Empowering mobility: an exploratory study of perceptions of Power Assist devices among older manual wheelchair users

INTRODUCTION: Power assist devices (PADs) are attachments for manual wheelchairs (MWCs) that can reduce physical strain and enhance community participation. However, the literature regarding their adoption by older adults is limited, and little is known about their decision-making. Understanding these perceptions is crucial for guiding clinical practice, user-centered design, and policy reform. OBJECTIVES: This study aimed to explore the perceptions of older adult MWC users towards PADs, identifying the user-defined criteria for evaluating these devices and the perceived barriers and enablers to their acquisition. METHODS: Following a qualitative descriptive approach, we conducted semi-structured interviews with nine older adult (age 50+) MWC users (both PAD users and non-users). Data were analysed using reflexive thematic analysis to identify and develop core themes. RESULTS: We identified four main themes. (1) Ready to roll: activity-driven preferences shape device selection; (2) A balancing act: trying to maximise safety, performance and health; (3) Navigating the triad of trust: Information sourcing and experiential validation; and (4) Falling through the cracks: structural barriers creating gaps between preferred and acquired devices. CONCLUSION: The participants in this study - primarily active older adults with established peer connections - demonstrated sophisticated assessment criteria, perceiving PADs as "activity enablers" for health preservation and sustained participation. A significant disconnect exists between these user-defined perceptions and the fragmented information and policy systems they must navigate. Findings highlight a need for user-centered design, comprehensive clinical skills training, and equitable funding policies that support secondary prevention to maintain older adults' mobility.