Wheelchair and seating prescription practices: a service evaluation in a sub-acute rehabilitation centre

Author: Belinda Robertson

Robertson, Belinda, 2017 Wheelchair and seating prescription practices: a service evaluation in a sub-acute rehabilitation centre, Flinders University, School of Health Sciences

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Abstract

Introduction Assistive devices are commonly used to support the independence of people living with disability by facilitating participation and enhancing overall wellbeing. Wheelchairs are a common assistive technology used to enhance mobility. Wheelchair and seating prescription is a complex, time consuming, and costly but important, intervention for people with mobility limitations. For many new wheelchair users, prescription occurs during an inpatient rehabilitation admission. Aim The primary aim of this study was to evaluate an inpatient rehabilitation centre’s existing wheelchair prescription service to explore strengths and weaknesses and provide guidance about areas for service development. The service evaluation considered the perspectives of staff and service users. In addition, a systematic review was conducted in order to identify which outcomes are commonly measured and the outcome measures used following new wheelchair and seating prescription. Method Systematic Review A systematic search was performed in four databases based on the following inclusion criteria: (1) prescription of a new wheelchair and/or seating system for long term use (2) participants aged 18 years or over. Details of the outcome measures used within the study were extracted and grouped by categories. Service Evaluation Community dwelling wheelchair users who had recently received services from the rehabilitation centre were invited to participate in a semi-structured telephone interview to explore their perception of the wheelchair prescription service. Participants were also asked to complete the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0) and the WHO Quality of Life-BREF (WHOQOL-BREF). Rehabilitation clinicians completed a survey regarding their wheelchair prescription experience, confidence and training needs in this area. Results Systematic Review Thirty-nine studies were included in this review; the studies used a range of methodologies but overall the quality of the included studies was found to be low and the populations heterogeneous. Activity and participation were the most commonly studied outcomes. Study-specific tools were used more often than standardised measures. Within the included papers, the psychometric properties of the standardised outcome measures were seldom reported. Service Evaluation Eight people who used wheelchairs as their primary means of mobility completed the two surveys (QUEST 2.0 and WHOQOL-BREF) and the semi-structured interview. Qualitative data revealed a high level of satisfaction with the wheelchair prescription although many of the participants had sourced alternative wheelchairs following discharge. Staff survey results (N=42) indicated that knowledge of clinical guidelines related to wheelchair prescription was varied and over half of the staff members did not feel confident in prescription practices. Conclusions Services should ensure that wheelchair prescription practices optimise client satisfaction and meet their needs while creating an environment in which staff develop and maintain their skills in this specialised area of practice. The complexity of measuring wheelchair prescription intervention needs to be recognised; the use of standardised outcome measures should be employed to demonstrate the benefits of wheelchair prescription and make findings meaningful to consumers, clinicians, and service providers.

Keywords: Wheelchair, seating, occupational therapy, rehabilitation
Subject: Health Sciences thesis

Thesis type: Masters
Completed: 2017
School: School of Health Sciences
Supervisor: Dr Kate Laver