490
User Assessment of Manual Wheelchair Ride Comfort
and Ergonomics
Michalle M. DiGiovine, BS, Rory A. Cooper, PhD, Michael L. Boninger, MD, Brad M. Lawrence, MS,
David P. VanSickle, PhD, Andrew J. Rentschler, BS
ABSTRACT. DiGiovine MM, Cooper RA, Boninger ML,
Lawrence BM, VanSickle DP, Rentschler AJ. User assessment
of manual wheelchair ride comfort and ergonomics. Arch Phys
Med Rehabil 2000;81:490-4.
Objective: To examine wheelchair-user perceived ride com-
fort during propulsion and to compare the ride comfort of
ultralight and lightweight manual wheelchairs. An ultralight
wheelchair is defined as having a high degree of adjustability,
whereas a lightweight wheelchair has minimal adjustability.
Design and Participants: Repeated measures design of a
sample of 30 community-dwelling manual wheelchair users
evaluating 7 different manual wheelchairs over an activities of
daily living course.
Setting: A rehabilitation engineering center.
Main Outcome Measures: Subject ratings of perceived ride
comfort and basic ergonomics while propelling over the
activities of daily living course. Ratings were recorded for each
wheelchair on individual tasks and for the course overall.
Results: The Invacare Action XT wheelchair was ranked
best for both ride comfort and basic ergonomics. The ride-
comfort scores ( p ⬍ .05) and wheelchair ergonomics ratings
( p ⬍ .05) for the ultralight wheelchair group were significantly
different from those for lightweight wheelchair group.
Conclusion: There are differences in perceived ride comfort
and basic ergonomics between the designs of the wheelchairs
(lightweight vs ultralight). Subjects perceived that ultralight
wheelchairs were more comfortable and had better basic
ergonomics than lightweight wheelchairs.
Key Words: Wheelchair; Ride comfort; Ergonomics; Pain.
娀 2000 by the American Congress of Rehabilitation Medi-
cine and the American Academy of Physical Medicine and
Rehabilitation
S EVERAL STUDIES have examined discomfort or pain in
the automotive and trucking industries with respect to the
vibrations that individuals feel in either a seated or a standing
From the Human Engineering Research Laboratories VA Pittsburgh Healthcare
System (Drs. DiGiovine, Cooper, Boninger, Lawrence, VanSickle, Rentschler); the
Department of Rehabilitation Science and Technology (Drs. Cooper, Boninger),
and Department of Bioengineering (Drs. Cooper, Boninger, Lawrence, VanSickle,
Rentschler), University of Pittsburgh; and the Division of Physical Medicine and
Rehabilitation, Department of Orthopaedic Surgery, University of Pittsburgh and
UPMC Health System (Drs. Cooper, Boninger), Pittsburgh, PA.
Submitted for publication March 12, 1999. Accepted in revised form September 20,
1999.
Supported in part by the US Department of Veterans Affairs, Rehabilitation
Research and Development Service (Merit Review Grant B805-RC), the Paralyzed
Veterans of America, and the Eastern Paralyzed Veterans of America.
No commercial party having a direct financial interest in the results of the research
supporting this article has or will confer a benefit upon the authors or upon any
organization with which the authors are associated.
Reprint requests to Rory A. Cooper, PhD, Human Engineering Research Laborato-
ries (151-R1), VA Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA
15206.
娀 2000 by the American Congress of Rehabilitation Medicine and the American
Academy of Physical Medicine and Rehabilitation
0003-9993/00/8104-5507$3.00/0
doi:10.1053/mr.2000.3845
Arch Phys Med Rehabil Vol 81, April 2000
position.1-5 Other research has examined durability of manual
wheelchairs without regard for ride comfort.6,7 Wheelchair ride
comfort may influence pain, pelvic/spinal deformity develop-
ment, and technology abandonment.
Pope and colleagues1 examined the dynamic responses of
individuals using three different cushion surfaces to establish a
correlation between vehicle driving and low back pain. They
found that soft cushions magnify the gain at the first natural
frequency of the driver, which amplifies the stress on the
driver’s spine. Zhao and Tang2 tested the comfort of a bus seat
to provide recommendations to the manufacturer. Their fuzzy-
set model required that two assumptions be made: that subjects
were aware of their feelings of comfort and that feelings of
comfort could be verbalized. The fuzzy-set model helped to
account for the uncertainty (fuzziness) in the respondent’s
answer. Their results indicate that subjects were able to rate ride
comfort reliably and could differentiate between seats. Bovenzi
and Betta3 showed that tractor drivers exposed to whole body
vibrations during prolonged sitting or awkward sitting postures
are at risk for low back pain. Hulshof and van Zanten4 reported
a correlation between exposure to vibrations and an increase in
developing low back pain, but suggested that there is a need for
more research.
The International Organization for Standardization (ISO) has
developed wheelchair standards that may someday aid consum-
ers and clinicians in making decisions about wheelchair selec-
tion.6 However, there are no ISO wheelchair standards for ride
comfort. Manual wheelchair durability, stability, and cost
effectiveness have been studied with American National Stan-
dards Institute (ANSI)/Rehabilitation Engineering and Assis-
tive Technology Society of North America (RESNA) stan-
dards.7 It is important to consider the consumer’s perception of
a manual wheelchair along with the quantitative results from
the ISO-ANSI/RESNA wheelchair standards. The manufac-
turer must recognize aspects of wheelchair design that lead to
discomfort for the consumer in order to manufacture the most
appropriate wheelchair. Clinicians and consumers should con-
sider the ride comfort of different wheelchairs in order to
provide the user with adequate mobility and to minimize the
risk of abandonment.
The purpose of this study was to have wheelchair riders rate
manual wheelchair ride comfort and ergonomics while travers-
ing an activities of daily living (ADL) driving course to
determine if the riders perceived differences. The survey
recorded information about eight tasks and basic wheelchair
ergonomics. It was hypothesized that the subjects would
express no preference in ride comfort or basic ergonomics for
the ultralight wheelchairs (class KO5) versus the lightweight
wheelchairs (class KO4). In this study, an ultralight wheelchair
was defined as having a high degree of adjustability, whereas a
lightweight wheelchair would have minimal adjustability. Both
lightweight and ultralight wheelchairs are designed for use as
long-term mobility aids.
 MANUAL WHEELCHAIR RIDE COMFORT, DiGiovine 491

Table 1: The Subjects’ Personal Wheelchairs

Model of No. of
Manufacturer Wheelchair Subjects

Invacare Action A4 1
Invacare Action Pro T 1
Invacare Ridelite* 1
Everest & Jennings Vision 2
Everest & Jennings Profile* 1
Etac Swede Elite 1
Sunrise Medical Quickie GP 5
Sunrise Medical Quickie TI rigid 1
Sunrise Medical Quickie RX* 1
Sunrise Medical Quickie Revolution 1
Sunrise Medical Quickie Shadow 1
Sunrise Medical Quickie 2 14
* Denotes lightweight wheelchair.

METHODS Fig 1. Depiction of wheelbase, track width, and caster trail.

Thirty manual wheelchair users (24 men, 6 women) gave
written informed consent to participate in this study. Prelimi-
nary data indicated that this would give us a 95% power to
detect differences at p ⬍ .05. Subjects were recruited through
mailings, advertisements, and by word-of-mouth. More than
200 subjects were contacted. All subjects included in the study
were manual wheelchair users because of spinal cord injury (23
with paraplegia and 2 with quadriplegia), multiple sclerosis (2),
spina bifida (2), or cerebral palsy (1). The subjects had been
using manual wheelchairs a mean ⫾ standard deviation of 15.7
⫾ 9.7 years and all were using a manual wheelchair as their
primary means of mobility within the community. The types of
personal wheelchairs used are presented in table 1. The
wheelchairs had approximate seat widths of 406mm (16in) and
seat depths between 406 to 456mm (16 to 18in).
Seven common manual wheelchairs were selected for com-
parison. The models were selected based on the numbers
purchased by the US Department of Veterans Affairs.6 All were
of the cross-brace folding type and were ordered with the
manufacturers’ standard features. The seat depths and seat
widths for all wheelchairs were 406 ⫻ 406mm (16 ⫻ 16in).
The backrests’ nominal heights (prior to adjustment) were
457mm (18in). All had a nominal caster diameter of 200mm
(8in) and a nominal wheel size of 610mm (24in). The ultralight
wheelchairs used spoked wheels, and the lightweight wheel-
chairs used composite MAG wheels. The ultralight wheelchairs
and the E&J Metro LX had pneumatic tires; the others had solid
tires. All had solid polyurethane casters. The four ultralight
wheelchairs selected were the Kuschall Champion 1000a;
Invacare Action XTb; Sunrise Medical Quickie 2HPc; and
Graham-Fields E&J Vision Epic.d The three lightweight wheel-
chairs selected were the Invacare 9000SLb; Sunrise Medical
Quickie Breezyc; and Graham-Fields E&J Metro LX.d The
wheelchairs’ masses are listed in table 2 (see fig 1). During
testing, the subjects could use either their personal cushions or a
75mm linear polyurethane foam cushion. We assumed that the
cushion was associated with the individual and not specific to
the wheelchair.
The ADL driving course was designed by the investigators to
represent common driving tasks encountered by manual wheel-
chair users in daily community living. The course was con-
structed indoors on a tile floor. Bright yellow tape was used to
mark the direction of the course. Colored tape was also used to
mark the beginning and end of each task. The course included a
dimple strip (guide strip for individuals with visual impair-
ments); carpet; tile surface; a simulated door threshold (12mm
high ⫻ 150mm long); a 50mm high ramp of 5° slope with curb
decent; a rumble strip approximately 5mm high (with guide
strip to denote change in traffic, road way, for individuals with
visual impairments); and 25mm, 50mm, and 75mm high
sinusoidal (speed) bumps. The course layout is shown in figure
2. All subjects completed the entire course.
Seating measurements were made of each subject’s personal
wheelchair, and adjustments were made in legrest length,

Table 2: Wheelchair Driving Measurements for Both Lightweight

and Ultralight Wheelchairs in the Factory Default Set-up
Rear Wheel Front Caster Wheel- Caster
Mass Trackwidth Trackwidth base Trail
Wheelchair (kg) (m) (m) (m) (cm)

Kuschall Champion 1000 13.9 .52 .45 .37 2.9

Invacare Action XT 15.2 .53 .45 .40 5.4
Quickie 2HP 15.2 .60 .50 .39 5.4
E&J Vision Epic 13.8 .58 .46 .34 5.7
Invacare 9000SL* 16.7 .49 .45 .39 5.7
Quickie Breezy* 14.5 .57 .51 .43 5.4
E&J Metro LX* 16.3 .48 .45 .44 5.6
All chairs are cross-brace foldable.
* Denotes a lightweight wheelchair. Fig 2. Illustration of the ADL driving course used during this study.

Arch Phys Med Rehabil Vol 81, April 2000

492 MANUAL WHEELCHAIR RIDE COMFORT, DiGiovine

Table 3: Ride Comfort Ranking and Mean ⴞ SD Data for Each Wheelchair on Every Task
Wheelchair Model
Task All Action Kuschall 2HP Metro LX* Breezy* 9000SL* Vision Epic

D 6.4 ⫾ 2.5 1 (7.9 ⫾ 1.3) 3 (6.7 ⫾ 2.4) 4 (6.6 ⫾ 2.2) 5 (6.1 ⫾ 2.9) 2 (6.8 ⫾ 1.7) 6 (5.3 ⫾ 2.8) 6 (5.3 ⫾ 2.6)
Carpet 6.9 ⫾ 2.4 1 (8.2 ⫾ 1.4) 3 (7.1 ⫾ 2.6) 4 (6.9 ⫾ 2.1) 5 (6.8 ⫾ 2.6) 2 (7.4 ⫾ 1.7) 6 (6.0 ⫾ 2.6) 6 (6.0 ⫾ 2.7)
DT 6.1 ⫾ 2.5 1 (7.7 ⫾ 1.5) 2 (6.7 ⫾ 2.4) 3 (6.6 ⫾ 2.0) 4 (5.9 ⫾ 2.7) 3 (6.6 ⫾ 1.8) 5 (5.2 ⫾ 2.4) 6 (4.2 ⫾ 2.8)
Ramp 5.9 ⫾ 2.4 1 (7.5 ⫾ 1.7) 2 (6.6 ⫾ 2.4) 4 (6.2 ⫾ 2.0) 5 (5.7 ⫾ 2.7) 3 (6.4 ⫾ 1.5) 7 (4.3 ⫾ 2.5) 6 (4.4 ⫾ 2.5)
R 6.2 ⫾ 2.4 1 (8.0 ⫾ 1.2) 3 (6.6 ⫾ 2.4) 4 (6.5 ⫾ 2.2) 5 (5.9 ⫾ 2.7) 2 (6.9 ⫾ 1.7) 6 (5.2 ⫾ 2.4) 7 (4.6 ⫾ 2.6)
S1 6.4 ⫾ 2.5 1 (7.8 ⫾ 1.4) 3 (6.6 ⫾ 2.7) 5 (6.4 ⫾ 2.1) 4 (6.5 ⫾ 2.4) 2 (6.9 ⫾ 1.9) 6 (5.4 ⫾ 2.6) 7 (4.9 ⫾ 2.8)
S2 5.5 ⫾ 2.5 1 (7.4 ⫾ 1.4) 3 (6.0 ⫾ 2.7) 5 (5.3 ⫾ 2.0) 4 (5.7 ⫾ 2.4) 2 (6.2 ⫾ 1.8) 6 (4.2 ⫾ 2.5) 7 (3.8 ⫾ 2.6)
S3 4.0 ⫾ 2.7 1 (6.2 ⫾ 2.3) 2 (4.7 ⫾ 2.7) 4 (3.4 ⫾ 2.4) 3 (4.2 ⫾ 2.4) 2 (4.7 ⫾ 2.3) 5 (2.4 ⫾ 2.1) 6 (2.2 ⫾ 2.6)
Overall 1 (7.6 ⫾ 1.6) 3 (6.4 ⫾ 2.6) 4 (6.0 ⫾ 2.4) 5 (5.8 ⫾ 2.7) 2 (6.5 ⫾ 1.9) 6 (4.8 ⫾ 2.7) 7 (4.4 ⫾ 2.8)
Abbreviations: D, dimple strip; DT, door threshold; R, rumble strip; S1, sine bump 25mm; S2, sine bump 50mm; S3, sine bump 75mm.
* Denotes lightweight wheelchair.

armrest height, and axle position (ultralight wheelchairs only)
of the test wheelchairs to match as closely as possible the
measurements of each subject’s personal wheelchair. The order
in which the test wheelchairs were presented was randomized
for each subject, all of whom propelled the seven test wheel-
chairs over the driving course three times. They were instructed
to complete the course at a comfortable pace (ie, freely chosen
speed), and were followed by a spotter during each trial. After
the third trial for each test wheelchair, the subject completed a
survey developed for this study, which was previously validated
in a pilot study.8
The survey scored ride comfort for each of the tasks on the
course and rated basic wheelchair ergonomics. The portion of
the ride comfort survey that evaluated the driving tasks used a
visual analog scale of 10cm in length.9 The scale ranged from
extreme discomfort (0cm) on the left to extreme comfort on the
right (10cm). Subjects were asked to place an ‘‘X’’ on the visual
analog scale to represent their level of comfort with each task
for each wheelchair. Later, a single investigator blinded to the
chair type measured the distance from the left edge of the scale
to the nearest millimeter using a rule. The wheelchair ergo-
nomic section of the survey consisted of four multiple-choice
questions that addressed support/stability, ease of maneuverabil-
ity, hand comfort on pushrim, and overall ride comfort on the
course. Five descriptors were used for the ratings of each
ergonomic question: Not at all (1), Fairly (2), Moderately (3),
Very (4), and Extremely (5). For the overall ride comfort
question the descriptors were Poor (1), Fair (2), Moderate (3),
Good (4), and Excellent (5). The ride comfort section scores
were analyzed using repeated measures multiple analysis of
variance with Sheffe’s post hoc analysis.10 The ergonomics and
overall ride comfort ratings of the survey were analyzed using
the Kruskal-Wallis test.10
RESULTS
The mean ride comfort scores for each driving task were
calculated for each of the seven wheelchairs (table 3). The
Invacare Action XT had a significantly ( p ⬍ .05) higher mean
comfort score across all tasks (7.6 ⫾ 1.6). In contrast, the E&J
Vision Epic had the lowest mean comfort score for seven of the
tasks and the second lowest mean for the ramp. The E&J Epic
had the lowest ride comfort rating overall for the ADL driving
course (4.5 ⫾ 2.8). Because less than half of the 30 subjects
scored the tile surface, it was not included in the statistical
analysis. All 30 subjects completed the remainder of the
questions. The results of comparing the ratings of all subjects
combined for the ultralight wheelchairs (6.2 ⫾ 2.6) and light-
weight wheelchairs (5.8 ⫾ 2.5) showed a significant difference
( p ⬍ 0.05) in overall ride comfort. There was also a significant
difference in subject-rated ergonomics among the ultralight
wheelchair group (3.2 ⫾ 1.1) and the lightweight wheelchair
group (2.7 ⫾ 1.1). The results of the ergonomic ratings are
presented in table 4.
Table 5 shows the results of the statistical analysis among
wheelchairs and across driving tasks. Significant differences
were found among several wheelchairs for various tasks. The
mean comfort scores for each wheelchair across all driving
tasks (except the tile surface) revealed significant differences
( p ⬍ .05) between the Invacare Action XT and the E&J Epic. In
addition, the analysis showed significant differences ( p ⬍ .05)
between the Invacare Action XT and the Invacare 9000SL for
all tasks. Table 6 presents the rankings of the wheelchairs based
on ride comfort and ergonomics. The Invacare Action XT is
ranked highest in both categories, whereas the E&J Epic and
Invacare 9000SL are among the lowest in both categories.
DISCUSSION
We tested seven of the most commonly prescribed manual
wheelchairs. The results indicate that there are differences in
ride comfort and ergonomics as perceived by the user. Differ-
ences were found among ultralight and lightweight wheelchairs
in both ride comfort and ergonomics. These differences may be
partially explained by the differences in design of these
wheelchairs.
The data from table 3 show that for all seven chairs the
reported ride comfort score was highest for carpeting and

Table 4: Wheelchair Ergonomic Rankings and Mean Data for Each Wheelchair
Wheelchair Model
Ergonomics Action XT Kuschall 2HP Metro LX* Breezy* 9000SL* Vision Epic

Support/stability 1 (3.5) 2 (3.4) 3 (3.2) 2 (3.4) 3 (3.2) 4 (2.7) 4 (2.7)

Ease of maneuverability 1 (3.6) 2 (3.4) 4 (3.1) 3 (3.2) 4 (3.1) 6 (2.2) 5 (2.6)
Hand comfort on pushrim 1 (3.4) 1 (3.4) 1 (3.4) 2 (2.9) 4 (2.1) 4 (2.1) 3 (2.8)
Overall course comfort 1 (3.6) 2 (3.2) 3 (3.1) 4 (2.9) 3 (3.1) 6 (2.0) 5 (2.2)
* Denotes lightweight wheelchair.

Arch Phys Med Rehabil Vol 81, April 2000

 MANUAL WHEELCHAIR RIDE COMFORT, DiGiovine 493

Table 5: Results From Statistical Analysis of Ride Comfort Among Wheelchairs and Across Tasks
Wheelchair Model
Task Action XT(a) Kuschall(b) 2HP(c) Metro LX(d) Breezy(e) 9000 SL(f) Vision Epic(g)

Dimple Strip f, g NS NS NS NS a a
Carpet f, g NS NS NS NS a a
Door Threshold f, g g g NS g a a, b, c, e
Ramp f, g f, g NS NS f, g a, b, e a, b, e
Rumble Strip f, g NS NS NS g a a, e
Sine Bump 25 f, g NS NS NS NS a a
Sine Bump 50 f, g g NS NS g a a, b, e
Sine Bump 75 c, f, g f, g a NS f, g a, b a, b
Overall b, c, d, e, f, g a, f, g a, f, g a, f, g a, f, g a, b, c, d, e a, b, c, d, e
Metro LX, Breezy, and 9000SL are lightweight wheelchairs. The letter(s) in each box correspond to the wheelchair whose mean was
significantly different ( p ⬍ .05) from the wheelchair assigned the letter at the top of each column.
Abbreviation: NS, no significant difference.

lowest for the 75mm high sinusoidal (speed) bump. Our
observations indicate that the subjects had the most difficulty
negotiating the high sinusoidal bump. This obstacle caused the
wheelchair to rapidly accelerate once the rear wheels had
crested the top of the sinusoid. The other tasks were rated
similarly for comfort, with the exception of the carpet and tile
floor. Carpet induces little shock or vibration,11 and therefore
was likely to be rated high for ride comfort although the rolling
resistance is highest on it. More than half of the subjects offered
no opinion on the tile floor. This was probably because they did
not recognize it as a task. None of the subjects experienced
difficulty negotiating either of the guide strips for individuals
with visual impairments (ie, 5mm high bumps and ridges), and
these tasks did not stand out in the ride comfort ratings.
Answers to the ergonomic questions provide some insight
into the subjects’ perceptions of the test wheelchairs (table 4).
The Invacare 9000SL was rated lowest overall. Among the
wheelchairs tested it also had the greatest mass (16.7kg) and a
short wheelbase (0.39m). This could affect maneuverability and
influence support/stability when a subject is performing tasks
that require fine control (eg, curbs, speed bumps). The Quickie
Breezy was the only wheelchair with a composite plastic
pushrim, as opposed to a metal pushrim, and it received the
lowest rating for pushrim comfort. Overall, the ultralight
wheelchairs achieved higher ergonomic ratings than the light-
weight wheelchairs.
Tables 5 and 6 show that the Invacare Action XT wheelchair
was rated highest in overall ride comfort and ergonomics on the
ADL driving course. Possible explanations for why this chair
was preferred are a favorable frame geometry (ie, a design
preferred by the subjects). Although 14 of the 30 subjects used a
Quickie 2HP as their personal wheelchair, they rated the Action
XT higher. Because both the Quickie 2HP and Action XT are
folding cross-brace frame wheelchairs, the higher rating for the
latter may be attributable to the differences in frame geometry.
The E&J Vision Epic and Invacare 9000SL received the lowest
scores and ratings. The short wheelbase of the E&J Epic, which
made it harder to ascend/descend obstacles, may account for the
low ride comfort scores. The Invacare 9000SL also has a short
wheelbase and the highest mass of the test wheelchairs.
Some subjects commented about feeling insecure when
propelling a different wheelchair in a foreign environment.
Other subjects indicated that they felt less secure in the test
wheelchair than in their personal wheelchair, even when the test
wheelchair was identical to their personal wheelchairs. The
subjects’ familiarity with their personal wheelchairs influenced
the scoring and ratings. Properly adjusting the legrests, armrests
and, when possible, the axle position reduced subject insecurity.
In future studies we will add comfort and security descriptors
and will attempt to distinguish between discomfort caused by
insecurity and discomfort caused by pain.12 Also, the influence
of various cushions and back supports on ride comfort probably
needs to be studied.
CONCLUSION
The results of this study provide information on the per-
ceived ride comfort and ergonomics of seven manual wheel-
chairs tested by 30 subjects. It is important to consider
consumer preferences when selecting wheelchairs. The Invacare
Action XT was rated the most comfortable wheelchair of those
tested. These subjects rated the ultralight wheelchairs higher
than lightweight wheelchairs for both ride comfort and ergonom-
ics. These findings have implications for the design and
selection of wheelchairs and provide some insight into possible
reasons for wheelchair abandonment.13
Acknowledgments: The authors thank Regina Moore, Tom
O’Connor, and Paula Stankovic for their assistance with recruitment
and data collection.

Table 6: Subject Rankings of Wheelchairs for Ride Comfort on ADL References

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Suppliers
a. Kuschall of America, 708 Via Alondra, Camarillo, CA, 93012.
b. Invacare Corporation, 899 Cleveland Street, Elyria, OH, 44035.
c. Sunrise Medical Incorporated: Quickie, 2842 Business Park Ave-
nue, Fresno, CA 93727-1328.
d. Graham-Fields, Everest & Jennings, 1100 Corporate Square Drive,
St Louis, MO, 63132.