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      The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia

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          Abstract

          Background

          For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization’s service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls.

          Methods

          This study used a convenience sample ( N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only.

          Results

          167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair ( p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list ( p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list ( p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a “wheelie”. The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist ( p = 0.019).

          Conclusions

          Wheelchair provision according to World Health Organization’s 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages.

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          Most cited references49

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          World report on disability.

          (2011)
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            Predictors of assistive technology abandonment.

            Technology abandonment may have serious repercussions for individuals with disabilities and for society. The purpose of this study was to determine how technology users decide to accept or reject assistive devices. Two hundred twenty-seven adults with various disabilities responded to a survey on device selection, acquisition, performance, and use. Results showed that 29.3% of all devices were completely abandoned. Mobility aids were more frequently abandoned than other categories of devices, and abandonment rates were highest during the first year and after 5 years of use. Four factors were significantly related to abandonment--lack of consideration of user opinion in selection, easy device procurement, poor device performance, and change in user needs or priorities. These findings suggest that technology-related policies and services need to emphasize consumer involvement and long-term needs of consumers to reduce device abandonment and enhance consumer satisfaction.
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              The right to assistive technology: for whom, for what, and by whom?

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                Author and article information

                Contributors
                mlt47@pitt.edu
                ceke@mit.edu
                Jlp46@pitt.edu
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                22 January 2016
                22 January 2016
                2015
                : 16
                : 26
                Affiliations
                [ ]Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA USA
                [ ]Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA USA
                [ ]Programa de Ingenieria Biomedica, Escuela de Ingeniería de Antioquia y Universidad CES, Envigado, Antioquia, Colombia
                [ ]Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
                Article
                1268
                10.1186/s12913-016-1268-y
                4722611
                26801984
                aa4e3dea-a18c-499e-aa6a-2d215f6eba71
                © Toro et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 November 2014
                : 12 January 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Health & Social care
                wheelchairs,wheelchair service provision,quality of life,participation,wheelchair skills,less resourced settings

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