Improving Wheelchair Appropriateness for Adults with Spinal Cord Injury
Individuals who receive inappropriate wheelchairs may experience adverse impacts on their physical functioning, safety, quality of life, vocational and economic standing. Understanding the reasons for disparities in wheelchair appropriateness is difficult, in part, because of the complex and multi-faceted process of wheelchair service delivery. This study integrated and expanded upon previously published models of wheelchair service delivery to provide a preliminary framework for developing more comprehensive, descriptive models for adults with spinal cord injury (SCI). Investigators conducted a literature review (1990-2007) and analyzed interviews (conducted June 2007) with ten experts (VA and non-VA) in wheelchair service delivery. In this article, ‘wheelchair service delivery’ includes the process of justifying wheelchair selection, approving the selected wheelchair, delivering it to the client, fitting and customizing the wheelchair, and providing follow-up care and consultation.
Findings show that most experts stress the importance of having both patients and providers play a key role in the process. For example, the primary patient factors identified were: wheelchair funding source, ability to pay out of pocket, decision-making capacity, self-awareness of needs, familiarity with products, and family influences. Suppliers also play an integral role and may significantly influence the appropriateness of the wheelchair provided. In addition, the authors identified a number of system-level factors (e.g., facility standards, policies, and regulations) that influence wheelchair service delivery. Thus, the authors provide a detailed, descriptive model of wheelchair service delivery that integrates the delivery process and device outcomes, and includes patient-, provider-, and system-level factors that may directly influence outcomes.
Eggers S, Myaskovsky L, Burkitt K, Tolerico M, Switzer G, Fine M, and Boninger M. A preliminary model of wheelchair service delivery. Archives of Physical Medicine and Rehabilitation June 2009; 90(6):1030-1038.
The study was partly funded through HSR&D. Drs. Eggers, Myaskovsky, Burkitt, Switzer, and Fine are part of HSR&D’s Center for Health Equity Research and Promotion in Pittsburgh.