Abstract
BackgroundWheelchairs for disabled children (≤18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports demonstrate the need for improved access to wheelchairs both locally and internationally. The use of health economics within this field is lacking. Provision of wheelchairs based on cost-effectiveness evidence is not currently possible. We conducted the first systematic review in this field to incorporate evidence of effectiveness, service user perspectives, policy intentions and cost-effectiveness in order to develop a conceptual framework to inform future research and service development.MethodsWe used an adapted EPPI-Centre mixed-method systematic review design with narrative summary, thematic and narrative synthesis. 11 databases were searched. Studies were appraised for quality using one of seven appropriate tools. A conceptual framework was developed from synthesised evidence.Results22 studies and 14 policies/guidelines were included. Powered wheelchairs appear to offer benefits in reduced need for caregiver assistance; improved communicative, personal-social and cognitive development; and improved mobility function and independent movement. From 14 months of age children can learn some degree of powered wheelchair driving competence. However, effectiveness evidence was limited and low quality. Children and parents placed emphasis on improving social skill and independence. Participation in wider society and development of meaningful relationships were key desired outcomes. Policy intentions and aspirations are in line with the perspectives of children and parents, although translation of policy recommendations into practice is lacking.ConclusionsThere is a distinct lack of high quality effectiveness and economic evidence in this field. Social and health needs should be seen as equally important when assessing the mobility needs of disabled children. Disabled children and parents placed highest priority on independence and psychosocial outcomes of wheelchair interventions. Translation of policy and guidelines into practice is lacking and more effective implementation strategies are required to improve services and outcomes. Future research should focus on outcome measure development, developing economic evaluation tools and incorporating these into high quality studies to address known research gaps. The novel conceptual framework maps current gaps in evidence and outlines areas for development.
Highlights
Wheelchairs for disabled children (≤18 years) can provide health, developmental and social benefits
It was decided that a mixed-method systematic review would be the most appropriate way to address the issues of interest
Inflation to 2011 prices [49,50] provides a cost per quality-adjusted life year (QALY) of £1187 and £2229 (40 and 50 year time horizon respectively). These results indicate that powered wheelchairs (PWC) interventions can be cost-effective in relation to the National Institute for Health and Clinical Excellence (NICE) £20,000 to £30,000 intervention cost threshold
Summary
Wheelchairs for disabled children (≤18 years) can provide health, developmental and social benefits. At present there is inadequate evidence to facilitate appropriate wheelchair service provision and support for those with disabilities [2]. This relates to both understanding of intervention cost-effectiveness and estimates of disability prevalence. Without adequate wheelchairs many disabled people are caught in a cycle of poverty and depravation, lacking the ability to access education, work and social facilities [4]. These issues have national economic impacts due to loss of productivity and health service resource use [2]
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