Wheelchair Service Research Articles

208P Are people living with neuromuscular disorders in the north of England satisfied with National Health Service wheelchair service provision?

208P Are people living with neuromuscular disorders in the north of England satisfied with National Health Service wheelchair service provision?

Training physiotherapy students in basic wheelchair provision. Experiences at two universities in Colombia

Wheelchair provision training is essential to overcome barriers related to the lack of knowledge of health professionals on this topic. Appropriate knowledge of the service provision process may lead to higher quality service and products, and thus be more likely to help people with mobility impairments achieve the fundamental human right of personal mobility. This study aimed to describe a training intervention for two groups of future physiotherapists in Colombia, assess cohort differences in performance on a knowledge test, and explore their post-training perceptions. A quantitative retrospective study with a historical, descriptive-comparative design was conducted. 525 sixth-semester participants completed the International Society of Wheelchair Professionals Wheelchair Service Provision – Basic Test online in Spanish after curriculum modifications were implemented. The test assesses knowledge in seven domains: Assessment; Prescription; Products; Fitting; User training; Follow-up, maintenance, and repairs; and Process. The training intervention was successfully implemented with Physiotherapy students from two institutions, resulting in a 57% increase in test approval rates. Participants demonstrated increased knowledge, satisfaction with the course content, and application of learning to their current work. These results suggest implications for what pedagogical approach to employ, when curricular change may be warranted, and specific considerations for the Colombian context. Furthermore, identifying the minimal knowledge basis for undergraduate programs and facilitating its dissemination can support interprofessional education and enhance professionals’ capacity to support wheelchair provision services.

Wheelchair outcome measurement instruments for children: a scoping review protocol

Purpose The proposed scoping review aims to explore and map wheelchair outcome measurement instruments for children in the literature. Method The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology. The review question and eligibility criteria were developed using the PCC (population, concept, context) mnemonic as follows: (P) children manual or motorised wheelchair users (aged ≤ 18 years), (C) wheelchair outcome measurement instruments, (C) primary sources of literature. The search will be conducted in nine relevant electronic databases. including grey literature from Academic Google. Study screening, selection, and data extraction will be performed independently by two authors. A third reviewer will resolve discrepancies between the authors. General characteristics, population, feasibility, interpretability data will be extracted in accordance with the COSMIN methodology (Consensus-based Standards for the selection of health Measurement Instruments). This will encompass data pertaining to the measurement properties of the domains of reliability, validity and responsiveness. A descriptive analysis will be carried out, and the results will be classified into categories and presented in tables accompanied by a descriptive summary. Results The results can inform future research directions, clinical practice and the development of wheelchair outcome measurement instruments. Furthermore, it will help professionals in rehabilitation and wheelchair services to find the wheelchair outcome measurement instruments according to the target population and cultural context.

Telerehabilitation for New Wheelchair Evaluations: A Retrospective Study of Patient Characteristics.

The purpose of this paper was to describe the clinical and personal factors of persons with disabilities (PwD) seeking a new wheelchair evaluation via telerehabilitation compared to in-person appointments. This retrospective cohort analysis used the Functional Mobility Assessment and Uniform Dataset, which is a nationwide registry with ongoing enrollment at 31 clinical sites of PwD seeking a new wheelchair evaluation. PwD were stratified into either a Telerehabilitation Group or In-Person Group. There were 1,669 PwD in the Telerehabilitation Group and 10,284 in the In-Person Group. The Telerehabilitation Group had a higher mean age and higher percentage of Progressively Acquired Disabilities than the In-Person Group. This project lays the groundwork for future comparative effectiveness studies, which may influence telerehabilitation reimbursement policies for wheelchair services.

Effects of the WHO 8-step wheelchair-service-delivery process on wheelchair users in El Salvador: a cohort study

Purpose To test the hypotheses that, after the delivery of manual wheelchairs following the WHO 8-step service-delivery process, wheelchair-related health and quality of life, wheelchair skills, wheelchair use, and poverty probability would improve; and that the number of wheelchair repairs required, adverse events, caregiver burden, and the level of assistance provided would decrease. Methods This was a longitudinal, prospective within-subject study including 247 manual wheelchair users, and 119 caregivers, in El Salvador who received a wheelchair following the WHO 8-step process as well as maintenance reminders. Outcome measurements were performed via structured questionnaires and dataloggers at the initial assessment, at wheelchair delivery, and at 3- and 6-month follow-up. Results Significant improvements in wheelchair-related health indicators (all with p < 0.004) and quality of life (p = 0.001), and a significant reduction in national and “extreme” poverty probability (p = 0.004 and p = 0.012) were observed by six months. Wheelchair use significantly decreased (p = 0.011 and p = 0.035) and wheelchair skills increased (p = 0.009). Caregiver burden did not change (p = 0.226) but the number of activities of daily living (ADLs) that required no assistance significantly increased (p = 0.001) by three months and those who required complete assistance decreased (p = 0.001). No changes were observed in wheelchair repairs (p = 0.967) and breakdowns over time with new wheelchairs. Conclusions Wheelchair service delivery using the WHO 8-step process on manual wheelchair users in El Salvador has positive effects on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. Further research is needed to determine the relative contributions of the intervention components.

A Remote-Learning Course can improve the subjective wheelchair-skills performance and confidence of wheelchair service providers: an observational cohort study

Purpose To test the hypothesis that a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence of wheelchair service providers, and to determine the participants’ views on the Course. Methods This was an observational cohort study, with pre-post comparisons. To meet the objectives of the six-week Course, the curriculum included self-study and weekly one-hour remote meetings. Participants submitted their Wheelchair Skills Test Questionnaire (WST-Q) (Version 5.3.1) “performance” and “confidence” scores before and after the Course. Participants also completed a Course Evaluation Form after the Course. Results The 121 participants were almost all from the rehabilitation professions, with a median of 6 years of experience. The mean (SD) WST-Q performance scores rose from 53.4% (17.8) pre-Course to 69.2% (13.8) post-Course, a 29.6% relative improvement (p < 0.0001). The mean (SD) WST-Q confidence scores rose from 53.5% (17.9) to 69.5% (14.3), a 29.9% relative improvement (p < 0.0001). Correlations between performance and confidence were highly significant (p < 0.0001). The Course Evaluation indicated that most participants found the Course useful, relevant, understandable, enjoyable, “just right” in duration, and most stated that they would recommend the Course to others. Conclusions Although there is room for improvement, a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence scores of wheelchair service providers by almost 30%, and participants were generally positive about the Course.

Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study.

Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults' interaction experience with the app and their perceived barriers to and facilitators of maintenance. Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Interviews with power and manual wheelchair users (37/57, 65%), wheelchair service providers (15/57, 26%), manufacturers (2/57, 4%), seating and mobility researchers (1/57, 2%), and insurance plan providers (2/57, 4%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83% women; and n=2, 17% men) participated in the usability testing study. Of the 12 participants, 9 (75%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future.

French-Canadian translation, cultural adaptation, and preliminary evaluation of the wheelchair service provision – basic test validity among occupational therapy students

Purpose The objectives were: (1) to translate and adapt the International Society of Wheelchair Professional (ISWP) basic Wheelchair Service Provision Test (bWSPT) into French-Canadian and (2) to conduct a preliminary evaluation of the French-Canadian version of the ISWP bWSPT internal consistency and relations with other variables among French-Canadian occupational therapy students. Methods For Phase 1, based on the International Test Commission Guidelines for Translating and Adapting Tests, a forward translation and adaptation from English to French-Canadian was conducted by a translation team. For Phase 2, the validity evidence of the French-Canadian bWSPT was evaluated through internal consistency and comparison of bWSPT scores and final grades of a wheelchair-specific course with a sample of occupational therapy students (positive, moderate correlation hypothesized). Internal consistency was measured with Cronbach’s α. The correlation was calculated using the Spearman’s Rank Correlation Coefficient. Results For phase 1, 61 of 167 items of the forward adaptation were revised and modified. All revisions were a consensus by the translation team. For phase 2, we found a Cronbach’s α of 0.50 and a correlation of ⍴ = 0.27 (p = 0.43) between the bWSPT French-Canadian version and the wheelchair-specific course final grade. The low variability of the data may explain the lower-than-expected correlation. Other possible data-driven reasons have been explored using post-hoc analysis. Conclusion The ISWP bWSPT, French-Canadian version, is not internally consistent and demonstrates a non-statistically significant, positive, weak correlation with the final grade of a wheelchair service provision-specific course among a cohort of 35 occupational therapy students. IMPLICATIONS FOR REHABILITATION The lack of adequately educated wheelchair service providers is a contributing factor to inappropriate wheelchair provision worldwide. The ISWP Wheelchair Service Provision Basic Test (ISWP bWSPT) has been created to evaluate competency among wheelchair service providers and provides a standardized test recognized internationally. A French-Canadian version of the ISWP bWSPT allows competency testing of French-speaking wheelchair service providers across Canada. This study shows that the French-Canadian version of the test is not internally consistent and has a low correlation with a wheelchair provision-specific course among a cohort of 35 occupational therapy students at a French-Canadian university suggesting further refinement is required to improve its measurement properties in this population of test-takers.

‘Sick with stress’: perspectives on airport travel from persons living with dementia and their travel companions

Persons living with dementia continue to desire and need air travel. This study gives voice to the current lived experiences of persons with dementia and their caregiving travel companions using U.S. airports. Forty-eight persons living with dementia and 176 travel companions shared information about themselves and their airport experiences through a web-survey. Results identified common challenges and ways in which U.S. airports could be improved to better serve persons living with dementia and their travel companions. Anxiety, understanding signs and announcements, and getting lost or separated were primary travel concerns. Participants detailed themes of frustration with security and locating family restrooms or quiet spaces. Many are unaware of the services available to assist travelers. Among other recommendations, participants suggested staff training on hidden disabilities to improve air travel experiences. Results inform ongoing efforts to develop dementia-friendly airports and support continuing independence and quality of life. Points of interest This study surveyed the air travel experiences of persons living with dementia and their travel companions to understand how going through the airport can be made more comfortable for them. Primary concerns voiced by the participants were anxiety and frustration at security, trouble finding their way around the airport, and not enough quiet spaces or family bathrooms. Participants shared that better staff training, hidden disability badges, and more wheelchair or electric cart services could help travelers like them and other persons living with disabilities. Airport updates that reduce noise and add more family bathrooms can make airport travel better for persons living with dementia and their travel companions. This paper shows how persons living with dementia and their travel companions’ could be more comfortable in public spaces like airports if we use their experiences and opinions to make improvements.

Identifying Accessibility Requests for Patients With Disabilities Through an Electronic Health Record–Based Questionnaire

People with disabilities experience disparities in health care access and outcomes, and inaccessible health care facilities are major barriers to health care access. Methods to collect accessibility request information are needed to improve health care outcomes for patients with disabilities. To evaluate an electronic health record (EHR)-based questionnaire designed to identify accessibility requests for patients with disabilities at an eye clinic. This cross-sectional pilot study implemented an EHR questionnaire and prospectively collected data on accessibility requests at a university-based eye clinic. The study included 55 722 patients making appointments at the Johns Hopkins Wilmer Eye Institute from April 1, 2019, to March 31, 2020. The Wilmer Eye Institute staff were trained to assess accessibility requests of patients making appointments in-person or via telephone using a standardized script and entering patient responses into the EHR. Data were later extracted for analysis and used to determine the proportion of patients making eye appointments who reported a disability accessibility request (physical, sensory, or intellectual) during their clinic visit. Accessibility request data were collected from 250 932 patient encounters. Patients had a mean (SD) age of 61.9 (20.6) years; most were women (146 846 [58.5%]) and were White individuals (162 720 [64.9%]). Of these, 23 510 (9.4%) encounters were associated with an accessibility request. The most reported accessibility request was mobility related (18 857 [7.5%]) (needing a cane, crutches, motorized scooter, walker, wheelchair, stretcher, assistance standing, or transport services), followed by sensory-related (2988 [1.2%]) (visual, hearing, or speech impairment), intellectual (353 [0.1%]), and other (1312 [0.5%]) (assistance with filling forms or service animal) requests. Patients with an accessibility request compared with those without, were older (72.6 vs 60.8 years), less likely to be White individuals (59.7% vs 65.4%), and more likely to be women (62.6% vs 58.1%), receiving Medicare (69.6% vs 41.5%), and have vision impairment (41.3% vs 13.6%) (P < .001 for all). In this cross-sectional study, a substantial proportion of patients making eye appointments reported having accessibility requests as captured using a new EHR-based questionnaire. Such standardization of data collection for disability-related accessibility requests in EHR is scalable, could be expanded to other clinical settings, and has the potential to improve accessibility of health care interactions for patients with disabilities.

Investigation of factors from assistive technology professionals that impact timeliness of wheelchair service delivery: a cross-sectional study

Purpose The purpose of this study was to examine factors associated with variability in time from assessment to device delivery (cycle time). Our hypothesis was that device type and type of insurance would be the strongest predictor of cycle time. Materials and methods Data were extracted from the Functional Mobility Assessment/Uniform Dataset (FMA/UDS) Registry that at the time of analysis contained a sample of 2588 people with disabilities (PWD) who were provided with a wheeled mobility device (WMD) between 21 March 2016 and 29 June 2021. To examine the effect of individual factors on the variability in cycle time, a robust linear regression analysis was conducted. Results The average national cycle time was 101.5 (SD = 59.9) d. Geographic area (Capital Metro [p < .001], Great Lakes [p = .016], and Northeast area [p < .001]), higher years since onset of disability (p < .001) and customizable devices (p = .021) were associated with higher cycle time. Non-customizable devices (p = .005), scooters (p < .001), Group 2 power wheelchairs (PWCs; p < .001), and funding source (Medicaid managed care (p < .001) and “other” (p = .028)) were associated with lower cycle time. Conclusions Longer cycle time is likely related to variations in clinical practice, insurance coverage criteria and the level of customizability of the device needed for a particular diagnosis, especially long-term disabilities. Implications for rehabilitation The national average number of days between initial evaluation and device delivery (cycle time) to deliver a wheeled mobility device (WMD) varies based on specific variables such as type of WMD, diagnosis and payer source. Geographic area, years since onset of disability, device type, primary diagnosis and funding source significantly impact cycle times. Increased complexity of the WMD, both manual and power wheelchairs (PWCs), was associated with longer cycle times. As more service delivery models emerge, specific benefits and challenges need to be reported on how they impact cycle time.

Wheelchair service provision education in Canadian occupational therapy programs.

Occupational therapists in Canada play a central role in wheelchair service provision. Inadequate entry-to-practice professional education has been identified as a major concern in the delivery of wheelchair related services. The goal of this study was to describe the current education provided in Canadian occupational therapy programs and to map this content against the recommended WHO 8-step wheelchair service provision process. The study used a descriptive cross-sectional online survey design. Educators were recruited from accredited occupational therapy programs in Canada. Participants completed a short sociodemographic questionnaire and a survey with 97 closed- and open-ended questions regarding the wheelchair service provision education provided in their curriculum. Survey data was then mapped according to the WHO 8-step wheelchair service provision process. Twenty-nine educators from all Canadian occupational therapy programs (n = 14) were enrolled. Most participants (55.2%) were full-time faculty members that had been teaching in occupational therapy programs for an average time of 10.9 years. All programs covered at least 4 of the WHO recommended steps, but only 5 programs covered all steps. Assessment and Prescription steps were covered in every program while the Referral & Appointment, Funding & Ordering, Fitting and User Training steps were covered in most programs. The pedagogic approach, the amount of time dedicated to wheelchair-related content, and the type of evaluation used varied greatly between programs. This study is the first to provide a detailed description of wheelchair service provision education across all Canadian occupational therapy programs according to the WHO 8 steps and provides a foundation for collaborative efforts to promote best practice in entry-to-practice professional education.

Current concepts in the treatment of neuromuscular scoliosis: clinical assessment, treatment options, and surgical outcomes.

The development of spinal deformity in children with underlying neurodisability can affect their ability to function and impact on their quality of life, as well as compromise provision of nursing care. Patients with neuromuscular spinal deformity are among the most challenging due to the number and complexity of medical comorbidities that increase the risk for severe intraoperative or postoperative complications. A multidisciplinary approach is mandatory at every stage to ensure that all nonoperative measures have been applied, and that the treatment goals have been clearly defined and agreed with the family. This will involve input from multiple specialities, including allied healthcare professionals, such as physiotherapists and wheelchair services. Surgery should be considered when there is significant impact on the patients’ quality of life, which is usually due to poor sitting balance, back or costo-pelvic pain, respiratory complications, or problems with self-care and feeding. Meticulous preoperative assessment is required, along with careful consideration of the nature of the deformity and the problems that it is causing. Surgery can achieve good curve correction and results in high levels of satisfaction from the patients and their caregivers. Modern modular posterior instrumentation systems allow an effective deformity correction. However, the risks of surgery remain high, and involvement of the family at all stages of decision-making is required in order to balance the risks and anticipated gains of the procedure, and to select those patients who can mostly benefit from spinal correction.

Wheelchair Skills Test Outcomes across Multiple Wheelchair Skills Training Bootcamp Cohorts.

User training is a critical component of wheelchair service delivery to ensure individuals with a mobility impairment can negotiate environmental barriers and promote their social participation. A wheelchair “bootcamp”, delivered during professional preparation education, is one strategy to better prepare occupational therapists for clinical rehabilitation practice by developing their own wheelchair skills. The purpose of this study was a retrospective review of a large dataset of student cohorts from a single site and delineate bootcamp effects on the Wheelchair Skills Test-Questionnaire (WST-Q) scores. Participant data from eight cohorts was consolidated (n = 307). Comparison of two WST-Q scoring formats revealed significantly lower scores for cohorts using the 4-point version, which was subsequently standardized to the other 3-point version. WST-Q change scores were similar between cohorts, and differences were more reflective of variability in skill level prior to bootcamp than post-bootcamp scores. Students were able to master most basic and intermediate level skills, while advanced skill acquisition was much more variable. This study provides more precise point estimates of wheelchair skill acquisition among occupational therapy students than previous studies. While confirming the benefits of bootcamp education, recommendations for further investigation were identified.

An exploratory analysis of global trends in wheelchair service provision knowledge across different demographic variables: 2017–2020

ABSTRACT To explore global trends in manual wheelchair service provision knowledge across geographic, professional, and socioeconomic domains. A secondary analysis of a dataset from the International Society of Wheelchair Professionals’ Wheelchair Service Provision Basic Knowledge Test was conducted. The dataset included test takers from around the world and was extracted from Test.com and International Society of Wheelchair Professionals’ Wheelchair International Network. Participants 2,467 unique test takers from 86 countries. Interventions Not applicable. International Society of Wheelchair Professionals’ Wheelchair Service Provision Basic Knowledge Test. We identified significant inverse associations between pass rate and the following variables: education (high school and some college), test taker motivation (required by academic program or employer), and country income setting (low and middle). There were significant positive associations between pass rate and the following variables: training received (offered by Mobility India or ‘other NGO’), and age group served (early childhood). Global wheelchair knowledge trends related to key variables such as training, occupation, and income setting have been preliminarily explored. Future work includes further validation of the primary outcome measure and recruitment of a larger sample size to further explore significant associations between additional test taker variables.

A cross-sectional survey investigating wheelchair skills training in Ireland

Purpose Wheelchair skills trainings are a vital aspect wheelchair provision yet are arguably overlooked and extent to which training is provided in the Irish context is highly variable. The primary aim of this study was to quantify whether a need exists to further develop wheelchair skills training in Ireland. Methods A cross sectional survey was conducted using SurveyMonkeyTM. Irish health professionals involved in wheelchair service delivery were asked how they offer wheelchair skills trainings and what components of wheelchair skills they train. To collect qualitative information, questions also explored how health professionals would like training to develop. Results Consensus among respondents was that training is often provided to new users (n = 91, 89%), however, it is limited to mostly transfers and simple mobility techniques. Further, it was reported that advanced mobility skills are sometimes (n = 81, 51%) or never taught (n = 81, 21%). The respondent’s confidence instructing various skills corresponded with the frequency of instruction. The responses captured a shared interest in developing standardised training programs and the development of continued education training in the area. Conclusion The findings from this study reinforce that a present need exists to further develop wheelchair skills training in Ireland, with the aim of improving Irish wheelchair service providers’ knowledge and confidence in advanced wheelchair skills needed to mobilise and perform activities of daily living. IMPLICATIONS FOR REHABILITATION Current clinical practice in Irish wheelchair service delivery includes basic wheelchair skills training, whereas training in advanced skills needed for improved independent mobility is highly variable. This study raises awareness that health professionals seek formal education and training in wheelchair skills to improve their knowledge and confidence in providing wheelchair skills training. There is a need to develop wheelchair skills training opportunities, both as a requirement for stakeholders involved in wheelchair provision and to address an unmet need for wheelchair users.

Practices and views of wheelchair service providers regarding wheelchair-skills training for clients and their caregivers: a global online survey

Purpose To determine the extent to which wheelchair service providers conduct wheelchair-skills training, the nature of training, and the providers’ perceptions on training. Materials and methods Anonymous global online survey consisting of 29 questions administered via the REDCap electronic data-capture tool to English-speaking wheelchair service providers. Results We received 309 responses from wheelchair service providers in 35 countries. Of the respondents who responded to the question “…do you typically provide wheelchair-skills training…?” 227 (81.6%) reported “yes, always” or “yes, usually” for clients and 213 (81.9%) for caregivers. The median duration of training sessions for clients and caregivers was 45 and 30 min; the median number of sessions was 2 for both. Regarding the importance of training, 251 (94.4%) answered “very important” for clients and 201 (78.5%) for caregivers. For clients and caregivers, 182 (68.4%) and 191 (74.3%) of respondents considered themselves adequately prepared for the trainer role. A variety of barriers and facilitators to training were identified. Conclusions Most wheelchair service providers report that they provide wheelchair-skills training for clients and their caregivers, most consider such training to be important and most consider themselves adequately prepared for the training role. However, the amount of training is generally minimal. Further efforts are needed to address the identified barriers to training. IMPLICATIONS FOR REHABILITATION Most wheelchair-service providers report that they provide wheelchair-skills training. Most consider such training to be important. Most consider themselves adequately prepared. However, the extent of training is generally minimal. These findings have implications for clinicians, educators, and policymakers.

Community-based wheelchair caster failures call for improvements in quality and increased frequency of preventative maintenance

Study designSecondary data analysis of wheelchair failures and service repair logs from a network of wheelchair suppliers.ObjectiveTo determine the frequency of wheelchair caster failures and service repairs across wheelchair manufacturers and models and investigate the relationships between them.SettingWheelchair caster failures and service repairs occurred in the community.MethodsReported caster failure types were classified based on the risk they pose for user injuries and wheelchair damage. Caster failures experienced by users of tilt-in-space and ultralightweight manual wheelchair models and Group 2, 3 and 4 power wheelchair models between January 2017 and October 2019 were analyzed using Chi-Square tests for independence. Correlational analysis of failures and service repairs was performed.ResultsA total of 6470 failures and 151 service repairs reported across four manufacturers and five models were analyzed. Failure types were significantly associated with manufacturers and models, respectively. Users of tilt-in-space wheelchairs, who require greater seating support, experienced twice the proportion of high-risk caster failures than the ultralightweight manual wheelchair users. Similarly, Group 3 and 4 power wheelchair users, who have complex rehabilitation needs, experienced 15-36% more high-risk failures than Group 2 users. Service repairs negatively correlated with high-risk manual wheelchair caster failures.ConclusionsWheelchair users who have greater seating and complex rehabilitation needs are at a higher risk for sustaining injuries and secondary health complications due to frequent caster failures. The study findings call for significant reforms in product quality and preventative maintenance practices that can reduce wheelchair failures and user consequences.

Contribution of Occupational Therapy Profession in Wheelchair Service Provision

Background: The Functioning Everyday with a Wheelchair (FEW) tool is a self-report questionnaire developed to measure consumers’ perceptions of how the features of their wheeled mobility and seating device support their ability to carry out their daily functions and routines independently, safely, and efficiently. Method: A committee of three bilingual qualified occupational therapists translated the English version into Arabic, which was verified by back translation. The final versions were administered with 26 bilingual English-Arabic speakers. The subjects were randomly assigned to answer either the English or Arabic version of the FEW questionnaire first, followed by answering the FEW questionnaire in the other language. The scores obtained were tested for agreement using the kappa statistic. Results: We found significant substantial agreement between the scores obtained from the two versions (p < 0.000). The kappa measurement of agreement was 0.755 (95% confidence interval, 0.59–0.92) Conclusion: The Arabic translation of the FEW self-report tool was generated for potential use in research and clinical practice and could be useful to wheelchair professionals who would like to use this tool for Arabic-speaking wheelchair users. Further validation of the developed Arabic version is recommended.

A Narrative Review of the Government Wheelchair Provision System in India

Background and aim: India has had a wheelchair-delivery system in place for several years but its impact on users is inadequate. Therefore, this research reviews the system to examine how the right to personal mobility can be served better. Method: this paper undertakes a narrative review of the existing government-aided wheelchair provision system from the perspectives of legislation and implementing agencies, both governmental and non-governmental, through document review and key informant interviews. Results: the results indicate that all steps of the government-funded wheelchair provision system are executed by the same system. Manufacture and supply take place nationally, but wheelchair services are largely absent. Moreover, the right to access mobility devices is not upheld for all users. Conclusion: the established government-aided wheelchair provision system is inadequate in terms of coverage, design, production, supply, and wheelchair services. Therefore, there is a need to reconsider the system by increasing its coverage and creating partnerships between the government, non-governmental agencies, and private agencies to improve access.