear what size surface is truly needed for individuals to transfer comfortably. To inform this standard, one would need to observe individuals transferring and then measure the size of the surface that they used to perform this task. A recent review of the literature confirms the Committee’s concern about inadequate information about wheelchair transfers:

... There is scarce evidence related to the impact of setup on the performance of independent transfers. The results of this expert review of the literature highlight the need for future studies particularly as it relates to how environmental factors such as height and gap distances, use of handholds, surface softness, number of transfers needed to go from the initial location to the final destination, use of assist devices, space available for transfer and obstacles or barriers impact the ability to perform independent transfers.¹

Likewise, the Committee had difficulty considering the optimal placement of hand supports due to the lack of data on functional placement of hands for individuals using wheelchairs and scooters. When considering mammography access standards, critical information was missing pertaining to breast anthropometrics, such as breast height while seated, standing, and in a wheelchair. These data are critical for determining optimal height ranges for an adjustable breast platform.

One particular gap in research is information on the costs and benefits or effectiveness of recommended accessibility standards. Committee members agreed that generating information about the potential costs of changing technologies to meet accessibility requirements would be more straightforward than tallying the benefits of these changes. Manufacturer representatives on the Committee described some of the costs to healthcare providers that might be incurred; in particular, manufacturers of medical examination tables estimated the costs of adapting the currently-available adjustable-height tables to comply with the range of standards discussed by the Committee. Additional costs include those of research and development of new product designs to improve accessibility.

In contrast, quantifying the benefits is challenging. Potential benefits include:

• Improving diagnostic efficiency for persons with disabilities, perhaps resulting in earlier diagnosis of conditions at more treatable stages than with previous equipment and thus improving patients’ outcome;

• Decreasing the risks of falls, injuries, and discomfort to patients during diagnostic procedures;

• Increasing the likelihood that persons with disabilities will choose to undergo diagnostic testing because they no longer anticipate discomfort and difficulties during testing (e.g., as with mammography screening); and

• For clinical personnel, reducing their risks of injuries from transferring patients onto and off of MDE.^QQ

Therefore, going forward, research on the costs and benefits of improving MDE access requires additional attention.

Notes

^QQ Clinical personnel and their supervisors also share responsibility for ensuring their safety during transfers, for example by explicit training in transfer ergonomics. Nonetheless, having accessible equipment should help minimize risks to patients and clinical staff.

Section 8 References

^1. Koontz A, Toro M, Kankipati P, Naber M, Cooper R. An expert review of the scientific literature on independent wheelchair transfers. Disability and Rehabilitation: Assistive Technology, January 2012; 7(1): 20–29, p. 28