Is any wheelchair better than no wheelchair? A Zimbabwean perspective

Exploring Barriers to Accessing Sexual and Reproductive Health Services among Adolescents and Young People with Physical Disabilities in South Africa

Despite South Africa having a progressive and liberal sexual and reproductive health (SRH) policy framework, adolescents and young people with disabilities (AYPWDs) are less likely to receive sexual and reproductive healthcare, being consequently predisposed to a long-term detrimental impact on their health. Our study explored the barriers to accessing sexual and reproductive health services (SRHSs) in clinics among AYPWDs in Mpumalanga, South Africa. We conducted a descriptive qualitative study with twenty-seven AYPWDs in four focus group discussions using semi-structured interviews, audiotaped and transcribed verbatim, and then applied a thematic analysis of the data. Employing a socio-ecological model, the findings show a poor socioeconomic status, lack of information on SRH, and the attitudes of AYPWDs as barriers at the individual level, hindering AYPWDs from accessing SRHSs in clinics. AYPWDs also faced difficulties to talk about SRH with parents, a lack of support to seek SRHSs, improper care from family/parents, and negative attitudes of friends, at the interpersonal level. They further expressed barriers at the community/societal level as negative attitudes of non-disabled community members and poor infrastructure for wheelchair use. At the organization level, their access to SRHSs was negatively affected by HCWs' maltreatment, described in the forms of negative attitudes, being judgmental using verbal abuse, discrimination, and bullying. Furthermore, AYPWDs described difficulties in communication with HCWs, as well as violating their confidentiality and misconceived ideas on their sexuality. Intensified efforts to strengthen public health strategies are needed to improve access to SRHSs by AYPWDs in South Africa, as well as enhancing the proficiency and communication skills of HCWs and educating AYPWDs, parents, and non-disabled community members on SRH.

[Satisfaction of wheelchair users in the Baixada Santista Metropolitan Region]

This article seeks to identify user satisfaction in relation to wheelchairs and the provision of public and private health services in the Baixada Santista Metropolitan Region. It involved a cross-sectional study with a quantitative approach. Participants answered a sociodemographic questionnaire and the Brazilian version of the Quebec Assistive Technology User Satisfaction Assessment. Data were analyzed using descriptive and comparative statistics by means of Student's t test. Cohen's d effect sizes were also calculated. Participants (n = 42) were "more or less satisfied" with the wheelchairs and "quite satisfied" with the services provided. Rigid frame wheelchair users were significantly more satisfied with their wheelchairs compared to users of wheelchairs weighing over 198 lbs. (p = 0.010, d = 1.04). Users of private services showed significantly greater satisfaction with the provision of the service compared to public services users (p = 0.021, d = 0.75). Wheelchair users in the Baixada Santista Metropolitan Region are more satisfied with the rigid frame wheelchair and less satisfied with public services.

Impact of Seating and Mobility Services for Individuals With Disabilities in El Salvador

IMPORTANCE

Outcomes research on the impact of seating and mobility services delivered using a short-term medical mission (STMM) model is limited.

OBJECTIVE

To evaluate the impact of seating and mobility services on the occupational performance of individuals with disabilities in El Salvador.

DESIGN

One-group retrospective pretest-posttest.

SETTING

Clinical (El Salvador).

PARTICIPANTS

Individuals with disabilities in El Salvador.

OUTCOMES AND MEASURES

Survey and the standardized Wheelchair Outcome Measure (WhOM) for those who received a wheelchair as their mobility device.

METHOD

Participants rated satisfaction with performance of preferred in-home and out-of-home occupations on the WhOM before and after receiving seating and mobility services.

RESULTS

For most survey questions assessing the impact on activities of daily living, more than 86% of the respondents selected agree or strongly agree. Nearly half of the respondents reported that questions regarding work and education were not applicable. Participants' WhOM scores (n = 86) demonstrated a statistically significant improvement in performance satisfaction for both in-home (p < .001; d > 1) and out-of-home (p < .001; d > 1) occupations after they received services, with a huge effect size (d > 2).

CONCLUSIONS AND RELEVANCE

The findings suggest that seating and mobility services provided by rehabilitation professionals in El Salvador improved occupational performance for people with disabilities. Compared with STMMs that solely provide equipment, the findings emphasize the importance of professional service provision with education and training as best practice. What This Article Adds: Seating and mobility services delivered through a STMM model may improve occupational performance for individuals with disabilities. However, STMMs should be carefully planned in collaboration with in-country partners, provide customized seating systems, and include education and training from licensed rehabilitation professionals.

Wheeled and Seated Mobility Devices Provision: Quantitative Findings and SWOT Thematic Analysis of a Global Occupational Therapist Survey

PURPOSE

To better understand the global role of occupational therapists and explore facilitators and barriers impacting user access to high quality, affordable wheeled and seated mobility device (WSMD) provision worldwide.

METHODS

Mixed-method approach utilizing quantitative findings and qualitative strengths, weaknesses, opportunities, and threats (SWOT) analysis of a global online survey.

RESULTS

A total of 696 occupational therapists from 61 countries completed the survey. Almost 49% had 10 or more years of experience with the provision of WSMDs. WSMD provision had positive, significant associations with attainment of certification (0.000), higher service funding (0.000), higher country income (0.001), standardized training (0.003), continuous professional development (0.004), higher experience (0.004), higher user satisfaction (0.032), custom-made device provision (0.038), higher staff capacity (0.040), and more time working with users (0.050); negative, significant associations were identified with high cost of WSMDs (0.006) and pre-made device provision (0.019). SWOT analysis identified high country income, funding, experience, training, certification from global partners, variety of roles and practice settings, and interdisciplinary teamwork as strengths and opportunities for professional growth, while low country income, lack of time/staff capacity/standardization/support services, and poor access to proper devices were indicated as weaknesses and threats.

CONCLUSION

Occupational therapists are skilled healthcare professionals and provide a variety of WSMD services. Efforts to build collaborative partnerships, enhance access to occupational therapists and funding options, improve service and standards for WMSD service delivery, and promote professional development will help to overcome challenges and facilitate WSMD provision globally. Promoting practices based on best available evidence for WSMD provision worldwide should be prioritized.

A Goal-Directed Program for Wheelchair Use for Children and Young People with Cerebral Palsy in Uganda: An Explorative Intervention Study

In this exploratory study, we investigate whether goal-directed intervention for wheelchairs can increase the activities of daily living for children and young people with cerebral palsy (CP) when implemented in rural Uganda. Thirty-two children and young people with CP (aged 3–18 years) participated in a home-visit intervention program, which included donating wheelchairs and setting individual goals. Goal achievement, frequency of wheelchair use, condition of wheelchairs, and caregivers’ perspectives were collected by interviews at 6–10 month after the start of intervention and the after three years. Our result show that most wheelchairs were in good condition and frequently used after 6–10 month with 83% goal achievement (132/158 goals; mean 4.3 (range 0–7). The caregivers reported several advantages (e.g., the child being happier) and few disadvantages (e.g., poor design and durability). At the three-year follow-up, only eleven wheelchairs were still used by 23 available participants (seven deceased and two moved). The children achieved 60% of their goals (32/53 goals mean 2.9; range 1–5). This demonstrates that the goal-directed intervention program for wheelchairs can be successfully implemented in a low-income setting with a high rate of goal achievement and frequent wheelchair use, facilitating participation. However, maintenance services are crucial to obtain sustainable results.

Patient Satisfaction with Occupational Therapy Services for Wheeled Mobility and Seating Devices

Satisfaction of 81 patients was evaluated before and after receiving occupational therapy services. There was a statistically significant difference between patients' scores before and after receiving occupational therapy services (p < .05). Over 85% indicated a high satisfaction in relation to quality and health outcomes attributed to occupational therapy services, 44% reported barriers related to limited availability, accessibility, and knowledge of occupational therapy services, and 35% made suggestions for improvements. Patient-therapist communication and easy access to occupational therapy services can enhance occupational therapy knowledge, lead to positive patient experience and quality health outcomes, and higher patient satisfaction.

The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes - a randomized control trial

INTRODUCTION

Over the last few decades, the quality of care and the quality of life of nursing home (NH) residents have significantly improved, but insufficient physical activity and social involvement still represent substantial challenges in modern nursing facilities. The main aim of this research was to assess the influence of physical exercises with dance movement therapy (DMT) elements on strength and other fitness components of the upper limbs and the overall functional performance of NH residents in wheelchairs compared to standard exercise programmes and usual care.

METHOD

The study participants were persons aged 68-85 who lived in NH and used manual wheelchairs as a primary means of mobility. Individuals meeting the inclusion criteria were assigned to one of the three groups: Group 1, basic exercise/BE group (n = 55); group 2, physical exercises with elements of dance movement therapy/PED group (n = 55); and group 3, control group, usual care/CO group (n = 55). The intervention for both exercising groups consisted of a 30-min session, two times a week, for 12 weeks in total. Outcome assessments were performed at baseline, 12 weeks after baseline (immediately after the intervention) and 24 weeks after baseline (12 weeks after the intervention). The main outcome was observed for hand grip strength (HGS), while secondary outcomes for box and block test (BBT), arm curl test (ACT), back scratch test (BS), chair sit-and-reach (CSR), peak expiratory flow (PEF), Barthel Index (BI), Berg Balance Scale (BBS) and the range of motion of the shoulder.

RESULTS

Prior to the start of the exercise programmes, all the tested groups were homogeneous. After 12 weeks the PED group presented higher statistically significant scores in HGSL, BBT, ACT, BS, CSR, BI, BBS: p < 0.001 and HGSR: p = 0.01, compared to the BE group. After 24 weeks from the beginning of the intervention the comparison between the PED group and the BE group showed statistically significant differences (p < 0.001) in favour of PED group in almost all areas: HGSR, HGSL, BBT: ACT, PEF, BS, CSR, BI. After 12 and 24 weeks both intervention groups performed better than the CO in all measures except for Katz ADL and shoulder extension.

CONCLUSION

Twelve weeks of physical exercises had beneficial effects on the strength and fitness of the upper limbs and overall functional performance in both exercise groups. This study demonstrated that group performing physical exercises with elements of DMT obtained statistically better scores in the majority of analysed domains than other groups.

TRIAL REGISTRATION

The study was registered in the Sri Lanka Clinical Trials Registry (Registration Number - SLCTR/2018/014 - Date of Registration 16/05/2018. Accessed on https://slctr.lk/trials/1045 ).

Preliminary steps of the development of a Minimum Uniform Dataset applicable to the international wheelchair sector

Assistive products outcomes are needed globally to inform policy, practice, and drive investment. The International Society of Wheelchair Professionals developed a Minimum Uniform Dataset (MUD) for wheelchair services worldwide with the intent to gather data that is comparable globally. The MUD was developed with the participation of members from around the globe and its feasibility piloted at 3 sites. Three versions of the MUD are now available—a short form with 29 data points (available in English, Spanish, and French) and a standard version with 38 data points in English. Future work is to validate and complete the translation cycles followed by promoting the use of the MUD globally so that the data can be leveraged to inform policy, practice and direct investments.

Community-based rehabilitation workers' perspectives of wheelchair provision in Uganda: A qualitative study

Background

The challenges of wheelchair provision and use in less resourced settings are the focus of global efforts to enhance wheelchair service delivery. The shortage of professional wheelchair service providers in these settings necessitates the collaboration of multiple stakeholders, including community-based rehabilitation (CBR) workers, whose role needs to be further understood.

Objectives

The aim of this study was to determine what CBR workers in three areas of Uganda perceived as (1) the challenges with wheelchair provision and use, (2) the factors contributing to these challenges, (3) the role they themselves can potentially play and (4) what facilitators they need to achieve this.

Method

This qualitative study in the transformative paradigm comprised focus group discussions to gather perceptions from 21 CBR workers in three areas of Uganda, each with an operational wheelchair service, participant observations and field notes. Thematic analysis of data was implemented.

Results

Community-based rehabilitation workers’ perceptions of challenges were similar while perceived causes of challenges differed as influenced by location, historical and current wheelchair availability and the CBR workers’ roles. Their main responsibilities included assistance in overcoming barriers to access the service, transfer of skills and knowledge related to wheelchairs, follow-up of users for wheelchair-related problem-solving, and user and community empowerment.

Conclusion

Community-based rehabilitation workers can contribute in various ways to wheelchair service delivery and inclusion of wheelchair users; however, their capabilities are not consistently applied. Considering the diversity of contextual challenges, CBR workers’ range of responsive approaches, knowledge of networks and ability to work in the community make their input valuable. However, to optimise their contribution, specific planning for their training and financial needs and effective engagement in the wheelchair services delivery system are essential.

Keywords

wheelchairs; less resourced settings; community-based rehabilitation; wheelchair service provision; service steps; Uganda; empowerment; inclusion; assistive device.

Development and evaluation of a wheelchair service provision training of trainers programme

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.

The long-term impact of wheelchair delivery on the lives of people with disabilities in three countries of the world

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.

Developing product quality standards for wheelchairs used in less-resourced environments

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.

Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study

BACKGROUND

The United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study's purpose was to describe wheelchair users' experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines.

METHODS

Local researchers in Nairobi and Manila interviewed 48 adult basic wheelchair users, with even distribution of those who had and had not received wheelchair services along with their wheelchair. Recordings were transcribed in the local language and translated into English. The study team coded transcripts for predetermined and emergent themes, using Atlas-ti software. A qualitative content analysis approach was taken with the WHO service delivery process as an organizing framework.

RESULTS

Wheelchair users frequently described past experiences with ill-fitting wheelchairs and little formal training to use wheelchairs effectively. Through exposure to multiple wheelchairs and self-advocacy, they learned to select wheelchairs suitable for their needs. Maintenance and repair services were often in short supply. Participants attributed shorter duration of wheelchair use to lack of repair. Peer support networks emerged as an important source of knowledge, resources and emotional support. Most participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for, and despite challenges, they were grateful to have some means of mobility. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support.

CONCLUSIONS

Interventions are needed to provide wheelchairs services efficiently, at scale, in an environment facilitating physical access and peer support, and reduced social stigma.

TRIAL REGISTRATION

Not applicable since this was a descriptive study.

Impact of structured wheelchair services on satisfaction and function of wheelchair users in Zimbabwe

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.