Disclosures: Lucy Kurzava Kendall, DO: No financial relationships or conflicts of interest

Objective: To establish the need to acquire a power wheelchair prior to absolute functional necessity in patients with ALS

Design: Retrospective chart review

Setting: Multidisciplinary outpatient ALS clinic at an academic institution

Participants: All ALS patients who received power wheelchairs between January 2020 and November 2021

Interventions: N/A

Main Outcome Measures: N/A

Results: In 22 ALS patients, the mean time from power wheelchair order to date of delivery was 125.09 (56.32) days, quantifying the extensive duration to receive a power wheelchair from time ordered. In patients who were deceased at time of analysis, the proportion of useable wheelchair time as a function of needed wheelchair time was 0.63 (0.21), demonstrating suboptimal wheelchair utilization during which time they were truly needed for functional independence.

Conclusions: An underestimated challenge facing ALS patients is the inability to acquire power wheelchairs in a timely fashion, limiting functional benefit from wheelchair utilization as their disease progresses. Prohibitive factors preventing ALS patients from acquiring wheelchairs include barriers associated with obtaining needed documentation, delays in obtaining insurance authorization, as well as patient denial regarding disease progression and functional necessity. Identifying and eliminating sources of these delays is crucial given the substantial financial costs and lengthy process required for wheelchair customization and rapidly progressive course of patients with motor neuron disease. Our data suggests a substantial hinderance on patient independence and comfort due to the inability to acquire power wheelchairs more rapidly, in a time period when they are most needed functionally. We propose a model to approximate when in their disease course it is most appropriate to initiate a custom power wheelchair order with two-fold applicability: to illustrate to payor sources that custom power wheelchair evaluation and order is needed prior to absolute medical necessity in these patients, as well as provide a model to patients indicating when they can anticipate relying on a power wheelchair for mobility.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/timing-of-power-wheelchair-prescription-acquisition-and-utilization-relative-to-disease-progression-in-an-als-patient-population/