463 - Timing of Power Wheelchair Prescription, Acquisition, and Utilization Relative to Disease Progression in an ALS Patient Population: A Longitudinal Study Update

Objectives: We aim to establish the need to acquire a power wheelchair prior to absolute functional necessity in patients with ALS. Prohibitive factors preventing ALS patients from obtaining power wheelchairs include barriers associated with obtaining needed documentation, delays in attaining insurance authorization, and patient denial regarding disease progression and need for power wheelchair. Identifying and eliminating these delays is of critical importance given the substantial financial costs and lengthy process required for wheelchair customization and the rapidly progressive course of most patients with motor neuron disease.

Design: Retrospective chart review of all ALS patients receiving power wheelchairs from January 2020-November 2021 who were seen at an academic multidisciplinary ALS clinic.

Results: In 22 ALS patients, the mean time from power wheelchair prescription by physician to delivery date was 125.1 (56.3) days, quantifying the waiting time required to receive a power wheelchair from time ordered. We proceed further to evaluate the limited proportion of useable wheelchair time as a function of needed wheelchair time in patients who were deceased at the time of analysis (n=17), revealing that patients had a wheelchair for only 74.5% of the time they required one.

Conclusions: We demonstrate suboptimal quantity of wheelchair utilization during which time they were truly needed for functional independence, due to delay in wheelchair acquisition. Our data highlights a substantial hinderance on patient independence and comfort due to the inability to acquire power wheelchairs in an appropriate timeframe. 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.