Date Published: September 08, 2017
Author(s): Deepan C. Kamaraj, Nathan Bray, Karen Rispin, Padmaja Kankipati, Jonathan Pearlman, Johan Borg.
Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities.
In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision.
The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups.
The three iterations of the conceptual framework are described in this manuscript.
We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe.
Wheelchairs are key assistive products that help improve the quality of life of people with disabilities (Shore & Juillerat 2012; World Health Organization 2016). Their use encourages community participation (Mortenson et al. 2012; Salminen et al. 2009), increases access to education (Dudgeon, Massagli & Ross 1997) and provides better opportunities of employment (Borg et al. 2012) for people with disabilities. These life-changing products could decrease healthcare expenditures and influence national and global economies (Bray et al. 2014; Greer, Brasure & Wilt 2012a). The World Health Organization (WHO) estimates that between 10% (WHO 2008a) and 15% (WHO 2011) of the world’s population (about one billion people) and 5% of children worldwide (around 95 million children aged 14 or under) have a disability (WHO 2008b). One in ten people with a disability requires a wheelchair for their mobility (Sheldon 2006). Estimates indicate that over 20 million people who need wheelchairs for their everyday mobility are unable to obtain them (WHO 2008a, 2008c, 2011).
The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, is housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP). The EBP-WG aims to identify and assess opportunities to improve the adoption of best practices in the field of wheelchair provision through coordination with stakeholders on a global scale. The CER-SC comprises wheelchair professionals and researchers from across the globe, and acts as the core support group for studies that evaluate effectiveness of wheelchair provision. The expertise of the CER-SC spans a wide range of disciplines, including biology, rehabilitative engineering, health economics, social medicine and global health. The CER-SC used its own familiarity with the literature and undertook a scoping literature search (using Google Scholar, PubMed and PsycInfo) to implement a two-step process in the development of the conceptual framework. The first step defined effectiveness as it pertains to wheelchair provision and the second step involved the development of the conceptual framework to evaluate the effectiveness of wheelchair provision. The framework was primarily developed through discussions within the CER-SC, with continuous mapping of concepts and terminology. This was an iterative process drawing on the expertise of each member of the CER-SC. Where there was disagreement, further discussion and literature searching took place to reach consensus.
Wheelchair provision is a complex rehabilitation intervention necessitating cooperation and collaboration between various healthcare or rehabilitation professionals and wheelchair users. However, studying the effectiveness of wheelchair service delivery models and the relationship between the various stakeholders has been a hurdle faced by rehabilitation professionals. To address this gap in scientific literature, this project adopted the principles of Comparative Effectiveness Research to develop a cohesive conceptual framework that could be used to evaluate wheelchair provision. Through the development of this framework, we hope to provide researchers, clinicians and policymakers a structured approach with common terminologies to identify key variables from the myriad factors that need to be considered when evaluating the effectiveness of wheelchair provision. Future work will aim to evaluate the efficacy of this framework.