Page 6 - Mobility Management, May 2019

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The Evidence for Tilt, Recline & ELRs
No matter how obvious the need for seating and wheeled mobility intervention might appear to the clinicians, ATPs and clients involved, funding
sources still require detailed justification for complex rehab technology (CRT).
When you’re writing your justification for tilt, recline and/or elevating legrests (manual or power), funding specialists say it’s not enough to just attach position papers and journal articles that hail the benefits of those positioning options. Payors want to know why you believe positioning options will support a particular client’s ability, for example, to more safely and independently perform mobility-related activities of daily living.
The first step is understanding what the evidence says tilt, recline and elevating legrests can do for wheelchair users.
A “Clinical Consensus” on Positioning
The most recent position paper on the subject from
the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) is the organization’s 2015 update. While RESNA states that position papers are “not intended to be formal, scientific meta-analyses,” RESNA says its papers “use evidence and expert advice to summarize best practices for assistive technology devices, evaluation and service delivery. Position papers provide a rationale for decision making and profes- sional skills for practitioners; and explain the medical or functional necessity of AT devices and services for policy makers and funding sources.”
RESNA’s latest paper on this subject lists a number of instances in which tilt, recline and/or elevating legrests are deemed medically necessary because they can help the client to achieve a number of goals, from realigning posture and enhancing function to improving respiration and bowel and bladder function, regulating spasticity and managing edema.1
RESNA’s paper also states that such beneficial effects are considered “a clinical consensus” that the organiza- tion reported in earlier work.
Making It Personal
Once you’re familiar with the benefits of tilt, recline and elevating legrests, the second step is to make it personal for funding sources.
In an interview with Mobility Management after the position paper was published, lead author Brad E. Dicianno, M.D., suggested the most effective way to use
6 MAY 2019 | MOBILITY MANAGEMENT
the paper is
to reference the portions of research that apply specif- ically to the client you’re working with.
Here’s an example of how that process could look:2
• Identify the issue that the positioning option could help: Client has a history of pressure injuries and chronic lower-extremity edema.
• Describe why the positioning option or options are needed. Client cannot independently and consistently weight shift and change positions.
• Locate the relevant research and explain that because the client’s condition matches conditions described in the research, the client could benefit from the positioning option(s) being discussed: The RESNA position paper on tilt, recline and elevating legrests says using tilt in combination with elevating legrests to raise the legs above the heart by about 30 cm has been found to help manage edema.
Staying Up to Date
Research is ongoing, and the industry’s understanding of how tilt, recline and elevating legrests affect client outcomes is a living, evolving concept.
While staying up to date on RESNA’s position papers is always a good idea — RESNA’s policy is to update posi- tion papers every five years to stay current with the latest research developments — another smart move is to call on manufacturers for support.
Many manufacturers have sample letters of justifica- tion or other examples of how CRT teams justified posi- tioning options. Every client is different, and documenta- tion needs to be specific to each client. But that doesn’t mean you can’t learn from other teams’ successes. m
Sources: (1) RESNA Position on the Application of
Tilt, Recline and Elevating Legrests for Wheelchairs:
2015 Current State of the Literature: http://tinyurl.com/ resnapositioning. (2) New Pressure Relief Studies Cited in Updated RESNA Paper, https://mobilitymgmt.com/arti- cles/2015/12/01/pressure-relief-studies.aspx
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