Development, validation and feasibility study of a remote basic skills assessment for wheelchair service providers

Assistive technology unmet need in Indonesia: challenges and opportunities for enhancing equitable access

PURPOSE

To analyze the rapid Assistive Technology Assessment (rATA) data and identify challenges and opportunities for improving access to assistive technology products (AP) in Indonesia.

MATERIALS AND METHODS

An explanatory sequential mixed-methods design consisting of a quantitative survey and a qualitative interview study was used. The rATA survey was administered to households in two randomly sampled provinces to collect data on AP met and unmet need. Descriptive statistics was used to analyze the survey data. Qualitative data were collected from unstructured videorecorded interviews with rATA policymakers. Interview transcripts were coded and analyzed using thematic analysis.

RESULTS

On average, data from rATA respondents (n = 11,300) revealed 60% of AP unmet need. A high proportion of funding sources came from the private sector, and contributions from the government remained low. Affordability and funding were the main barriers to access. From the policymaker interviews (n = 5), four essential themes emerged, i.e., "resources and workforce", "funding", "laws and policies", and "guidelines and standards". From each theme, key challenges and opportunities were identified.

CONCLUSIONS

Affordability remained a major challenge, in part because government-sponsored funding was still inadequate, forcing people with low financial status to self-produce AP. One potential opportunity would be to localize AP production and improve local workforce training. Integrated national funding schemes and intersectoral coordination could accelerate improvement in meeting AP unmet need. This study may provide evidence of current challenges and opportunities to help improve the field of rehabilitation through enhanced access to AP services in Indonesia.

Evaluation of providers' assistive technology service delivery practices in Pakistan

PURPOSE

Globally, one in three individuals needs at least one assistive product. The primary objective of this study was to conduct a survey of Pakistani rehabilitation service providers to determine what proportion provide assistive technology and if their characteristics (including geographical region, education, and experience) are associated with adherence to the service delivery process. The secondary objective was to determine if individuals that provide assistive technology adhere to a standard assistive technology service delivery process. The tertiary objective was to determine if the providers that adhered to a standard delivery process had characteristics that differed from the rest of the service providers.

MATERIALS AND METHODS

An online survey composed of multiple-choice questions was distributed to physiotherapists, community-based healthcare workers, and related rehabilitation professions through a convenience sampling method. SPSS Statistics was used to develop correlation matrices to determine Pearson's coefficient of number of steps, education level, experience level and continuing education received.

RESULTS

There were 71 respondents from 4 Pakistani provinces. 53.5% of respondents stated they provide assistive technology. There was participation in most steps of the service delivery process. There is weak correlation between number of steps and education level, number of steps and experience level, and number of steps and continuing education received.

CONCLUSIONS

While the majority of respondents provide assistive technology, a significant proportion (46.5%) don't. This may suggest there is a need for additional advocacy and awareness raising of the benefits of and how to access assistive technology in Pakistan.

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.

The influence of shoulder pain and fear of falling on level and non-level transfer technique

BACKGROUND

Level and non-level transfers are essential tasks of daily living for wheelchair users. Minimal research has examined the role of shoulder pain and fear of falling on transfer quality. The purpose of this study is to (1) examine the association between shoulder pain, fear of falling (FoF) and transfer quality and (2) explore the feasibility of assessing non-level transfers to-and-from the floor.

METHODS

Cross-sectional design was used to explore shoulder pain, FoF, and transfer quality in 30 manual wheelchair users (aged 18-42; 15 males). Participant demographic information (age, sex, race, disability, and years using wheelchair), Spinal Cord Injury-Fall Concern Scale (SCI-FCS), and Wheelchair User Shoulder Pain Index (WUSPI) was collected. Three types of transfers: (1) level, (2) uphill, and (3) floor-to-table were graded by a trained researcher using the Transfer Assessment Instrument (TAI) 3.0. Kruskal-Wallis test was used to determine differences in transfer quality based on condition. Spearman correlation was used to determine associations between demographic data, WUSPI, SCI-FCS, and transfer quality scores.

RESULTS

All participants safely completed the uphill non-level transfer; 27 safely completed the floor-to-table non-level transfer. Statistical analysis revealed no difference in TAI score across transfer conditions. Spearman correlation revealed a significant correlation between WUSPI and SCI-FCS scores (r = .68, P = .01) and WUSPI and uphill TAI scores (r = -.45, P = .01).

CONCLUSION

Increases in shoulder pain are related to decreased uphill transfer quality and increased FoF. Non-level transfers to-and-from the floor are feasible within clinical or laboratory settings.

An exploratory analysis of global trends in wheelchair service provision knowledge across different demographic variables: 2017-2020

OBJECTIVE

To explore global trends in manual wheelchair service provision knowledge across geographic, professional, and socioeconomic domains.

DESIGN

A secondary analysis of a dataset from the International Society of Wheelchair Professionals' Wheelchair Service Provision Basic Knowledge Test was conducted.

SETTING

The dataset included test takers from around the world and was extracted from Test.com and International Society of Wheelchair Professionals' Wheelchair International Network.

PARTICIPANTS

2,467 unique test takers from 86 countries.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

International Society of Wheelchair Professionals' Wheelchair Service Provision Basic Knowledge Test.

RESULTS

We identified significant inverse associations between pass rate and the following variables: education (high school and some college), test taker motivation (required by academic program or employer), and country income setting (low and middle). There were significant positive associations between pass rate and the following variables: training received (offered by Mobility India or 'other NGO'), and age group served (early childhood).

CONCLUSION

Global wheelchair knowledge trends related to key variables such as training, occupation, and income setting have been preliminarily explored. Future work includes further validation of the primary outcome measure and recruitment of a larger sample size to further explore significant associations between additional test taker variables.