Resources search

Background: Premature failures of wheelchairs in less-resourced environments (LREs) may be because of shortcomings in product regulation and quality standards. The standards published by the International Organization for Standardization (ISO) specify wheelchair tests for durability, safety and performance, but their applicability to products used in the rugged conditions of LREs is unclear. Because of this, wheelchair-related guidelines published by the World Health Organization recommended developing more rigorous durability tests for wheelchairs.

Objectives: This study was performed to identify the additional tests needed for LREs.

Methods: First, a literature review of the development of ISO test standards, wheelchair standards testing studies and wheelchair evaluations in LREs was performed. Second, expert advice from members of the Standards Working Group of the International Society of Wheelchair Professionals (ISWP) was compiled and reviewed.

Results: A total of 35 articles were included in the literature review. Participation from LREs was not observed in the ISO standards development. As per wheelchair testing study evidence, wheelchair models delivered in LREs did not meet the minimum standards requirement. Multiple part failures and repairs were observed with reviewed field evaluation studies. ISWP experts noted that several testing factors responsible for premature failures with wheelchair parts are not included in the standards and accordingly provided advice for additional test development.

Conclusion: The study findings indicate the need to develop a wide range of tests, with specific tests for measuring corrosion resistance of the entire wheelchair, rolling resistance of castors and rear wheels, and durability of whole wheelchair and castor assemblies.

Background: Comparative effectiveness research on wheelchairs available in low-resource areas is needed to enable effective use of limited funds. Mobility on commonly encountered rolling environments is a key aspect of function. High variation in capacity among wheelchair users can mask changes in mobility because of wheelchair design. A repeated measures protocol in which the participants use one type of wheelchair and then another minimises the impact of individual variation.

Objectives: The Aspects of Wheelchair Mobility Test (AWMT) was designed to be used in repeated measures studies in low-resource areas. It measures the impact of different wheelchair types on physical performance in commonly encountered rolling environments and provides an opportunity for qualitative and quantitative participant response. This study sought to confirm the ability of the AWMT to discern differences in mobility because of wheelchair design.

Method: Participants were wheelchair users at a boarding school for students with disabilities in a low-resource area. Each participant completed timed tests on measured tracks on rough and smooth surfaces, in tight spaces and over curbs. Four types of wheelchairs designed for use in low-resource areas were included.

Results: The protocol demonstrated the ability to discriminate changes in mobility of individuals because of wheelchair type.
Conclusion: Comparative effectiveness studies with this protocol can enable beneficial change. This is illustrated by design alterations by wheelchair manufacturers in response to results.
 

Background: An estimated 70 million people with disabilities need wheelchairs. To address this global crisis, the World Health Organization (WHO) proposed an eight-step wheelchair service provision model to ensure service quality regardless of resource setting. The International Society of Wheelchair Professionals (ISWP) aims to facilitate the integration of the WHO eight-step model into professional rehabilitation programmes.

Objective: To develop an enhanced understanding of the current wheelchair service provision education provided in professional rehabilitation programmes worldwide.

Methods: In a cross-sectional design, an online survey was distributed to ISWP contacts of educational institutions. Quantitative responses were analysed through summary statistics and qualitative answers were analysed by content analyses. When relevant, educational institutions were stratified into resource settings.

Results: Seventy-two representatives of educational institutions in 21 countries completed the survey. Wheelchair content was taught in 79% of represented institutions, of which 75% of respondents reported using original course material, 10% of respondents used WHO Wheelchair Service Training Packages and 15% of respondents used other available resources. The majority of educational institutions teaching with their own wheelchair-related course material taught ≤ 20 hours. Fourteen of the 15 respondents without wheelchair education, expressed an interest in integrating wheelchair education into their academic curricula.

Conclusion: The majority of the educational institutions teach wheelchair education; however, there is great variability in what and how it is taught and evaluated. The results demonstrate the need for more in-depth investigation regarding the integration process of wheelchair education in educational institutions, with the ultimate goal of improving wheelchair service provision worldwide.

Background: Lack of access to mobility for people with disabilities, particularly in less- resourced settings, continues to be widespread. Despite challenges to wheelchair delivery, the benefits to health, employment, social integration and life satisfaction are apparent.

Objectives: Previous studies have explored the impact of receiving a wheelchair on the lives of the users through cross-sectional or short-term longitudinal analysis. The current study was undertaken to evaluate whether previously reported changes were sustained after 30 months of use, and whether results varied between two differing models of a wheelchair.

Method: One hundred and ninety-one subjects from Peru, Uganda and Vietnam received one of two models of wheelchair provided by the Free Wheelchair Mission. Using interviews to record survey results, data were collected at the time the wheelchair was received and following 12 and 30 months of use. Variables of overall health, employment, income and travel were explored through non-parametric analysis.

Results: There was a significant improvement in overall health and distance travelled after 12 months, but these changes were no longer significant by 30 months (Friedman test for overall change, p = 0.000). Employment status showed a small but significant increase at 12 and 30 months (Cochran’s Q, p = 0.000). Reported income increased slowly, becoming significantly different at 30 months (Friedman test, p = 0.033). There was no association between the model of wheelchair received and the incidence of pressure ulcers, pain or maintenance required. There was higher satisfaction with the GEN_2 wheelchair at 12 months (p = 0.004), but this difference was not apparent by 30 months. Overall wheelchair satisfaction and maintenance levels were favourable.

Conclusion: While overall health status, and distance travelled into the community fluctuated over time, receipt of one of two models of a wheelchair in less-resourced settings of the world appears to have a positive sustained impact on employment and income. Further investigations should be carried out to confirm these results and explore the factors responsible for fluctuating variables. This study affirms the importance of long-term follow-up of outcomes associated with wheelchair distribution in less-resourced environments.

Background: South Africa’s Constitution guarantees everyone, including persons with disabilities, the right to education. A variety of laws are in place obliging higher education institutions to provide appropriate physical access to education sites for all. In practice, however, many buildings remain inaccessible to people with physical disabilities.

Objectives: To describe what measures South African universities are taking to make their built environments more accessible to students with diverse types of disabilities, and to assess the adequacy of such measures.

Method: We conducted semi-structured in-depth face-to-face interviews with disability unit staff members (DUSMs) based at 10 different public universities in South Africa.

Results: Challenges with promoting higher education accessibility for wheelchair users include the preservation and heritage justification for failing to modify older buildings, ad hoc approaches to creating accessible environments and failure to address access to toilets, libraries and transport facilities for wheelchair users.

Conclusion: South African universities are still not places where all students are equally able to integrate socially. DUSMs know what ought to be done to make campuses more accessible and welcoming to students with disabilities and should be empowered to play a leading role in sensitising non-disabled members of universities, to create greater awareness of, and appreciation for, the multiple ways in which wheelchair user students continue to be excluded from full participation in university life. South African universities need to adopt a systemic approach to inclusion, which fosters an understanding of inclusion as a fundamental right rather than as a luxury.

Background: In many countries, availability of basic training and continued professional development programmes in wheelchair services is limited. Therefore, many health professionals lack access to formal training opportunities and new approaches to improve wheelchair service provision. To address this need, the World Health Organization (WHO) developed the WHO Wheelchair Service Training of Trainers Programme (WSTPt), aiming to increase the number of trainers who are well prepared to deliver the WHO Wheelchair Service Training Packages. Despite these efforts, there was no recognised method to prepare trainers to facilitate these training programmes in a standardised manner.

Objectives: To understand if the WSTPt is an effective mechanism to train aspiring wheelchair service provision trainers.

Method: An action research study was conducted using a mixed-methods approach to data collection and analysis to integrate feedback from questionnaires and focus groups from three WHO WSTPt pilots.

Results: Trainees were satisfied with the WHO WSTPt and the iterative process appears to have helped to improve each subsequent pilot and the final training package.

Conclusion: The WHO WSTPt is an effective mechanism to train wheelchair service provision trainers. This programme has potential to increase the number of trainees and may increase the number of qualified service providers.
 

Background: Because of the adverse environmental conditions present in less-resourced environments (LREs), the World Health Organization (WHO) has recommended that specialised wheelchair test methods may need to be developed to support product quality standards in these environments. A group of experts identified caster test methods as a high priority because of their common failure in LREs, and the insufficiency of existing test methods described in the International Organization for Standardization (ISO) Wheelchair Testing Standards (ISO 7176).

Objectives: To develop and demonstrate the feasibility of a caster system test method.

Method: Background literature and expert opinions were collected to identify existing caster test methods, caster failures common in LREs and environmental conditions present in LREs. Several conceptual designs for the caster testing method were developed, and through an iterative process using expert feedback, a final concept and a design were developed and a prototype was fabricated. Feasibility tests were conducted by testing a series of caster systems from wheelchairs used in LREs, and failure modes were recorded and compared to anecdotal reports about field failures.

Results: The new caster testing system was developed and it provides the flexibility to expose caster systems to typical conditions in LREs. Caster failures such as stem bolt fractures, fork fractures, bearing failures and tire cracking occurred during testing trials and are consistent with field failures.

Conclusion: The new caster test system has the capability to incorporate necessary test factors that degrade caster quality in LREs. Future work includes developing and validating a testing protocol that results in failure modes common during wheelchair use in LRE.

Background: Providing wheelchairs without comprehensive support services might be detrimental to user satisfaction and function.

Objectives: This paper compares wheelchair user satisfaction and function before and after implementation of comprehensive wheelchair services, based on the World Health Organization guidelines on wheelchair service provision in less resourced settings, in Zimbabwe.

Method: A pre- and post-test study with a qualitative component was done. Quantitative data were collected with the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and the ‘Functioning Every day with a Wheelchair Questionnaire’. Data were collected from 55 consecutively sampled wheelchair users, who received a new wheelchair in the study period. Qualitative data were collected through two audio recorded focus groups and two case studies and are presented through narrative examples.

Results: The proportion of adult users who were satisfied significantly increased for all wheelchair and service delivery aspects (p = 0.001 - 0.008), except follow-up (p = 0.128). The same was true for children’s post-test ratings on all variables assessed (p = 0.001 - 0.04), except training in the use of the device (p = 0.052). The biggest improvement in satisfaction figures were for comfort needs (44.3%), indoor mobility (43.2%), outdoor mobility (37.2%), safe and efficient, independent operation (33.5%) and transport (31.4%). The qualitative data illustrated user satisfaction with wheelchair features and services.

Conclusion: The wheelchair service programme resulted in significant positive changes in user satisfaction with the wheelchair, wheelchair services and function. It is recommended that the Zimbabwean government and partner organisations continue to support and develop wheelchair services along these guidelines.