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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. 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. 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. 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. Providing manual wheelchairs using the 8-step process of the WHO has benefits on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. The WHO 8-steps service delivery process for manual wheelchairs can be used in less-resourced settings. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONPurpose: This study evaluates the effect of power wheelchair telemonitoring and battery charging training on user charging behavior and repair measures and assesses the relationship between wheelchair usage and repair measures to support technician-led servicing.Methods: This is a retrospective analysis of two matched cohorts with a total of n=237 users from the NHS service dataset. In the training cohort, a wheelchair usage telemonitoring device monitored the battery usage of n=119 power wheelchair users for 12 months. Users whose battery charging behavior was not optimal were instructed on appropriate charging practices. Wheelchair usage parameters of wheelchair drive and power time every month were used to predict repairs and associated costs.Results: Fifty-four out of 119 users in the training cohort did not charge batteries regularly and were instructed on appropriate charging. Twenty-six of them changed their behavior and charged their batteries every night. This cohort experienced reduced battery repairs by 18%, wheelchair repairs by 11%, and repair costs by £3,092 compared to a matched standard care cohort (n=118). User age and drive time were associated with repair measures. Drive time predicted time-to-failure for wheelchair parts and classified failure risk with the area under the receiver operating characteristic curve as 0.71 (95% CI 0.61 to 0.82; p<.001). Conclusions: By leveraging the significant relationships between wheelchair usage and repairs, wheelchair users at risk of part failures can be identified, and technician-led servicing tools for proactive interventions can be developed. Wheelchair battery health telemonitoring and instructing users on appropriate battery charging reduced repairs and associated costs.Proactive wheelchair servicing by repair technicians in collaboration with wheelchair users safeguards users against critical part failures and minimises repair-related operating costs for service providers.Providers should leverage wheelchair telemonitoring technologies and related research outputs to improve repair services and support their clients’ continued mobility and community participation.It is important that healthcare plans and policies recognise the benefits of proactive wheelchair servicing and use data as a tool to allocate device usage and performance-based reimbursements.Proactive wheelchair servicing by repair technicians in collaboration with wheelchair users safeguards users against critical part failures and minimises repair-related operating costs for service providers.Providers should leverage wheelchair telemonitoring technologies and related research outputs to improve repair services and support their clients’ continued mobility and community participation.It is important that healthcare plans and policies recognise the benefits of proactive wheelchair servicing and use data as a tool to allocate device usage and performance-based reimbursements. [ABSTRACT FROM AUTHOR]

It is documented that wheelchair failures occur frequently, repair times are lengthy, and users often experience adverse consequences. This study aims to gather evidence on efficiency of current wheelchair repair processes from the perspective of complex rehabilitation technology (CRT) suppliers who perform repairs within the United States. A 20 statement survey was developed to identify barriers and facilitators related to wheelchair repairs across the domains of administrative and operational factors as well as to identify future opportunities for improvement. Key statements in these areas included time to perform a repair, documentation requirements, tracking repair progress, reimbursement, technician competency, emerging strategies and preventative maintenance. The online survey was broadly disseminated to a nationwide network of CRT suppliers for data collection. A total of 127 responses were received. Results showed that administrative statements received the lowest scores while those statements dealing with future opportunities received the highest scores. Areas of the industry that suppliers were in most disagreement with included wait time for insurance approval, reimbursement for parts, reimbursement for technician travel time and lack of coverage for preventative maintenance. Telehealth system usage, preventative maintenance coverage, tracking repairs and repair scheduling were future opportunities that suppliers were in most agreement with. Administrative issues exist in the CRT industry due to restrictive insurance policies associated with repairs and maintenance. Future opportunities to improve the process exist including payment models and the application of telehealth, device monitoring and service-based performance incentives to reduce adverse consequences to the user. Highlights the direct importance and barriers faced within the wheelchair repair industry by CRT suppliers. In a sample of CRT suppliers, there is agreement there exists many administrative and operational issues related to wheelchair repairs. There is agreement among survey respondents of opportunities to investigate further telehealth and remote strategies, preventative maintenance coverage and online tracking for wheelchair repairs. [ABSTRACT FROM AUTHOR]

Wheeled mobility and seating (WMS) devices allow users to achieve greater mobility independence. Previous studies determined that 53% of wheelchair users required one or more repairs over a 6-month period; however, there are a limited number of studies that have evaluated types of repairs. The purpose of this study was to describe the types of manual wheelchair, power wheelchair, and scooter repairs within the Wheelchair Repair Registry (WRR) and examine the association between WMS devices and the frequency of repairs. A dataset of 4,645 devices distributed in the United States was collected from equipment suppliers who performed and logged community-based wheelchair repair services. The results demonstrated common repairs found across devices were within the wheels/tires/forks and batteries/ cables categories. Device type was the most significant predictor of variance in the number of repairs. Customizable manual wheelchairs, tilt-in-space, Groups 2 & 3 power wheelchairs, and scooters were associated with higher number of repairs compared to non-customizable manual wheelchairs, pediatric, heavy-duty manual wheelchairs, and Group 4 power wheelchairs. The higher failure rate found in specific devices may be associated with a population of more active users, environment/conditions where equipment is used, time spent in equipment, additional features on device, or lower durability. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) estimates that only 17–37% of the approximately 77 million people who need a wheelchair have access to one. Many organizations are trying to address this need through varying service delivery approaches. For instance, some adhere to WHO's recommended 8-steps service approach while others provide wheelchairs with little to no service. There is limited and sometimes conflicting evidence of the impact of the WHO's recommendations on the outcomes of wheelchair provision. To help build this evidence, we \explored outcomes of two groups of users who received their wheelchairs through two service models over time. The 8-Steps group (n = 118) received a wheelchair selected from a range of models from service providers trained using the WHO process, and the standard of care (SOC) group (n = 24) received hospital-style wheelchairs and without clinical service. Interviews were conducted at baseline and at follow-up 3 to 6 months after provision, to collect data about wheelchair usage, satisfaction, skills, maintenance and repairs, and life satisfaction. Across-group statistical comparisons were not appropriate due to significant differences between groups. In general, participants used their wheelchairs every day but reported very low mobility levels (<500 meters for the 8-steps group, and <100 meters for the SOC group.) The 8-steps group used their wheelchair for either between 1–3 hours per day, or more than 8 hours per day. The SOC used it between 1 and 3 hours per day. Overall, wheelchair usage and wheelchair skills decreased over the 3- to 6-month data collection timeline. Wheelchair breakdowns were common in both groups emphasizing the need for maintenance, occurring more frequently in the 8-Steps (28.8%) compared to the SOC group (8%), and emphasizing the need for maintenance services. No significant differences were found when comparing device satisfaction across wheelchairs types. Our results emphasize the need for routine maintenance to address frequent wheelchair breakdowns. Our results also demonstrate a large disparity in several outcome variables across groups which motivates future studies where across-group comparisons are possible. [ABSTRACT FROM AUTHOR]

Introduction: Wheelchair casters fail frequently in the field causing multiple user consequences and wheelchair breakdowns. To inform caster design improvement, there exists no validated tools that can collect caster failures. This need motivated the development of a user-reported, caster failure inspection tool (C-FIT). Methods: To develop C-FIT, a multistep design and testing approach was used which included face validity testing, test-retest reliability testing and expert review. Reliability testing was conducted with two independent cohorts of wheelchair professionals who inspected caster failures physically and online through pictures. The tool was revised based on testing outcomes and expert feedback. For preliminary data collection and evaluating usability, C-FIT was piloted at wheelchair service centers in Scotland, Indonesia and Mexico. Results: Caster failure items reported in the literature were screened to develop the initial list of C-FIT items. Face validity testing conducted through surveys with wheelchair experts (n = 6) provided 14 items for C-FIT inclusion. The test-retest reliability was found to be high for 10 items with physical failure inspections (n = 12). For each of these items, 75% or more participants had substantial to almost perfect agreement scores (κ = 0.6–1.0). Lower reliability scores were found with online failure inspections (n = 11). C-FIT received positive usability feedback from study participants and data collectors in the field. Pilot field data (n = 31) included comprehensive details about failures useful for manufacturers, designers and researchers to improve caster designs. Conclusions: The C-FIT tool developed in this study has substantial reliability and can be used for documenting caster failures at wheelchair service centers. Collecting data on caster failures is an important first step to inform design improvements and caster quality testing methods. The caster failure inspection tool is a reliable tool that can be used during wheelchair repair and servicing to collect caster failures in a standardized way. The failure data can be used by wheelchair manufacturers, designers, technicians and researchers to develop reliable caster designs. Wheelchair providers can select caster designs based on context of use. [ABSTRACT FROM AUTHOR]