Wheelchair Service Research Articles

A Revised Occupational Therapy Definition of Client-Centred Practice

This paper reports on the second phase of a research project to determine a British occupational therapy definition of client-centred practice. Sixty-seven occupational therapists participated in nine focus groups, structured according to the nominal group technique. These groups involved therapists working in social services, mental health, learning disabilities, paediatrics, neurology, a wheelchair service and with elderly clients and there were two groups in general medicine. A hundred and sixty-five components of client-centred practice were generated and subsequently analysed to form seven themes. Frequencies and medians of the components ranked in the top five were also calculated. In addition, three questions were asked to solicit opinions on the definition that was created in the first phase of this study and frequencies were also determined from these responses. All these data were used to inform revisions to the definition created in phase one. This revised definition was then reviewed by members of the Council of the College of Occupational Therapists as the final validating group. The resulting final definition will enable therapists to determine whether or not they are using a client-centred approach.

Wheelchair training needs for OTs and physiotherapists

Following the McColl report and the devolution of the wheelchair service into the NHS, the training needs of therapists working in this area increased considerably. A survey was undertaken to identify where such needs existed and to gain information about the type of programme required. The results show that there is a demand for further education and training for therapists working in NHS wheelchair services.

Provision of electrically powered indoor/outdoor wheelchairs

Variations in NHS wheelchair service delivery result in inequality for service users. The introduction of electrically powered indoor/outdoor wheelchairs was studied in three geographically different wheelchair services. A major reason for inequality was differing interpretation of NHS guidelines and methods of allocating funding. The study also raised issues relating to wider mobility and the environment.

Current Literature: Wheelchair Services

Current Literature: Wheelchair Services

The wheelchair voucher scheme: a comparative study

The wheelchair voucher scheme was introduced in 1996 to give wheelchair users more choice in the provision that was available to them. Three options were proposed offering a chair from the NHS range or a voucher towards the purchase of a chair through new partnership or independent options. This study examines the implementation of the new scheme by three wheelchair services representing inner city, suburban and rural populations, using questionnaires and semi-structured interviews with senior therapists. No users selected the partnership scheme and many users who expressed an interest finally chose the NHS model. The rural district, with a high elderly population, found lightweight transit chairs were most frequently requested. Uptake was lowest in the inner city area. Feedback from the users has been positive. Further advertising of the scheme is planned, together with monitoring to assess its efficacy among wheelchair users.

Effectiveness in Wheelchair Service Provision

Services that provide wheelchairs to permanently disabled people have undergone fundamental changes following the recommendations of the McColl report in 1986. The devolution of centralised wheelchair services to the National Health Service (NHS) health districts in 1991 coincided with the implementation of the government's proposals for NHS reforms and community care initiatives. This paper describes a four-part research study, undertaken to identify and investigate key factors which propose effectiveness in the post-devolution wheelchair service. The sample comprised 125 wheelchair therapists as service providers and a total of 130 service users. The user sample consisted of 84 people issued with NHS manual wheelchairs, 27 indoor powered wheelchair users and 19 special seating users. An integrated methodology was employed, including questionnaires, interviews, participant observation and case studies. The research identified the development of client-centred referral and assessment procedures for wheelchairs and seating, and highlighted the need for increased therapist training. Close links between wheelchair services and local therapists were found, providing greater access to assessment for wheelchair users. An increased demand for wheelchairs outside the NHS range and a rising number of referrals for elderly people were recorded, although the management of finite resources resulted in eligibility criteria designed to control supply and provision variations between districts.

Review of Wheelchair Services in England

This article reviews the results of investigations into wheelchair service provision in the United Kingdom since its devolution to National Health Service trusts in 1991. The following key issues persist: – Funding: The existing dilemma is to find how far a comprehensive service can be provided in a climate with decreasing, real-term funding. – Staffing: The availability of specialist staff on a multidisciplinary team is variable across the country. Some people are not being used in a manner that is suitable to their education and training. – Education and training. Educational backgrounds are variable; however, guidelines for standards have been published for occupational therapists, physiotherapists and rehabilitation engineers. – Accessibility: Users are often not provided with enough information to feel that they have been able to contribute to the prescription of their wheelchairs. – Assessment and prescription: This procedure varies from being based on a referral form to individual meetings between the therapist and the user. – Audit. User satisfaction and the provision of data for purchasers are the advantages of doing regular audits. Where the standards of provision are decided at local level without national guidelines, it is important that information about successful outcomes on limited resources is shared among service managers, therapists and rehabilitation engineers.

Powered wheelchairs: are we enabling or disabling?

Following the unsuccessful issue of three powered indoor National Health Service (NHS) wheelchairs, a survey was carried out of 40 users in a London wheelchair service to identify the problems with issue and possible areas for improvement to practice. The survey identified improvements that were necessary both from the service and the manufacturers' booklets. The improvements include the issue of written instructions and information to complement verbal instruction given at handover. Such information should be as interesting to read as possible, make use of appropriate language and diagrams (especially in area where English is often not the first language), colour, text and print size to maximise comprehension to these severely disabled users and often their elderly relatives or carers. The importance of the role of the rehabilitation engineer in training the user, giving instruction at handover and annual review are highlighted to ensure that the equipment remains working, suitable and up to date for the individual's needs. Training in interpersonal and communication skills and the importance of recall should also be emphasised. The implementation of the findings should lead to increasing contact with the service by the user, reduction in repair and replacement costs, regular review, correct supply and will therefore enable users to increase their independence with appropriate equipment.

Wheelchair Services: Good News for Wheelchair Users?

Wheelchair Services: Good News for Wheelchair Users?

An audit of wheelchair service provision in three regions

In 1993-94 three regional groups of wheelchair service managers developed locally applicable standards using the National Guidelines for Wheelchair Services, and carried out a regional audit to measure how well those standards were being met. This article describes how the audit projects were developed. Focusing on one region, it also gives a general overview of services provided, key points from the results and some of the recommendations agreed.

The seating clinic

Provision of an appropriate seat for a child with poor postural control or deformity not only improves function by ensuring he feels secure and comfortable, but also forms an important part of his programme of postural management. Children with severe physical disability often spend the majority of their day sitting or lying down and receive comparatively short periods of therapy. Long periods of immobility, particularly in an asymmetric posture, are a recognised cause of deformity. 1 If special seating, together with devices to develop postural control in other positions such as lying and standing reflect and reinforce therapy aims, the child will be encouraged to develop and improve his postural control and the risks of deformity are reduced. A special seating clinic for children and teenagers was set up in Reading 9 years ago, as there were many young people with severe seating problems. At that time the wheelchair service was provided by the Artificial Limb and Appliance Centre and focused on mobility. The majority of patients seen were adults, frequently in the geriatric age group, and the needs of children were often poorly understood. Special seating depended on referral to the Regional Rehabilitation Service and this was usually not considered until deformity precluded use of a standard wheelchair. In 1991 the NHS took over the management of the Wheelchair Service. Their brief is now wider and includes consideration of their patients’ comfort, function, posture, pressure relief and changing needs as well as mobility. Seating advice for complex cases is available at supradistrict or regional level but dedicated children’s services are not available in all regions. This is disappointing as prescriptive seating has been developed for children with motor handicaps, combining bio-mechanical principles with therapy aims, so as to promote maturation of sitting posture and control deforming forces.

Wheelchairs for the elderly.

An overview of the provision of wheelchair services and wheelchair design in the UK

Assessment for the Prescription of Wheelchairs: What Training is Available to Therapists?

The aim of this study was to discover the amount of time spent on and some of the content of the training presently available to therapists, both in colleges and from the wheelchair service. The method was a postal questionnaire, which was sent to all colleges of occupational therapy and physiotherapy and to a geographically selected sample of centres in the wheelchair service. The results indicated that the mean number of hours of training was statistically significantly higher for colleges of occupational therapy compared with colleges of physiotherapy (OT mean=26.19 hours: PT mean=9.66 hours, t=2.52, df=21, p=0.02) and for colleges of occupational therapy compared with the wheelchair service (OT mean=26.19 hours: WS mean=9.41 hours, t=-2.58, df=20, p=0.02). No statistically significant difference was observed between colleges of physiotherapy and the wheelchair service. The results indicated that the situation has improved slightly since the McColl Report in 1986, which recommended changes within the wheelchair service.

Batteries Not Included: the campaign for state funding for indoor/outdoor powered wheelchairs

Batteries Not Included is a national campaign, initiated by the Muscular Dystrophy Group and supported by 150 other organisations, with the single objective of securing guaranteed funding for indoor/outdoor powered wheelchairs, generally not available through the state system. This article outlines the background to the campaign and summarises the controversial findings of a recent comprehensive survey of UK wheelchair service providers.

Prescribing wheelchairs: the opinions of wheelchair users and their carers

The first stage in the process of developing an audit tool for wheelchair services was a study to examine the expectations of wheelchair users and their carers. The findings demonstrate an expectation that the wheelchair will improve their quality of life, enable them to maintain or attain a level of mobility, and help the user to achieve an acceptable level of independence. Wheelchair users also required a wheelchair that was comfortable, easy to propel, that had an acceptable appearance and was safe. For the carer/attendant the main requirements were for a chair that was easy to push and lightweight for lifting. They also hoped that the wheelchair would improve the quality of both their life and that of the user, and improve or maintain their health status. The results also suggest that information on carers may not be routinely collected during assessment, and that there is a need to formalize a sensitive approach to assessing the expectations of users and their carers. The authors conclude that a correctly prescribed wheelchair benefits both user and carer.

Wheelchair Referrals in England

A survey was carried out into the processes developed for dealing with wheelchair referrals in England following the devolution of the wheelchair service to the NHS. It was found that a large number of therapists were employed within wheelchair services, over two-thirds of them on a part-time basis. The survey identified the declining role of doctors in making wheelchair referrals, and highlighted discrepancies in the level of assessment offered, the provision to temporary users and the residency criteria.

Powered Wheelchairs and Tetraplegic Patients: Improving the Service

To improve the powered wheelchair service offered to patients with a spinal cord injury, the occupational therapy staff at the National Spinal Injuries Centre conducted a literature review, carried out a survey of current powered wheelchair users and arranged demonstrations of the majority of powered wheelchairs available in the United Kingdom. The information gathered from this enabled the therapists to update their knowledge, and provided them with material to run a powered wheelchair assessment clinic where each patient can receive objective and informed guidance on which wheelchairs are most suitable for his/her needs. To assist patients further with their decision, they were able to try a variety of powered wheelchairs and options for an extended period of time.

Wheelchair Stump Boards and Their Use with Lower Limb Amputees

A three-part study was undertaken into the supply of wheelchair stump boards by the Disablement Services Authority and their use by therapists and by patients with an amputation. The research highlighted the importance of stump boards in the prevention of post-operative complications occurring in the stump, and showed that the delay that frequently occurs when stump boards are ordered necessitates the manufacture of temporary models in occupational therapy departments. With the devolution of the wheelchair service to the NHS in 1991, it will be interesting to see if the needs of the individual patient gain higher priority.

Pushchairs

Pushchairs for adults are used by two distinct groups: the high dependency users who cannot walk or use a self-propelling chair and the occasional users who may be able to walk indoors but are unable to walk significant distances outdoors. In the past, both disparate groups were provided with similar wheelchairs described as Model 9 or Model 10 in the United Kingdom. For the high dependency user the wheelchair may be individually adapted to accept specialized supportive seating and pressure relief cushions. The standard wheelchair without adaptation is supplied to the occasional user. For disabled children, the UK wheelchair service provides about 1200 pushchairs and buggies. About 400 of those are the more specialized type such as the Avon, while the rest are standard children's buggies, openly available at a High Street shop. The continued free supply of the standard buggy through the UK Wheelchair Service is questionable. A recent survey carried out by the UK Wheelchair Service showed that prescribers were not aware of the importance of lightness., foldability and appearance to parents and carers and conversely that parents often did not understand the necessity for supportive seating. The prevention of deformities in children by providing correctly supportive wheelchair seating is accepted. The Disablement Services Authority in the UK is investigating the possibilities of producing children's wheelchairs that will satisfy the requirements of user, parent and prescriber.

Audit of a regional wheelchair service

Audit of a regional wheelchair service