Date Published: September 08, 2017
Author(s): Karen H. Fung, Paula W. Rushton, Rachel Gartz, Mary Goldberg, Maria L. Toro, Nicky Seymour, Jonathan Pearlman.
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.
To develop an enhanced understanding of the current wheelchair service provision education provided in professional rehabilitation programmes worldwide.
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.
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.
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.
The World Health Organization (WHO) estimates that there are 70 million people worldwide who require a wheelchair for mobility (World Health Organization 2008). According to the Jhpiego Corporation, the percentage of demand met for wheelchairs in low-resourced countries is often below 5% (Jhpiego Corporation 2015). Even for the people who do have wheelchairs, a significant number use poorly fitting or inappropriate wheelchairs, which may lead to secondary injuries and to a high likelihood of abandoning the technology (Jhpiego Corporation 2015). The wheelchair service provider is tasked with providing a wheelchair that meets the needs of the user in relation to the user’s environment and daily activities, which often includes complex postural support and pressure relief.
We achieved our goal of developing a more comprehensive understanding of the current state of wheelchair service provision education provided in academic curricula around the world. With responses from 72 educational institutions from 21 countries of all resource settings, this is one of the first studies to investigate this situation on a global scale. This survey expands on previous studies that examined only partial aspects of the wheelchair service provision education offered in professional rehabilitation programme curricula, such as wheelchair assessment and skills training (Best, Miller & Routhier 2015; Coolen et al. 2004; Kirby et al. 2011; White 2003) or wheelchair prescription (Silcox 1995).
This study had several limitations. The volunteer sample captured using this cross-sectional research design may have consisted of individuals who prioritise and had pre-existing interest in wheelchair service provision education. Thus, the results cannot be generalised to all educational institutions that may or may not include wheelchair service provision education. Additionally, the sample was underrepresented in respondents from LRSs. As the survey was Internet-based and written in English, these factors may have limited the participation to respondents who were comfortable responding in English. Finally, each respondent answered on behalf of his or her entire institution, possibly masking the differences between each professional programme offered.
Future studies need to address the limitations by including translated, low-bandwidth and paper options to reduce bias in the recruitment. A follow-up survey will further investigate the topics in original wheelchair service provision education to see if and how they reflect the WHO eight-step model. Additional detail on wheelchair service provision content in curricula specific to each professional programme will be collected directly from stakeholders in academia who participate in the development of curricula, such as programme directors. Information on pedagogic methods (e.g. in class lectures or distance education programmes) of current and prospective wheelchair service provision content will also enlighten the situation. Other initiatives include qualitative interviews and partnerships with pilot sites that will enhance the ISWP’s understanding of barriers and facilitators faced by educational institutions currently integrating the WHO eight-step model into their curricula. Despite the limitations, this study is the first to describe current wheelchair service provision education in professional rehabilitation programme curricula on a global scale.
Although the majority of the educational institutions reported teaching wheelchair-related content, there is great variability in what and how it is taught and evaluated. The WHO eight-step model and other readily available resources could serve as guides for wheelchair service provision education. The survey results inform the development of integration tools to guide educational curricula development, with the ultimate goal of improving the quality of wheelchair service provision worldwide.