Electric beds: Recommendations based on users' satisfaction

By Claude Vincent and Louise Demers
This article originally appeared in the March/April 2002 issue of Occupational Therapy Now Magazine published by the Canadian Association of Occupational Therapists.

An increasing number of severely disabled people living in the community ae using fully adjustable electric beds to facilitate bed mobility and transfers. A fully adjustable electric bed is a type of bed that provides three different types of adjustments: bed height and angle adjustment of the head and foot of the bed. In 1998-1999 in the province of Quebec, 674 beds were allocated by the Office des personnes handicapées du Québec, for a sum totalling $1,065,000. The products available on the market vary according to different features, such as minimum and maximum height, sturdiness, dimensions, operating speed and braking system. What is the level of satisfaction of electric bed users who spend an average of 10 to 12 hours a day in bed, where they sleep, dress, wash and occasionally eat?

Using evidence-based data to validate occupational therapy practice in the area of fully adjustable electric beds, l'Équipe de consultation sur les aides techniques (ÉCAT) conducted a study to explore users' levels of satisfaction. ÉCAT, an interest group focusing on assistive devices, is composed of 12 occupational therapists from four regions in Quebec.

The aim of this study was to answer two questions: 1) What are the elements that users consider important in their evaluation of electric beds? 2) What is the level of satisfaction expressed for two models of electric beds frequently recommended by occupational therapists? This article will briefly describe the evaluation procedures and the results of the study, followed by a discussion focusing on how occupational therapists could use the conclusions of the study in their clinical practice.

Evaluation procedures of client satisfaction with electric beds

A survey was conducted using a sample of 32 users of single beds (two manufacturers) and 11 users of double beds (one manufacturer). Users, ranging in age from 13 to 65 years, were recruited with the assistance of the members of ÉCAT and their work colleagues.

All participants completed, at home, the Quebec User Evaluation of Satisfaction with Assistive Technology, Version 2.0 (Demers et al., 2000). This standardized and validated evaluation tool includes 12 elements of satisfaction, organized into two sub-scales linked to technical aspects and services, respectively. Using a five-point scale, the user had to specify his or her level of satisfaction toward each statement, ranging from "not at all satisfied" to "very satisfied". For example, question 5 reads: "To what degree are you satisfied with the sturdiness (durability, resistance to wear) of your assistive device?" Space is provided after each question for users' comments, which are essential to the correct interpretation of the users' points of view.

The users were then asked to select the three statements that they considered the most important amongst all the statements. An average score for the levels of satisfaction (ranging from 1.00 to 5.00) was derived for each sub-scale. Users were then invited to answer five additional questions regarding the noisiness, braking system, remote control device, operating speed, height and angle adjustment at the head of the electric bed.

Evidence-based data collected in the field
Which elements do users consider important in their evaluation of electric beds?

Four elements in particular were chosen by more than 12 participants (Figure 1). The users of single beds felt that comfort and ease of use are the most important characteristics to consider when choosing a bed (n=21). According to ÉSAT, comfort is defined as the physical and psychological well-being associated with an assistive device. Ease of use refers to the simplicity of operation of an assistive device. Security (n=17) and efficiency (n=12) follow in order of importance, in second and third place, respectively. Efficiency is defined as the extent to which the desired goal is attained with the assistive device. Security refers to the absence of risk, the safety and reliability of the assistive device.

What is the degree of satisfaction expressed regarding two models of electric beds frequently recommended by occupational therapists?

Generally, users express a high level of satisfaction (over 4.00) in reference to the features studied, regardless of the model evaluated. Standard deviations are relatively low, which indicates that the users' answers are similar. Figure 2 shows the average level of satisfaction for each of the elements being studied. Despite a generally positive evaluation, there are some slight differences between the users' answers that are worth mentioning. For example, noisiness and the braking system were given ratings slightly lower than 4.00, lower than the ratings given to the other elements. Also, the Rotec single bed stands out with regard to its efficiency, as it is given a higher rating of satisfaction than the Invacare single bed. The only significant difference between the data on single and double beds concerns the dimensional element. It appears that people using a double bed were more satisfied with the dimensions than people using a single bed. No diagram of satisfaction dealing with double beds is presented here since the data is identical to those in Figure 2 (single beds), with the exception of the dimensional element.

The users' comments relate to the bed positions and functions, the remote control device and the accessories. The following statements are typical examples of dissatisfaction expressed by users of electric beds:

• The bed is not high enough to allow me to dress my son or change his diaper.
• It would be easier if the bed could be adjusted to a lower height to assist in my transfers between my chair and the bed.
• When in a sitting position, the angle of the head end is not straight enough to allow me to eat comfortably in bed.
• I would like to have raised buttons on the remote control.
• Noisy motor: it makes a loud bang at the base when it stops.
• The bed side rails should be reinforced; they are not very strong. A footboard would be very useful to prevent anything resting on the bed from falling on to the floor when the foot end is inclined.

This type of qualitative data could be useful when selecting a fully adjustable electric bed as well as for client follow-up.

Recommendations for the improvement of occupational therapy practice

Elements of comfort, ease of use, security and efficiency seem to be the most important factors to consider when selecting a fully adjustable electric bed. The bed dimensions also appear to be a significant element to consider, especially when clients with special needs are involved.

Comfort

This is certainly the most important element to consider. At the same time, one has to be careful since its interpretation is complex. Some users perceive comfort at a physical level, in terms of the physical contact between the body and the surface on which the person lies (i.e. mattress comfort). In fact, in order to maximize comfort, the occupational therapist must also be concerned with the type of mattress, which seems to be as important, if not more, than the type of bed. Others perceive comfort in terms of the dynamic sensation felt when the bed is elevated or when it is adjusted at the head or foot (i.e. comfort experienced from change of position). And again, other users interpret comfort globally at a psychological level, in other words by considering the bed as contributing to an improvement in the quality of life (i.e. comfort while engaging in self-care activities). Therefore, it appears that comfort is an element that an occupational therapist must discuss in detail with the user.

Ease of use

This seems strongly linked to the choice of remote control device. The occupational therapist must be concerned with the level of complexity for programming individual bed functions. Often, the remote control device may have too many buttons, which are too small or which may require that the user presses two buttons simultaneously. Finally, some remote control devices are more fragile than others and are often in need of repair.

Efficiency and Security

These are often linked to a problem of stability with the fully adjustable bed. The occupational therapist must be attentive to the client if he or she mentions the occurrence of mechanical vibrations when modifying bed positions. The therapist must also encourage the users to monitor signs of mechanical inefficiencies such as inadequate braking system, slow or intermittent operating speed or noisy mechanisms.

Double bed users seem more satisfied than single bed users regarding the dimensions of their beds. The occupational therapist that recommends a fully adjustable double bed must often demonstrate to the third party payor that the client has a real need for this type of bed. The therapist can base his or her recommendation on the fact that the client experiences reduced mobility and one of the following characteristics: obesity, above average height or stature, inability to roll over in a restricted space or a desire to continue sharing the bed with a partner. A rationale can be formulated on the fact that people who were allocated double beds are more satisfied because the double bed meets their needs and corresponds to the nature of their problems.

This is one of the first studies on the perception of home users in the area of fully adjustable electric beds. Despite the contextual limitations associated with the survey, this article contributes to the documentation of evidence-based occupational therapy practice. For further research, it would be recommended to pursue other home-based studies and to compare user satisfaction between older and newer bed models that are being developed on a continuing basis.

About the authors

Claude Vincent, OT(C), Ph.D. graduated from l'Université de Montréal in Occupational Therapy (Baccalaureate, 1990) and in Public Health (Doctorate, 1997). She is a professor at l'Université Laval and a researcher at the Centre interdisciplinaire de recherche en réadaptation et intégration sociale, located at l'Institut de réadaptation en déficience physique de Québec. She is a member of l'Équipe de consultation sur les aides techniques since 1994. Tel. (418) 656-2131, ext. 6078 e-mail: claude.vincent@rea.ulaval.ca

Louise Demers, OT(C), Ph.D. graduated from l'Université de Montréal in Occupational Therapy (Baccalaureate, 1985) and in Biomedical Sciences (Rehabilitation) (Doctorate, 1999). She became a professor at l'Université de Montréal and a researcher at l'Institut universitaire de recherche en gériatrie, in Montréal. She was a member of l'Équipe de consultation sur les aides techniques from 1996 to 2001. Tel. (514) 340-2800, ext. 3010, e-mail : louise.demers@umontreal.ca.

References

Demers, L., Weiss-Lambrou, R., & Ska, B. (2000). Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST version 2.0) - An outcome measure for assistive technology devices. Webster, NY : Institute for Matching Person and Technology.

Acknowledgements

The authors wish to thank the members of ÉCAT for their comments and precious collaboration in the realization of this article. We would like to extend a special thanks to Isabelle Deaudelin and Annie Giroux for their analysis and presentation of the data.