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Short N, Henton P, Smitson E, Barg A, Baumgartner L, Brown T, Jurek M, Langbein K, Oajaca G. Effectiveness of custom seating and mobility services for individuals with disabilities in Guatemala. Disabil Rehabil Assist Technol 2024:1-7. [PMID: 38950575 DOI: 10.1080/17483107.2024.2365938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024]
Abstract
The purpose of this study was to evaluate the effectiveness of custom seating and mobility services provided via an international service learning (ISL) model on the occupational performance of individuals with disabilities in Guatemala. A one-group prospective pretest-posttest design was implemented using the standardized Wheelchair Outcome Measure (WhOM - Spanish) administered on the day of wheelchair fitting, and at 3- and 6-month intervals after receiving seating and mobility services. A two-tailed t-test demonstrated a statistically significant (p < 0.001) improvement in satisfaction for in-home and out-of-home occupations for all participants (n = 71) at 3-months with a huge effect size (d > 2) and this improvement was maintained at the 6-month interval. The results were consistent for various areas of occupational performance (e.g. activities of daily living). The provision of customized seating and mobility services by occupational therapists through an ISL model demonstrated effectiveness at improving satisfaction with occupational performance for individuals with disabilities in Guatemala. Cultural humility, customization of equipment based on personal and environmental factors, inclusion of education and training, and collaboration with in-country partners were identified as contributors to positive outcomes.
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Affiliation(s)
- Nathan Short
- Abilene Christian University OT Program, Abilene, TX, USA
| | | | | | - Anya Barg
- Huntington University, Huntington, IN, USA
| | | | | | | | | | - Gilma Oajaca
- Bethel International Ministries, Chimaltenango, Guatemala
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Garcia-Mendez Y, D'Innocenzo M, Pearlman J, Vásquez-Gabela S, Rosen P, Rodriguez-Funes MV, Kirby RL, Mhatre A. Effects of the WHO 8-step wheelchair-service-delivery process on wheelchair users in El Salvador: a cohort study. Disabil Rehabil Assist Technol 2024; 19:2076-2087. [PMID: 37740696 DOI: 10.1080/17483107.2023.2256808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE To test the hypotheses that, after the delivery of manual wheelchairs following the WHO 8-step service-delivery process, wheelchair-related health and quality of life, wheelchair skills, wheelchair use, and poverty probability would improve; and that the number of wheelchair repairs required, adverse events, caregiver burden, and the level of assistance provided would decrease. METHODS This was a longitudinal, prospective within-subject study including 247 manual wheelchair users, and 119 caregivers, in El Salvador who received a wheelchair following the WHO 8-step process as well as maintenance reminders. Outcome measurements were performed via structured questionnaires and dataloggers at the initial assessment, at wheelchair delivery, and at 3- and 6-month follow-up. RESULTS Significant improvements in wheelchair-related health indicators (all with p < 0.004) and quality of life (p = 0.001), and a significant reduction in national and "extreme" poverty probability (p = 0.004 and p = 0.012) were observed by six months. Wheelchair use significantly decreased (p = 0.011 and p = 0.035) and wheelchair skills increased (p = 0.009). Caregiver burden did not change (p = 0.226) but the number of activities of daily living (ADLs) that required no assistance significantly increased (p = 0.001) by three months and those who required complete assistance decreased (p = 0.001). No changes were observed in wheelchair repairs (p = 0.967) and breakdowns over time with new wheelchairs. CONCLUSIONS Wheelchair service delivery using the WHO 8-step process on manual wheelchair users in El Salvador has positive effects on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. Further research is needed to determine the relative contributions of the intervention components.
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Affiliation(s)
| | - Megan D'Innocenzo
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephanie Vásquez-Gabela
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Perth Rosen
- Momentum Wheels for Humanity, Chatsworth, CA, USA
| | | | - R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada
| | - Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Nuri RP, Xu X, Aldersey HM. Users' satisfaction and experiences in using assistive devices distributed by a rehabilitation centre in Bangladesh: a cross-sectional study. Disabil Rehabil Assist Technol 2024; 19:868-877. [PMID: 36215415 DOI: 10.1080/17483107.2022.2129849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE This study aimed to understand Bangladeshi users' satisfaction with their assistive devices, including (a) device characteristics, e.g., size, weight, safety, ease of use, comfort, and effectiveness, and (b) availability of parts and repair services. We also described how frequently individuals with disabilities living in the community used assistive devices in their daily activities and how the use of assistive devices promoted individuals' wellbeing. METHOD We conducted a cross-sectional survey with assistive device users or their guardians (if under 18) in Bangladesh about their experience and satisfaction with their assistive device 6 months after receiving it. The research team developed a survey questionnaire consisting of both closed and open-ended questions. All data were collected via telephone interviews. We employed descriptive statistics to analyse quantitative data and inductive analysis for the qualitative data. RESULTS We found that out of the 376 participants, nearly 95% used assistive devices on a regular basis, and their satisfaction with the devices was high. Participants reported that assistive devices improved mobility, independence, and wellbeing of persons with disabilities. A few participants (6.4%) reported that their devices were damaged. Some participants identified concerns with their assistive devices, including (i) inappropriate size of ankle-foot orthoses, manual self-propelled wheelchairs, and prostheses, (ii) back slabs (a type of brace) being too short, and (iii) walking frames being too large. Several participants noted pain and discomfort when they used their assistive device. Additionally, some participants stated that environmental factors (e.g., muddy roads) contributed to the disrepair of their assistive devices. Finally, participants recounted that repair services were limited in rural areas of Bangladesh. CONCLUSION These findings indicate that the provision of assistive devices requires accommodating individuals' needs and ensuring appropriate environments in which to function. The results support the need for follow-up services after distributing assistive devices. Further research could explore the impact of assistive devices on the family quality of life of persons with disabilities.IMPLICATIONS FOR REHABILITATIONIt is essential for rehabilitation professionals to conduct follow-up services after distributing assistive devices among persons with disabilities.There is a need for the government of Bangladesh to revisit the Rights and Protection of Persons with Disability Act of 2013 and provide further clarity about their commitment to the provision of assistive devices and associated services (e.g., repair services) and its subsequent implementation.Policymakers in Bangladesh must be proactive to translate policy commitments into practice, as it relates to building an accessible environment for people using assistive devices. Further, government efforts are needed to educate policy implementers in all relevant ministries so that all responsible bodies are fully familiar with their national and international commitments regarding the rights of persons with disabilities.Future research could (i) include user's satisfaction with the service delivery process and (ii) measure the impact of assistive devices on family quality of life of persons with disabilities.
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Affiliation(s)
| | - Xiaolin Xu
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Ferretti EC, Curi HT, Andrade LF, Cooper RA, Soárez PCD. Conceptual mapping proposed to comprehend the effect of wheelchair mobility on social participation and quality of life: a systematic review. Disabil Rehabil Assist Technol 2024; 19:814-830. [PMID: 36260418 DOI: 10.1080/17483107.2022.2126904] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify and synthesise the available evidence on the effect of mobility on social participation and quality of life (QoL) of wheelchairs (WC) on adults who use WC as their primary means of mobility. MATERIALS AND METHODS Systematic review undertaken in accordance with the Centre for Reviews and Dissemination Guidelines and registered in the PROSPERO International Prospective Register of Systematic reviews. Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane Library, LILACS, CINAHL, PEDro, SCOPUS, Web of Science, and BVS ECOS) were searched with the following PICO eligibility criteria: (P) Population was individuals with mobility limitations that live in their community, aged 18 or older; (I) Intervention was mobility devices, such as manual and powered wheelchairs; (C) Comparators, not applied; (O) Outcome was factors that can be influenced by wheelchair use, such as: social participation, health-related quality of life and QOL. Critical appraisal of methodological quality of studies were undertaken. RESULTS A total of 18 studies were included. The proportion of studies evaluating the effects of mobility on participation was higher than to mobility on QoL. WC quality, device benefit (ease of repairs and maintenance), confidence using a WC and WC skills were key factors determining participation. The provision of WC according to the eight steps service proposed by the Word Health Organisation contributed to higher levels of physical health, WC satisfaction, hours using the WC and QoL enhancement. CONCLUSION Attention should be given to enhance WC service provision (with continuous service support) as well as professional continuing education.IMPLICATIONS FOR REHABILITATIONWheelchair technology is a key element in rehabilitation. Significant effort should be made to provide and maintain the wheelchair as a facilitator to participation. A great attention should be done to enhance wheelchair services as well as professional continuous education.Wheelchair skills are associated with participation and may be targeted in clinical intervention.
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Affiliation(s)
- Eliana Chaves Ferretti
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brazil
| | - Haidar Tafner Curi
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luana Foroni Andrade
- Departamento de Terapia Ocupacional, Universidade Federal de Sergipe, Lagarto, SE, Brazil
| | - Rory A Cooper
- Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Goldberg M, Rushton P, Kirby RL, Muñera S, Kandavel K, Pearlman J, Tawashy A. Wheelchair service provision content in professional rehabilitation organisations' standards documents and contemporary initiatives: a rapid review. Disabil Rehabil Assist Technol 2024; 19:78-89. [PMID: 35446737 DOI: 10.1080/17483107.2022.2063421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to identify opportunities, challenges, contemporary initiatives and strategies for preparing entry-level practitioners who are competent at the basic level of wheelchair service provision across four key international professional rehabilitation organisations as revealed by their educational standards, relevant guidelines and policy statements, and other publicly available information. METHOD A rapid review was conducted in 2021 from the International Society of Physical and Rehabilitation Medicine (ISPRM), the International Society for Prosthetics and Orthotics (ISPO), World Physiotherapy, and the World Federation of Occupational Therapists (WFOT). Additional grey-literature and grey-data searches were conducted to identify contemporary initiatives that may support competency development in wheelchair service provision. RESULTS A total of 17 standards, guidelines, and policy statement documents were selected for detailed review. Each of the four organisations published at least one document containing language relating to wheelchair service provision. Twelve contemporary initiatives relating to wheelchair service provision were identified from the grey literature across the four organisations. Six additional initiatives were identified from the organisations' social media accounts. Themes emerged in the areas of contemporary content, opportunities, and challenges. CONCLUSION Global standardisation could help harmonise professional societies' approach to training wheelchair service providers.IMPLICATIONS FOR REHABILITATIONThere is a need to provide more descriptive content on wheelchair service provision in education and service standards and related documents to influence what is taught in professional rehabilitation programs that are accredited or approved by professional rehabilitation organisations.The organisations' networks are vast and may also help to promote additional continuing education in this area.
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Affiliation(s)
- Mary Goldberg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
- International Society of Wheelchair Professionals, Medellin, Colombia
| | - Paula Rushton
- International Society of Wheelchair Professionals, Medellin, Colombia
- Université de Montréal, Montreal, Canada
| | - R Lee Kirby
- International Society of Wheelchair Professionals, Medellin, Colombia
- Dalhousie University, Halifax, Canada
| | - Sara Muñera
- International Society of Wheelchair Professionals, Medellin, Colombia
| | - Krithika Kandavel
- International Society of Wheelchair Professionals, Medellin, Colombia
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
- International Society of Wheelchair Professionals, Medellin, Colombia
| | - Amira Tawashy
- International Society of Wheelchair Professionals, Medellin, Colombia
- Dalhousie University, Halifax, Canada
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Borgnis F, Desideri L, Converti RM, Salatino C. Available Assistive Technology Outcome Measures: Systematic Review. JMIR Rehabil Assist Technol 2023; 10:e51124. [PMID: 37782310 PMCID: PMC10687703 DOI: 10.2196/51124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The World Health Organization claimed that measuring outcomes is necessary to understand the benefits of assistive technology (AT) and create evidence-based policies and systems to ensure universal access to it. In clinical practice, there is an increasing need for standardized methods to track AT interventions using outcome assessments. OBJECTIVE This review provides an overview of the available outcome measures that can be used at the follow-up stage of any AT intervention and integrated into daily clinical or service practice. METHODS We systematically searched for original manuscripts regarding available and used AT outcome measures by searching for titles and abstracts in the PubMed, Scopus, and Web of Science databases up to March 2023. RESULTS We analyzed 955 articles, of which 50 (5.2%) were included in the review. Within these, 53 instruments have been mentioned and used to provide an AT outcome assessment. The most widely used tool is the Quebec User Evaluation of Satisfaction with Assistive Technology, followed by the Psychosocial Impact of Assistive Technology Scale. Moreover, the identified measures addressed 8 AT outcome domains: functional efficacy, satisfaction, psychosocial impact, caregiver burden, quality of life, participation, confidence, and usability. The AT category Assistive products for activities and participation relating to personal mobility and transportation was the most involved in the reviewed articles. CONCLUSIONS Among the 53 cited instruments, only 17 (32%) scales were designed to evaluate specifically assistive devices. Moreover, 64% (34/53) of the instruments were only mentioned once to denote poor uniformity and concordance in the instruments to be used, limiting the possibility of comparing the results of studies. This work could represent a good guide for promoting the use of validated AT outcome measures in clinical practice that can be helpful to AT assessment teams in their everyday activities and the improvement of clinical practice.
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Charbonnet M, Sylvester L, Wang H, DeGrace BW. Provision of paediatric wheelchairs in low resource settings: a scoping review. Disabil Rehabil Assist Technol 2023; 18:1120-1138. [PMID: 34614386 DOI: 10.1080/17483107.2021.1986582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Inadequate wheelchair provision in children can lead to delays in growth and development, poorer health, and decreased participation. Wheelchair provision for children can be challenging, especially in low-resource settings, due to limited resources. Therefore, the purpose of the scoping review was to gain an understanding of the current state of paediatric wheelchair provision in low resource settings and identify factors, strategies, and gaps that can lead to more successful wheelchair provision. METHODS This scoping review used literature published after 2010, related to paediatric wheelchair provision in low resource settings. We searched online databases and grey literature and extracted data based on categories from the World Health Organisation Guidelines to wheelchair provision in low resource settings. RESULTS 34 articles were used to identify and analyse common themes and successful strategies related to wheelchair provision for children in low resource settings. Aspects of paediatric wheelchair provision were mentioned in the literature but were rarely the focus. End-user outcomes were the least represented category in the literature. CONCLUSION Based on the currently available evidence the overall state of a wheelchair for children is inadequate. Improvements in design and production, personnel capacity, and service delivery systems are recommended to promote best practices. The lack of child-focussed wheelchair provision and end-user involvement in the research process urgently needs to be addressed.Implications for RehabilitationIdentify best practiceIdentify gaps in knowledgeDetermine areas of need for future research.
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Affiliation(s)
- Monique Charbonnet
- Doctor of Science in Rehabilitation Program, University of Oklahoma-Health Science Center, Oklahoma City, OK, USA
| | - Lorraine Sylvester
- Department of Rehabilitation Science, University of Oklahoma-Health Science Center, Oklahoma City, OK, USA
| | - Hongwu Wang
- Department of Rehabilitation Science, University of Oklahoma-Health Science Center, Oklahoma City, OK, USA
| | - Beth W DeGrace
- Department of Rehabilitation Science, University of Oklahoma-Health Science Center, Oklahoma City, OK, USA
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Ferretti EC, Suzumura E, Rozman LM, Cooper RA, de Soárez PC. Economic evaluation of wheelchairs interventions: a systematic review. Disabil Rehabil Assist Technol 2023; 18:1163-1174. [PMID: 34753399 DOI: 10.1080/17483107.2021.1993360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The overall aim of this systematic review was to identify and synthesise the best available evidence on effectiveness, resource use and costs involved in wheelchair interventions of adults with mobility limitations. METHODOLOGY This systematic review was undertaken in accordance with the Centre for Reviews and Dissemination Guidelines. The protocol for this systematic review was registered with PROSPERO International Prospective Register of Systematic reviews. The following PICOS eligibility criteria were considered: (P) Population was individuals with mobility limitations that live in their community (e.g., non-institutionalized), with aged 18 or older; (I) Intervention was mobility assistive technologies (MAT), such as manual and powered wheelchairs; (C) Comparators (Not Applied); (O) Outcome, the primary outcome of interest, was established as the cost-effectiveness of wheelchair interventions. Direct and indirect costs per unit of effect were expressed in terms of clinical outcome units, quality-adjusted life years gained, utility scores, quality of life measures and incremental cost-effectiveness ratios to inform the economic outcomes. (S) Study design was considered as a health economic evaluation (i.e., including cost-effectiveness analysis, cost-utility analysis and cost benefit analysis as well as partial economic evaluations). The Consolidated Health Economic Evaluation Reporting Standards - CHEERS, checklist was used for summarising and interpreting the results of economic evaluations. RESULTS Sixteen studies were included, two were identified as full health economic evaluations and 14 were considered partial health economic evaluations. CONCLUSION Only two full health economic analyses of wheelchair interventions have been conducted and both focussed on powered wheelchair provision. There are important gaps in current knowledge regarding wheelchair health economic methods and available outcome measures, which there is a great need for further research.Implication for RehabilitationSystematic reviews of health economic evaluation studies are useful for synthesising economic evidence about health interventions and provide insight in new research development.Organisations involved in the provision of wheelchairs should apply cost-effectiveness outcome measures to help raise the standard of provision, to support evidence-based practice, and to improve resource utilisation.
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Affiliation(s)
- Eliana C Ferretti
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, Brazil
| | - Erica Suzumura
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luciana M Rozman
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rory A Cooper
- Human Engineering Research Laboratories, University of Pittsburgh and US Department of Veterans Affairs, Pittsburgh, PA, USA
| | - Patrícia C de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Sarsak HI, von Zweck C, Ledgerd R. Wheeled and Seated Mobility Devices Provision: Quantitative Findings and SWOT Thematic Analysis of a Global Occupational Therapist Survey. Healthcare (Basel) 2023; 11:healthcare11081075. [PMID: 37107909 PMCID: PMC10137666 DOI: 10.3390/healthcare11081075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
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.
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Affiliation(s)
| | - Claudia von Zweck
- World Federation of Occupational Therapists, 1211 Geneva, Switzerland
| | - Ritchard Ledgerd
- World Federation of Occupational Therapists, 1211 Geneva, Switzerland
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A Goal-Directed Program for Wheelchair Use for Children and Young People with Cerebral Palsy in Uganda: An Explorative Intervention Study. J Clin Med 2023; 12:jcm12062325. [PMID: 36983325 PMCID: PMC10051618 DOI: 10.3390/jcm12062325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
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.
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de Serres-Lafontaine A, Labbé D, Batcho CS, Norris L, Best KL. Social participation of individuals with spinal injury using wheelchairs in rural Tanzania after peer training and entrepreneurial skills training. Afr J Disabil 2023; 12:975. [PMID: 36756462 PMCID: PMC9900306 DOI: 10.4102/ajod.v12i0.975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Individuals with spinal cord injury (SCI) in less-resourced settings reported barriers to community integration, including inaccessible rehabilitation services, restricted environments and limited social integration. Peer training and entrepreneurial skills training are provided by Motivation, a nonprofit organisation, and Moshi Cooperative University to enhance occupational engagement of individuals with SCI in less-resourced settings. Objective This study aimed to explore the impact of peer training and entrepreneurial skills training on the social participation of individuals with SCI living in Tanzania. Method Using a qualitative photovoice approach, 10 participants captured meaningful photos and provided captions according to five standardised questions (PHOTO technique) to convey their messages. Participants selected up to 34 photos that best illustrated their experiences in the community. A mixed inductive-deductive thematic analysis was guided by the International Classification of Functioning, Disability and Health. Results Two interrelated themes emerged: (1) 'influencing factors', which revealed how participants' inclusion in the community was influenced by their activities and personal and environmental factors and (2) 'empowerment', which highlighted participants' desire to advocate and promote awareness of needs and hopes. Conclusion Participants emphasised the importance of accessibility and equal opportunities. Whilst some were able to overcome obstacles, others experienced continued inaccessibility that inhibited meaningful occupations. Daily participation challenges of individuals with SCI in rural Tanzania were highlighted. Although the Motivation programmes were perceived to have powerful impacts on social participation, continued efforts and advocacy are needed to overcome accessibility issues and to meet the physical, psychological and social needs of Tanzanians living with SCI. Contribution This article highlights the importance of accessibility and equal opportunities for individuals with disability living in rural Tanzania. Peer-training and entrepreneurial programs offer community-based rehabilitation services that were perceived by people with disabilities to have a powerful impact on social participation and vocation. However, continued efforts and advocacy are needed to meet the needs of Tanzanians living with spinal cord injury.
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Affiliation(s)
- Annabelle de Serres-Lafontaine
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
| | - Delphine Labbé
- Department of Disability and Human Development, University of Illinois at Chicago, Illinois, United States
| | - Charles S. Batcho
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
| | - Lucy Norris
- Motivation Charitable Trust, Bristol, United Kingdom
| | - Krista L. Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
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Ebuenyi ID, Kafumba J, Smith EM, Jamali-Phiri MZ, Munthali A, MacLachlan M. Empirical research and available data on assistive technology for persons with disabilities in Malawi: A review. Assist Technol 2023; 35:94-106. [PMID: 34292129 DOI: 10.1080/10400435.2021.1956641] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Empirical research and data are necessary for policy, planning and provision of services for persons with disabilities. Research data may be available but still not used by researchers and policy makers. The aim of this study is to explore existing empirical research and sources of data on Assistive Technology (AT) in Malawi in order to facilitate the development of an AT policy and Assistive Product List (APL). A two-stage process using a scoping review methodology was adopted to identify (1) empirical research on AT in Malawi and (2) sources of existing data on AT in Malawi. Following a narrative synthesis, 12 heterogenous studies that reported on the use, availability, sources and knowledge about AT in Malawi were identified. Identified studies suggest that there is high unmet need for AT and services in Malawi. Five major sources of data on disability and AT were Identified. Only 2 out of the 12 studies had used existing sources of data. The high unmet need for AT and services in Malawi have substantial implications for persons with disabilities. Developing mechanisms that will improve the use of existing data on AT in all countries is pivotal for the efficient and effective development of AT ecosystems.
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Affiliation(s)
- Ikenna D Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- IRIS Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Emma M Smith
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | | | | | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic
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13
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Layton N, O’Connor J, Fitzpatrick A, Carey S. Towards Co-Design in Delivering Assistive Technology Interventions: Reconsidering Roles for Consumers, Allied Health Practitioners, and the Support Workforce. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14408. [PMID: 36361299 PMCID: PMC9656004 DOI: 10.3390/ijerph192114408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
A complexity of factors, from health and technology innovations to policy redesign to achieve consumer-directed care, are impacting traditional roles for Australian allied health practitioners (AHPs). This pilot study considers roles for AHPs in relation to assistive technology (AT) interventions. Articulating 'who does what' may serve a number of purposes including de-professionalization of the discourse; better utilization of support networks and workforces; and alignment with contemporary policy. Yet, a suitable framework to assist with collaborative AT implementation between relevant stakeholders was not identified within the existing literature. This research aimed to develop and pilot an AT collaboration tool which enables AHPs, consumers, their support networks and the support workforce, to navigate policy redesign toward ethical consumer-directed implementation of AT interventions. An AT collaboration tool was developed based upon practice-based knowledge, relevant regulatory and practice evidence and identifies relevant stakeholders, AT service steps and roles, and quality indicators to support competent practice. The tool was piloted in four separate and diverse practice analyses of AT interventions (custom prosthetics, home enteral nutrition, communication devices, and vehicle modifications) considering four allied health professions (prosthetics and orthotics, dietetics, speech pathology, occupational therapy). Pilot testing of the tool supports the feasibility of re-framing AT provision using competency-based and risk-informed approaches and enabling more inclusive roles for consumers and the support workforce. Further testing of the tool is indicated, followed by strategic actions for uptake by individuals, professions and policymakers. The AT collaboration tool has potential to enable AHPs to fulfil ethical obligations for consumer-centered practice, and to facilitate consumer choice, both in Australia and internationally.
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Affiliation(s)
- Natasha Layton
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Clayton, Melbourne, VIC 3800, Australia
- Australian Rehabilitation and Assistive Technology Association (ARATA), Frankston, VIC 3199, Australia
| | - Jackie O’Connor
- Australian Rehabilitation and Assistive Technology Association (ARATA), Frankston, VIC 3199, Australia
| | - Amy Fitzpatrick
- Australian Rehabilitation and Assistive Technology Association (ARATA), Frankston, VIC 3199, Australia
| | - Sharon Carey
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia
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14
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Alswang JM, Belshe WB, Killi D, Bandawe W, Silliman ES, Bastian AC, Upchurch BK, Bastian MF, Pinal SM, Klein MB, Ndhlozi B, Silva M, Chipolombwe J, Thompson RM. Mobility impairment and life satisfaction in the Northern Region of Malawi. Afr J Disabil 2022; 11:1013. [PMID: 36262824 PMCID: PMC9575362 DOI: 10.4102/ajod.v11i0.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background There exist many psychosocial sequelae associated with mobility impairment, especially in low-resource settings where access to mobility assistive devices is limited. Objectives This study aims to (1) define the burden and presenting aetiologies of mobility impairment in the rural Northern Region of Malawi and (2) assess the relationship between physical disability, life satisfaction and access to mobility aids. Methods At mobility device donation clinics throughout the Northern Region of Malawi, adults living with mobility impairment were surveyed with a demographic questionnaire and a series of validated surveys to assess their physical activity levels (Global Physical Activity Questionnaire [GPAQ]), degree of mobility impairment (Washington Group Extended Set Questions on Disability) and life satisfaction (patient-reported outcomes measurement information systems satisfaction with participation in social roles and general life satisfaction). Results There were 251 participants who qualified for inclusion, of which 193 completed all surveys. Higher physical activity scores were positively correlated with increased life satisfaction: (1) satisfaction with participation in social roles (0.481, p < 0.0001) and (2) general life satisfaction (0.230, p < 0.001). Respondents who had previously used a formal mobility device reported 235.5% higher physical activity levels ([139.0%, 333.0%], p = 0.006), significantly higher satisfaction with participation in social roles ([0.21, 6.67], p = 0.037) and equivocally higher general life satisfaction ([-1.77, 3.84], p = 0.470). Conclusion Disability and mental health do not exist in isolation from one another. Given the positive correlations between formal mobility device usage and both physical activity and life satisfaction, interventions that increase access to mobility-assistive devices in undertreated populations are imperative. Contribution This study contributes to the understanding of the complex relationship between physical disability, access to mobility aids, and life satisfaction. Results from this study suggest the potential benefit that increasing access to mobility aids may have in improving the quality of life of mobility impaired persons in resource-limited settings, such as the Northern Region of Malawi.
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Affiliation(s)
- Jared M. Alswang
- Harvard Medical School, Harvard University, Boston, MA,United States of America
| | - William B. Belshe
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Dexter Killi
- Department of Physiotherapy, Mzuzu Central Hospital, Mzuzu, Malawi
| | - Weston Bandawe
- Department of Physiotherapy, St. John’s Hospital, Mzuzu, Malawi
| | - Erin S. Silliman
- School of Medicine, Boston University, Boston, MA, United States of America
| | - Aaron C. Bastian
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, NY, United States of America
| | - Brooke K. Upchurch
- Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
| | - Megan F. Bastian
- School of Medicine, Saint Louis University, Saint Louis, MO, United States of America
| | - Sierra M. Pinal
- Department of Orthopedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America,Center for Cerebral Palsy, Orthopaedic Institute for Children, Los Angeles, CA, United States of America
| | - Mark B. Klein
- Dornsife College of Letters, Arts and Science, University of Southern California, Los Angeles, CA, United States of America
| | | | - Mauricio Silva
- Department of Orthopedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America,Orthopaedic Institute for Children, Los Angeles, CA, United States of America
| | - John Chipolombwe
- Department of Internal Medicine, Mzuzu Central Hospital, Mzuzu, Malawi
| | - Rachel M. Thompson
- Department of Orthopedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America,Center for Cerebral Palsy, Orthopaedic Institute for Children, Los Angeles, CA, United States of America
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15
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Serres-Lafontaine AD, Labbé D, Batcho CS, Norris L, Best KL. Social participation of individuals with spinal injury using wheelchairs in rural Tanzania after peer training and entrepreneurial skills training. Afr J Disabil 2022. [DOI: 10.4102/ajod.v11i0.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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16
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Liebenberg A, Geiger M, Visagie S. Parental experiences on the role of wheelchairs in the lives of their children with mobility impairments: a qualitative exploration in Dubai. Disabil Rehabil Assist Technol 2022; 17:310-317. [DOI: 10.1080/17483107.2020.1782488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anjanet Liebenberg
- Department of Global Health, Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
| | - Martha Geiger
- Department of Global Health, Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
| | - Surona Visagie
- Department of Global Health, Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
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17
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Wheelchair service provision education in Canadian occupational therapy programs. PLoS One 2022; 17:e0262165. [PMID: 35176039 PMCID: PMC8853462 DOI: 10.1371/journal.pone.0262165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
Occupational therapists in Canada play a central role in wheelchair service provision. Inadequate entry-to-practice professional education has been identified as a major concern in the delivery of wheelchair related services. The goal of this study was to describe the current education provided in Canadian occupational therapy programs and to map this content against the recommended WHO 8-step wheelchair service provision process. The study used a descriptive cross-sectional online survey design. Educators were recruited from accredited occupational therapy programs in Canada. Participants completed a short sociodemographic questionnaire and a survey with 97 closed- and open-ended questions regarding the wheelchair service provision education provided in their curriculum. Survey data was then mapped according to the WHO 8-step wheelchair service provision process. Twenty-nine educators from all Canadian occupational therapy programs (n = 14) were enrolled. Most participants (55.2%) were full-time faculty members that had been teaching in occupational therapy programs for an average time of 10.9 years. All programs covered at least 4 of the WHO recommended steps, but only 5 programs covered all steps. Assessment and Prescription steps were covered in every program while the Referral & Appointment, Funding & Ordering, Fitting and User Training steps were covered in most programs. The pedagogic approach, the amount of time dedicated to wheelchair-related content, and the type of evaluation used varied greatly between programs. This study is the first to provide a detailed description of wheelchair service provision education across all Canadian occupational therapy programs according to the WHO 8 steps and provides a foundation for collaborative efforts to promote best practice in entry-to-practice professional education.
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Abstract
Having predictable, stable and adequate financial resources is essential for achieving universal coverage of essential health products and services, including assistive products. Access to such resources would enable governments and participating organizations to initiate and maintain a system for providing assistive products and associated services, as well as to grow the scope and scale of their operations over time. While limited funding is not the only reason to explain the shortfall in the provision of assistive products globally, unpredictable and inadequate public funding has been cited as the primary cause of poor access to these products in many countries. Several financing options have been presented in this paper that could be considered by decision-makers to initiate or supplement the financing of assistive products.
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Affiliation(s)
- Kiu Tay-Teo
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Diane Bell
- Faculty of Business and Management Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.,Department of Health Systems Governance and Financing, Stellenbosch University, Stellenbosch, South Africa
| | - Matthew Jowett
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
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19
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D’Innocenzo ME, Pearlman JL, Garcia-Mendez Y, Vasquez-Gabela S, Zigler C, Rosen P, Dewi EH, Praptoraharjo I, Mhatre A. Exploratory investigation of the outcomes of wheelchair provision through two service models in Indonesia. PLoS One 2021; 16:e0228428. [PMID: 34061868 PMCID: PMC8168880 DOI: 10.1371/journal.pone.0228428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/27/2021] [Indexed: 11/18/2022] Open
Abstract
The World Health Organization (WHO) estimates that only 17-37% of the approximately 77 million people who need a wheelchair have access to one. Many organizations are trying to address this need through varying service delivery approaches. For instance, some adhere to WHO's recommended 8-steps service approach while others provide wheelchairs with little to no service. There is limited and sometimes conflicting evidence of the impact of the WHO's recommendations on the outcomes of wheelchair provision. To help build this evidence, we \explored outcomes of two groups of users who received their wheelchairs through two service models over time. The 8-Steps group (n = 118) received a wheelchair selected from a range of models from service providers trained using the WHO process, and the standard of care (SOC) group (n = 24) received hospital-style wheelchairs and without clinical service. Interviews were conducted at baseline and at follow-up 3 to 6 months after provision, to collect data about wheelchair usage, satisfaction, skills, maintenance and repairs, and life satisfaction. Across-group statistical comparisons were not appropriate due to significant differences between groups. In general, participants used their wheelchairs every day but reported very low mobility levels (<500 meters for the 8-steps group, and <100 meters for the SOC group.) The 8-steps group used their wheelchair for either between 1-3 hours per day, or more than 8 hours per day. The SOC used it between 1 and 3 hours per day. Overall, wheelchair usage and wheelchair skills decreased over the 3- to 6-month data collection timeline. Wheelchair breakdowns were common in both groups emphasizing the need for maintenance, occurring more frequently in the 8-Steps (28.8%) compared to the SOC group (8%), and emphasizing the need for maintenance services. No significant differences were found when comparing device satisfaction across wheelchairs types. Our results emphasize the need for routine maintenance to address frequent wheelchair breakdowns. Our results also demonstrate a large disparity in several outcome variables across groups which motivates future studies where across-group comparisons are possible.
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Affiliation(s)
- Megan E. D’Innocenzo
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jonathan L. Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Yasmin Garcia-Mendez
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Stephanie Vasquez-Gabela
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Christina Zigler
- Department of Population Health Science, Duke University, Durham, North Carolina, United States of America
| | - Perth Rosen
- United Cerebral Palsy (UCP) Wheels for Humanity, Chatsworth, California, United States of American
| | - Eviana Hapsari Dewi
- Department of Health Policy and Management, Gadjah Mada University, Yogyakarta, Indonesia
| | - Ignatius Praptoraharjo
- Department of Health Policy and Management, Gadjah Mada University, Yogyakarta, Indonesia
| | - Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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20
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Taylor J, Forgeron P, Vandyk A, Finley A, Lightfoot S. Pediatric Health Outcome Evaluation in Low-and Middle-Income Countries: A Scoping Review of NGO Practice. Glob Pediatr Health 2021; 8:2333794X21991011. [PMID: 33614849 PMCID: PMC7868502 DOI: 10.1177/2333794x21991011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objective. The purpose of this study was to explore the research on the delivery and evaluation of pediatric health services by non-governmental organizations in low-and middle-income countries to better understand how they contribute to positive and sustainable health outcomes. Methods. A scoping review was completed using a 2-step study selection procedure. Results. Of the 5742 studies, 17 met criteria, including quantitative and mixed method designs, representing 10 different non-governmental organizations with programs in 33 low-and middle-income countries. Health outcomes were reported 89 times across the studies. A total of 56 different outcomes were identified in total, of which 24 were positive, 27 were negative, and 5 were unchanged. Conclusions. Widespread variation between non-governmental organizations exist, however, comprehensive pediatric health outcome evaluation is growing. Further emphasis should be given to adolescent specific research and robust measurement of quality of life.
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Affiliation(s)
| | | | | | - Allen Finley
- Dalhousie University & IWK Health Centre, Halifax, NS, Canada
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21
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Smith EM, Ebuenyi ID, Kafumba J, Jamali-Phiri M, MacLachlan M, Munthali A. An overview of assistive technology products and services provided in Malawi. Disabil Rehabil Assist Technol 2020; 18:387-391. [PMID: 33301351 DOI: 10.1080/17483107.2020.1854356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Assistive technology is the products and services used by individuals with functional limitations to enable participation in society and realisation of rights afforded by the United Nations Convention on the Rights of Persons with Disabilities. The Assistive Product List is a comprehensive list of products identified as essential for access through universal health coverage. Key stakeholders, including organisations of persons with disabilities, civil service organisations, academic organisations and government ministries are collaborating to integrate assistive technology into policy and develop a priority assistive products list for Malawi. OBJECTIVE To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi. STUDY DESIGN Online survey of representatives from key stakeholder organisations. METHODS We surveyed representatives of key stakeholder organisations to gather information regarding assistive technology product and service provision in Malawi. Responses were analysed using counts for closed-ended questions, and conventional content analysis for open-ended questions. RESULTS A total of 36 of the 50 APL products were provided by eight organisations. Related services were provided for 36 of the 50 APL products by twelve organisations. Five organisations reported providing both products and services. Products and services are largely funded by donation and provided free to those who require them. CONCLUSION A range of organisations in Malawi play a role in assistive product delivery and related services. Coordinated AP delivery and service provision is required at a national level which is sustainable and inclusive, and is based on identified needs of the Malawian population.Implications for rehabilitationPolicies supporting assistive product and service provision must acknowledge the contextual needs of the communities where they are implemented.Coordination is required for assistive product and service provision at the national and subnational level.Existing and potential gaps in service provision must be addressed when implementing a national assistive products list.
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Affiliation(s)
- Emma M Smith
- Assisting Living and Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Ikenna D Ebuenyi
- Assisting Living and Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | | | - Malcolm MacLachlan
- Assisting Living and Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland.,Olomouc University Social Health Institute (OUSHI), Palacki University, Olomouc, Czech Republic
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22
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Kamalakannan S, Rushton PW, Giesbrecht E, Rusaw DF, Bouziane SA, Nadeau M, McKee J, Gowran RJ, Kirby RL, Pedersen JP, Tasiemski T, Burrola-Mendez Y, Tofanin M, Goldberg M, Pearlman J. Wheelchair service provision education for healthcare professional students, healthcare personnel and educators across low- to high-resourced settings: a scoping review protocol. Disabil Rehabil Assist Technol 2020; 18:343-349. [PMID: 33301358 DOI: 10.1080/17483107.2020.1852325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Appropriate wheelchair provision is necessary for addressing participation barriers experienced by individuals with mobility impairments. Health care professionals involved in the wheelchair service provision process require a specific set of skills and knowledge to enable wheelchair use that meets individual posture, mobility and daily living requirements. However, inconsistencies exist in academic programmes globally about providing comprehensive education and training programmes. The planned scoping review aims to review and synthesize the global literature on wheelchair service provision education for healthcare professional students, healthcare personnel and educators offered by universities, organizations and industries. METHODS This scoping review will be guided by the Joanna Briggs Institute (JBI) methodological framework. Comprehensive literature searches will be conducted on various global electronic databases on health to seek out how wheelchair service provision education is organized, integrated, implemented and evaluated. Two independent reviewers will perform eligibility decisions and key data extractions. Data from selected studies will be extracted and analysed using conventional content analysis. Information related to wheelchair service provision education including curriculum development, content, teaching methods, evaluation and models of integration will be synthesized. IMPLICATIONS AND DISSEMINATION The planned scoping review will be the first to examine all aspects of wheelchair service provision education across professionals, settings and countries. We anticipate that results will inform the content of a Wheelchair Educators' Package, and if appropriate, a follow-up systematic review. An article reporting the results of the scoping review will be submitted for publication to a scientific journal.Implications for RehabilitationA comprehensive examination of wheelchair service provision education could help develop strategies to address the unmet need for wheelchair services globally.Findings for this review will facilitate the planning and development of an evidence-based education package that could bridge the existing knowledge gaps related to safe and effective wheelchair service provision among health professionals involved.This review will also inform the potential barriers and enablers for effective integration and implementation of wheelchair service provision education worldwide.
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Affiliation(s)
- Sureshkumar Kamalakannan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Public Health Foundation of India, Indian Institute of Public Health, Hyderabad, India
| | - Paula W Rushton
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Ed Giesbrecht
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Canada
| | - David F Rusaw
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | | | - Melodie Nadeau
- Department of Biology, University of Concordia, Montréal, Canada
| | - Jennifer McKee
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Rosemary J Gowran
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Health Implementation Science and Technology, University of Limerick, Limerick, Ireland
| | - R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada
| | - Jessica P Pedersen
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tomasz Tasiemski
- Department of Adapted Physical Activity, Poznań University of Physical Education, Poznań, Poland
| | - Yohali Burrola-Mendez
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Consejo Nacional de Ciencia y Tecnología (CONACyT), Ciudad de México, México
| | - Marco Tofanin
- Department of Neurosciences and Neurorehabilitation, Neurorehabilitation Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mary Goldberg
- International Society of Wheelchair Professionals, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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23
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Geilen BG, de Witte L, Norman G, George CE. Quality of wheelchair services as perceived by users in rural Bangalore district, India: a cross-sectional survey. Disabil Rehabil Assist Technol 2020; 17:965-973. [PMID: 33244999 DOI: 10.1080/17483107.2020.1839576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM This study investigated the current state of wheelchair services in Bangalore Rural district, as provided by Bangalore Baptist Hospital, and identified areas for improvement. METHOD a cross-sectional survey was held among 50 wheelchair users. Data was collected on demographics, satisfaction, wheelchair skills and level of disability using QUEST, WST-Q and CHART-SF questionnaires. RESULT Overall satisfaction can be described as more or less satisfied, scoring 3.8 out of 5. Wheelchair users were less satisfied with the services compared to the wheelchair itself. The skills a wheelchair users had were strongly correlated with satisfaction scores (p < 0.01). Differences in satisfaction between genders were observed and related to multiple factors. CONCLUSION Wheelchairs should be easy to use with support services being easily accessible. A wheelchair should be delivered together with a training program to provide the user with the skills to operate and maintain the wheelchair. There are gender-wise differences in satisfaction towards wheelchair services that influence satisfaction.Implications for rehabilitationTraining of wheelchair skills should be part of the delivery process as this positively impacts satisfaction of wheelchair users and increases their independent mobility.Requirements towards a wheelchair and its support service are gender specific. Recognizing and acting upon the differing needs between male and female wheelchair users should be an integral part of a wheelchair provision service.Wheelchair users should take part in the development and implementation of novel technologies, policies and service delivery schemes as their need is not always answered. This could lead to a reduced uptake, or even failure, of innovations in (wheelchair) services.The financial situation of a wheelchair user is a factor that influences satisfaction. Therefore, empowering and/or enabling wheelchair users to take part in activities that earns them an income should be part of a wheelchair service.
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Affiliation(s)
- Bart G Geilen
- Department of Health, Ethics and Society, Maastricht University, Maastricht, Netherlands
| | - Luc de Witte
- School of Health and Related Research, Sheffield University, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Gift Norman
- Department of Community Health and Palliative Care, Bangalore Baptist Hospital, Bangalore, India
| | - Carolin Elizabeth George
- Department of Community Health and Palliative Care, Bangalore Baptist Hospital, Bangalore, India
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24
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Toro-Hernández ML, Augustine N, Kankipati P, Karg P, Rispin K, Schein RM, Kandavel K, D’Innocenzo ME, Goldberg M, Pearlman J. Preliminary steps of the development of a Minimum Uniform Dataset applicable to the international wheelchair sector. PLoS One 2020; 15:e0238851. [PMID: 32915874 PMCID: PMC7485892 DOI: 10.1371/journal.pone.0238851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/25/2020] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Nancy Augustine
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Padmaja Kankipati
- Specialized Mobility Operations and Innovation Pvt. Ltd, Bangalore, India
- Member of the International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
| | - Patricia Karg
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Karen Rispin
- Member of the International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- School of Arts and Science, Letourneau University, Longview, Texas, United States of America
| | - Richard M. Schein
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Member of the International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
| | - Krithika Kandavel
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Megan E. D’Innocenzo
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mary Goldberg
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jonathan Pearlman
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Ardianuari S, Goldberg M, Pearlman J, Schmeler M. Development, validation and feasibility study of a remote basic skills assessment for wheelchair service providers. Disabil Rehabil Assist Technol 2020; 17:462-472. [PMID: 32862734 DOI: 10.1080/17483107.2020.1799250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The purpose of this study was to develop, validate and conduct a feasibility study of three remote basic skills assessment modalities for wheelchair service providers (WSP) including an online case study quiz (m1), an in-person skills assessment (m2) and a video conference skills assessment (m3). METHODS We conducted a literature review; developed and validated 3 basic skills assessments; and conducted a feasibility study of each modality. RESULTS The literature review revealed that a validated remote basic skills assessment for WSP that reflects all World Health Organization (WHO) 8 wheelchair service provision steps did not exist. We recruited a total of 12 participants for the feasibility study. Two participants dropped out of the study prior to completing a second testing modality. Related to test performance, the results show that our first hypothesis was rejected because only m1 mean score was comparable to the International Society of Wheelchair Professionals (ISWP) Basic Knowledge Test (SD = 0.44). This is in contrast with the Wilcoxon signed-rank test results that show a statistically significant difference between these two modalities. We are therefore not confident that the knowledge test was an appropriate comparison to m1 skills assessment. Hypothesis two was not rejected. The feasibility results reveal 86% success. CONCLUSION M1, 2 and 3 have the potential to serve as remote basic skills assessments. However, according to both test performance and feasibility criteria, we believe that m2 has the highest potential to be included in certification processes for basic wheelchair service providers, like the one offered by ISWP.IMPLICATIONS FOR REHABILITATIONA universal remote basic skills assessment that can be accessed across the globe, especially in remote locations where a skilled and experienced provider is not available, is needed.Such test can be an asset to training or professional organisations like ISWP as a way to test WSP competency or to warrant certification.WSP clinical knowledge and skills are essential for the prescription of an appropriate wheelchair to avoid physical harm, abandonment of the device and unnecessary expenses.Properly prescribed wheelchairs allow people with impaired mobility to gain increased ability to perform ADLs, participate in communities, and reduce secondary medical complications such as upper limb repetitive strain injuries, pain, and/or pressure sores.
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Affiliation(s)
- Satria Ardianuari
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Goldberg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Schmeler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Bane HM, Sheafer V, Rispin K. Preliminary test-retest reliability of the Wheelchair Satisfaction Questionnaire. Disabil Rehabil Assist Technol 2020; 17:555-558. [PMID: 32762568 DOI: 10.1080/17483107.2020.1800115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Economic realities in lower-and-middle-income countries (LMICs) present an increased need for outcome measures for wheelchair efficacy, as these measures enable optimized use of funds. As the provision level of wheelchairs is low in these areas, and many wheelchairs are inappropriate for their intended users, use of funds based on evidence is especially necessary. The Wheelchair Satisfaction Questionnaire (WSQ) was designed to be a snapshot of a wheelchair user's level of satisfaction with their wheelchair. The WSQ is comprised of 16 visual analogue scale questions. Each question includes an option for a qualitative explanatory comment. The current study examined initial test-retest reliability of the WSQ. MATERIALS AND METHODS The WSQ was administered twice to the same set of wheelchair users who were secondary students at a school for students with disabilities. A demonstration was given to the participants to explain how to mark the analogue scale. Participants were instructed to answer each item honestly and without peer input. A one-week time span separated test and retest. Scores for both sessions were entered into SPSS. An interclass coefficient of 0.70 or above indicates acceptable test-retest reliability. RESULTS The ages of participants ranged from 13 to 24, with a mean age of 17.86 years. Sixty-five participants completed the questionnaire fully in both test and retest and were included in this study. A high degree of reliability was found between scores from both tests. The interclass coefficient was r(63) = .863, p = .01, indicating statistically significant agreement between test and retest. CONCLUSION The results support the WSQ as a reliable measure, confirming the WSQ as a reliable tool for user feedback on wheelchair function. Because the WSQ is designed to provide user feedback with enough granularity to give data on particular aspects of wheelchair structure and function, data can facilitate repair and modifications to wheelchair parts. Studies using the WSQ to assess specific wheelchair types could indicate consistent patterns of user satisfaction and dissatisfaction, revealing relevant design issues. The WSQ is designed to give wheelchair users a voice that can empower user centred modification and design changes to facilitate improved health, opportunity, and social interaction.Implications for RehabilitationResults from the WSQ could enable manufacturers to utilize user feedback to improve the design of wheelchairs for use in LMIC's, and providers could be better-informed in the selection of wheelchair types for specific environments.The WSQ could provide immediate user feedback to inform wheelchair modification and selection to best serve a particular user.The WSQ could be used in clinical settings over time to collect longitudinal data from wheelchair users, which could identify the most commonly perceived reasons for user dissatisfaction in a particular clinical setting.
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Affiliation(s)
- Heather M Bane
- School of Psychology and Counseling, LeTourneau University, Longview, TX, USA
| | - Vicki Sheafer
- School of Psychology and Counseling, LeTourneau University, Longview, TX, USA
| | - Karen Rispin
- Department of Biology, LeTourneau University, Longview, TX, USA.,Assistive Technology Catalyst Project, LeTourneau University, Longview, TX, USA
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Ekman B, Mishra S, Pupulin A, Khasnabis C, Allen M, Huber M. Sustainable and equitable provision of wheelchairs in low- and middle-income countries: an economic assessment of the models for wheelchair provision in Tajikistan. Disabil Rehabil Assist Technol 2020; 16:865-870. [PMID: 32228245 DOI: 10.1080/17483107.2020.1745909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Reaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries. Tajikistan has recently adopted several policies and national strategies to strengthen the rights of people with disabilities and improve the provision of assistive products. However, Tajikistan faces a number of challenges, including ensuring sustainable funding for the provision of wheelchairs in the medium and long term. METHODS This study presents the results of a recent analysis of the economic aspects of the provision of wheelchairs in Tajikistan to inform policy making in other low- and middle-income countries. The study draws on several sources of information, including local cost data, consultations with national and international experts and stakeholders, and reviews of the existing evidence. RESULTS Countries are advised to adopt an incremental approach to wheelchair provision. In the short term, countries may wish to import wheelchairs to move towards universal coverage. In the medium-to-long term, countries may wish to invest in national capacities for local production. CONCLUSION Countries will need to continue implementing strategies to ensure universal access to wheelchairs without the risk of financial hardship for users, regardless of the approach to provision that has been chosen.Implication for RehabilitationReaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries.Countries are advised to adopt an incremental approach to wheelchair provision.The model of wheelchair importation may be a realistic model over the short- to medium-term for many LMICs countries to ensure effective and equitable provision of wheelchairs.In this article, we identify that sufficient funding needs to be allocated to the provision of wheelchairs regardless of the model of provision.
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Affiliation(s)
- Björn Ekman
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Mhatre A, Reese N, Pearlman J. Design and evaluation of a laboratory-based wheelchair castor testing protocol using community data. PLoS One 2020; 15:e0226621. [PMID: 31923276 PMCID: PMC6953824 DOI: 10.1371/journal.pone.0226621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/29/2019] [Indexed: 11/19/2022] Open
Abstract
Wheelchair castors fail frequently causing physical, social and economic consequences for wheelchair users. These failures occur in spite of established wheelchair test methods and regulations, suggesting that the existing tests may not be sufficient to screen poorly designed castors. An expert stakeholder group, convened by the International Society of Wheelchair Professionals (ISWP), noted castor failures as a high priority and recommended that a new castor testing system should be developed. In a previous study, the effect of shock exposure on castor durability was studied. The current paper extends the previous work and focuses on the development of a castor testing protocol based on shock, corrosion and abrasion exposure data collected in the community. The testing protocol was applied to 8 different castor models tested under four conditions: shock, corrosion + shock, abrasion + shock and abrasion + corrosion + shock. For each model, a total of n = 8 samples were evaluated across the four conditions. Results demonstrate that corrosion and abrasion reduced castor durability between 13% to 100% depending on the model. Importantly, the inclusion of corrosion and abrasion resulted in changes in the failure modes for 75% of the tested models and two-thirds of the altered failure modes are associated with increased risk of injury for wheelchair users. These results suggest that corrosion and abrasion present in the community reduce castor durability, thus supporting their inclusion in the castor testing protocol and potentially other wheelchair standards.
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Affiliation(s)
- Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
| | - Norman Reese
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
- Engineering & Engineering Technology, LeTourneau University, Longview, Texas, United States of America
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals, Pittsburgh, Pennsylvania, United States of America
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Bayley MT, Kirby RL, Farahani F, Titus L, Smith C, Routhier F, Gagnon DH, Stapleford P, Alavinia SM, Craven BC. Development of Wheeled Mobility indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2019; 42:130-140. [PMID: 31573457 PMCID: PMC6783799 DOI: 10.1080/10790268.2019.1647934] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Wheeled mobility is critical for individuals with Spinal Cord Injury or Disease (SCI/D) related paralysis. The World Health Organization (WHO) developed guidelines highlighting eight steps in wheelchair service delivery: (1) referral and appointment; (2) assessment; (3) prescription; (4) funding and ordering; (5) product preparation; (6) fitting; (7) user training; and, (8) follow-up maintenance/repairs. This article describes the processes used to develop structure, process and outcome indicators that reflect the WHO guidelines within the Domain of Wheeled Mobility rehabilitation for Canadians. Methods: Wheeled mobility experts within the SCI-High Project Team used the WHO guideline to inform the Construct refinement and development of a Driver diagram. Following seven meetings, the Driver diagram and review of outcome measures and literature synthesis regarding wheelchair service delivery informed indicator selection and group consensus. Results: The structure indicator examines the proportion of SCI/D service providers within a rehabilitation program who have specialized wheelchair training to ensure prescription, preparation, fitting, and maintenance quality. The process indicator evaluates the average number of hours of wheelchair service delivery provided per patient during rehabilitation. The intermediary outcome indicator (rehabilitation discharge), is a target capacity score on the Wheelchair Skills Test Questionnaire (WST-Q). The final outcome indicators (at 18 months post rehabilitation admission) are the Life Space Assessment (LSA) and the Wheelchair Use Confidence Scale (WheelCon) short form mean scores. Conclusion: Routine implementation of the selected Wheeled Mobility structure, process and outcome indicators should measurably advance care within the Wheeled Mobility Domain for Canadians living with SCI/D by 2020.
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Affiliation(s)
- Mark T. Bayley
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R. Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Farnoosh Farahani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Laura Titus
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Cher Smith
- Department of Occupational Therapy, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - François Routhier
- Department of Rehabilitation, Laval University, Québec City, Québec, Canada
| | - Dany H. Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Québec, Canada
| | - Patricia Stapleford
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, Neural Engineering & Therapeutic Team, KITE, Toronto Rehabilitation Institute- University Health Network, 520 Sutherland Drive, Toronto, ON, Canada, M4G 3V9; Ph: (416) 597-3422.
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Toro-Hernández ML, Kankipati P, Goldberg M, Contepomi S, Tsukimoto DR, Bray N. Appropriate Assistive Technology for Developing Countries. Phys Med Rehabil Clin N Am 2019; 30:847-865. [PMID: 31563175 DOI: 10.1016/j.pmr.2019.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Access to appropriate and affordable assistive technology is a human right, and a public health and development priority. This article elaborates on these aspects and illustrates the various opportunities and barriers to achieving equitable access to assistive technology through 4 specific country snapshots. In Brazil, mobility aids are provided through universal health coverage in rehabilitation reference centers in urban areas. A community-based rehabilitation pilot project in Argentina demonstrates how to reach an excluded indigenous community. A rapidly developing national legal framework in Colombia with imminent implementation challenges is showcased, as is a technology transfer model in India.
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Affiliation(s)
| | - Padmaja Kankipati
- Specialized Mobility Operations & Innovation, 804, Brigade Rubix, No. 20, HMT Main Road, Yeshwanthpura, Bangalore 560022, India
| | - Mary Goldberg
- International Society of Wheelchair Professionals, Department of Rehabilitation Science and Technology, Human Engineering Research Laboratories, University of Pittsburgh, 6425 Penn Avenue Suite 400, Pittsburgh, PA 15206, USA
| | - Silvana Contepomi
- Asociación Argentina de Tecnología Asistiva (AATA), Francia 3166, San Isidro 1642, Argentina
| | - Denise Rodrigues Tsukimoto
- Physical Medicine and Rehabilitation Institute (IMREA), Hospital das Clinicas, University of Sao Paulo, IMREA Rua Diderot, 43, Sao Paulo, Sao Paulo CEP: 04116030, Brazil
| | - Nathan Bray
- School of Health Sciences, Bangor University, Bangor, Gwynedd LL57 2EF, UK
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Kirby RL, Doucette SP. Relationships Between Wheelchair Services Received and Wheelchair User Outcomes in Less-Resourced Settings: A Cross-Sectional Survey in Kenya and the Philippines. Arch Phys Med Rehabil 2019; 100:1648-1654.e9. [DOI: 10.1016/j.apmr.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
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Seymour N, Geiger M, Scheffler E. Community-based rehabilitation workers' perspectives of wheelchair provision in Uganda: A qualitative study. Afr J Disabil 2019; 8:432. [PMID: 31061818 PMCID: PMC6494910 DOI: 10.4102/ajod.v8i0.432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 10/03/2018] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Nikola Seymour
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - Martha Geiger
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - Elsje Scheffler
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
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Chesani FH, Mezadri T, Lacerda LLVD, Mandy A, Nalin F. A percepção de qualidade de vida de pessoas com deficiência motora: diferenças entre cadeirantes e deambuladores. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17018525042018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A rotina das pessoas com deficiência física inclui o uso de diferentes recursos de tecnologia assistiva, que podem auxiliar em seu desenvolvimento físico e intelectual, afetando diretamente sua qualidade de vida. O objetivo deste estudo foi avaliar a percepção da qualidade de vida de pessoas cadeirantes e deambuladoras com deficiência física no município de Itajaí, Santa Catarina. Trata-se de uma pesquisa descritiva de corte transversal e caráter exploratório quantitativo, cuja. amostra foi constituída por 163 participantes (91 cadeirantes e 72 deambuladores), que responderam a um questionário estruturado com informações socioeconômicas e de saúde e ao instrumento do World Health Organization Quality of Life Instruments (WHOQOL-bref), para mensurar a qualidade de vida. Na avaliação dos domínios físico e psicológico não foram observadas diferenças significativas entre os dois grupos, portanto a percepção da qualidade de vida não foi afetada pela utilização da cadeira de rodas. No entanto, examinando-se o domínio de relações sociais e meio ambiente, a percepção da qualidade de vida foi significativamente menor para cadeirantes com paresias, em relação às plegias e à amputação.
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Affiliation(s)
| | | | | | - Anne Mandy
- Universidade de Brighton, United Kingdom
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Burrola-Mendez Y, Toro-Hernández ML, Goldberg M, Pearlman J. Implementation of the hybrid course on basic wheelchair service provision for Colombian wheelchair service providers. PLoS One 2018; 13:e0204769. [PMID: 30286127 PMCID: PMC6172015 DOI: 10.1371/journal.pone.0204769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/13/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction People with mobility impairments often rely on wheelchairs as their primary means of mobility. Untrained wheelchair service providers may provide inappropriate wheelchairs and services which result in negative consequences in wheelchair users’ health, quality of life, safety, and social participation. This study aimed to evaluate the influence of the Spanish Hybrid Course on Basic Wheelchair Service Provision, a training based on the World Health Organization’s Wheelchair Service Training Program-Basic Level, to increase knowledge in basic level wheelchair service provision among a group of wheelchair service providers from Colombia. In addition, we developed a satisfaction survey which participants completed after the training to understand levels of satisfaction with the training intervention. Methods A quasi-experimental study was conducted to evaluate changes in basic level wheelchair knowledge using the Wheelchair Service Provision–Basic Test. Paired sample t tests were used to assess pre-and post-training changes in basic level wheelchair knowledge. The Hybrid Satisfaction Survey was developed in collaboration with a multidisciplinary, international stakeholders’ group. The survey’s construct of interest was level of satisfaction determined by interaction, instructor, instruction methodology, content, and technology, using a five-point Likert scale (0 = strongly disagree to 4 = strongly agree). The survey was completed anonymously after the training intervention and analyzed using frequencies and percentages. Results Fifteen wheelchair service providers in Colombia completed the Spanish Hybrid Course. Mean post-scores were significantly higher (Mean (M) = 56.13, Standard Deviation (SD) = 7.8), than pre-assessment scores (M = 50.07, SD = 8.38, t(14) = 4.923, p = <0.0001). Participants who completed the surveys (N = 15) reported that the Spanish Hybrid Course was well received, with 98.66% of responses distributed in favorable levels (>3). Conclusions The Spanish Hybrid Course proved to be effective in increasing basic level wheelchair knowledge with a high satisfaction level among participants. Further testing is needed to evaluate the effectiveness of this course across different individuals and countries as a potential tool to build professional capacity in basic level wheelchair provision.
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Affiliation(s)
- Yohali Burrola-Mendez
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,Consejo Nacional de Ciencia y Tecnología, México City, México
| | | | - Mary Goldberg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Burrola-Mendez Y, Goldberg M, Gartz R, Pearlman J. Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts. PLoS One 2018; 13:e0199251. [PMID: 29906794 PMCID: PMC6003808 DOI: 10.1371/journal.pone.0199251] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/04/2018] [Indexed: 01/30/2023] Open
Abstract
Introduction Wheelchair users worldwide are at high risk of developing secondary health conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Society of Wheelchair Professionals (ISWP) has developed a Hybrid Course based on the World Health Organization’s Wheelchair Service Training Package—Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet access that reduces the in-person training exposure from five to three and a half days, making it less expensive and more convenient for both trainees and trainers. Methods The Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters Higher Educational Rubric, web design guidelines for low bandwidth, experts’ opinions, and the best practices for blended course design. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken by six graduate students in Rehabilitation Sciences at the University of Pittsburgh by measuring pre- and post knowledge using the validated ISWP Wheelchair Service Provision—Basic Test. The outcome measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others’ evaluation and the results of the training intervention. Results Hybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision—Basic Test after participating in the training, with an average increase of 10.84±5.42, p = 0.004, Cohen’s d = 1.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of three evaluations and reported a percentage of agreement between evaluators of 84%. Conclusions The Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Science graduate students.
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Affiliation(s)
- Yohali Burrola-Mendez
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mary Goldberg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Rachel Gartz
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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MacLachlan M, Banes D, Bell D, Borg J, Donnelly B, Fembek M, Ghosh R, Gowran RJ, Hannay E, Hiscock D, Hoogerwerf EJ, Howe T, Kohler F, Layton N, Long S, Mannan H, Mji G, Odera Ongolo T, Perry K, Pettersson C, Power J, Delgado Ramos V, Slepičková L, Smith EM, Tay-Teo K, Geiser P, Hooks H. Assistive technology policy: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit. Disabil Rehabil Assist Technol 2018; 13:454-466. [PMID: 29790393 DOI: 10.1080/17483107.2018.1468496] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Increased awareness, interest and use of assistive technology (AT) presents substantial opportunities for many citizens to become, or continue being, meaningful participants in society. However, there is a significant shortfall between the need for and provision of AT, and this is patterned by a range of social, demographic and structural factors. To seize the opportunity that assistive technology offers, regional, national and sub-national assistive technology policies are urgently required. This paper was developed for and through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit; organized under the auspices of the World Health Organization's Global Collaboration on Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address and recognizes that AT policy should be tailored to the realities of the contexts and resources available. AT policy should be developed as a part of the evolution of related policy across a number of different sectors and should have clear and direct links to AT as mediators and moderators for achieving the Sustainable Development Goals. The consultation process, development and implementation of policy should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access to AT and are addressed systematically within this paper. We illustrate an example of good practice through a case study of AT services in Norway, and we note the challenges experienced in less well-resourced settings. A number of economic factors relating to AT and economic arguments for promoting AT use are also discussed. To address policy-development the importance of active citizenship and advocacy, the need to find mechanisms to scale up good community practices to a higher level, and the importance of political engagement for the policy process, are highlighted. Policy should be evidence-informed and allowed for evidence-making; however, it is important to account for other factors within the given context in order for policy to be practical, authentic and actionable. Implications for Rehabilitation The development of policy in the area of asssitive technology is important to provide an overarching vision and outline resourcing priorities. This paper identifies some of the key themes that should be addressed when developing or revising assistive technology policy. Each country should establish a National Assistive Technology policy and develop a theory of change for its implementation.
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Affiliation(s)
- Malcolm MacLachlan
- a Assisting Living & Learning (ALL) Institute, Maynooth University , Maynooth , Ireland.,b Centre for Rehabilitation Studies , Stellenbosch University , Tygerburg , South Africa.,c Olomouc University Social Health Institute, Palacky University Olomouc , Olomouc , Czech Republic
| | | | - Diane Bell
- e Centre for Rehabilitation Studies, Stellenbosch University , Cape Town , South Africa
| | | | | | | | | | - Rosemary Joan Gowran
- j Department of Clinical Therapies, Faculty of Education and Health Sciences , University of Limerick , Limerick , Ireland
| | | | | | | | - Tracey Howe
- n Glasgow Caledonian University , Glasgow , UK
| | - Friedbert Kohler
- o Hammond Care Braeside Hospital, University of New South Wales , Sydney , Australia
| | - Natasha Layton
- p Department of Health Professions, Swinburne University of Technology , Hawthorn , Australia
| | - Siobhán Long
- q Assistive Technology and SeatTech Services , Enable Ireland , Dublin , Ireland
| | - Hasheem Mannan
- r Health Systems Research Group , University College Dublin , Dublin , Ireland
| | - Gubela Mji
- b Centre for Rehabilitation Studies , Stellenbosch University , Tygerburg , South Africa
| | | | - Katherine Perry
- t Independent Consultant & Policy Advocate , Brussels , Belgium
| | - Cecilia Pettersson
- u Department of Architecture and Civil Engineering , Chalmers University of Technology , Goteborg , Sweden
| | - Jessica Power
- v Centre for Global Health , Trinity College Dublin , Dublin , Ireland
| | | | - Lenka Slepičková
- x Olomouc University Social Health Institute, Palacky University Olomouc , Olomouc , Czech Republic
| | - Emma M Smith
- y Graduate School, University of British Columbia , Vancouver , British Columbia , Canada
| | - Kiu Tay-Teo
- z Melbourne School of Population and Global Health , Melbourne University , Melbourne , Australia
| | | | - Hilary Hooks
- a Assisting Living & Learning (ALL) Institute, Maynooth University , Maynooth , Ireland
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Smith EM, Gowran RJ, Mannan H, Donnelly B, Alvarez L, Bell D, Contepomi S, Ennion Wegner L, Hoogerwerf EJ, Howe T, Jan YK, Kagwiza J, Layton N, Ledgerd R, MacLachlan M, Oggero G, Pettersson C, Pousada T, Scheffler E, Wu S. Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology. Disabil Rehabil Assist Technol 2018; 13:445-453. [PMID: 29772939 DOI: 10.1080/17483107.2018.1470683] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND METHODS This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit. FINDINGS Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel. CONCLUSIONS There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements. Implications for Rehabilitation Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community. Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery. A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally.
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Affiliation(s)
- Emma M Smith
- a Rehabilitation Sciences, GF Strong Rehabilitation Research Program, University of British Columbia , Vancouver , Canada
| | - Rosemary Joan Gowran
- b School of Allied Health, University of Limerick , Limerick , Ireland.,c University of Sunshine Coast , Sunshine Coast , Australia
| | - Hasheem Mannan
- d School of Nursing, Midwifery & Health Systems Health Sciences Centre, University College Dublin , Dublin , Ireland
| | | | - Liliana Alvarez
- f School of Occupational Therapy, Western University , London , Canada
| | - Diane Bell
- g World Health Organization , Geneva , Switzerland
| | - Silvana Contepomi
- h Argentine Assistive Technology Association , Buenos Aires , Argentina
| | - Liezel Ennion Wegner
- i Department of Physiotherapy, University of Western Cape , Cape Town , South Africa
| | | | | | - Yih-Kuen Jan
- l The Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign , Champaign , IL , USA
| | - Jeanne Kagwiza
- m College of Medicine and Health Sciences, University of Rwanda , Kigali , Rwanda
| | - Natasha Layton
- n Department of Health Professions, Swinburne University , Hawthorn , Australia
| | | | - Malcolm MacLachlan
- p Assisting Living & Learning (ALL) Institute, Maynooth University , Maynooth , Ireland
| | | | - Cecilia Pettersson
- q Department of Architecture and Civil Engineering, Chalmers University of Technology , Goteborg , Sweden
| | - Thais Pousada
- r Faculty of Health Sciences, of A Coruña , A Coruña , Spain
| | - Elsje Scheffler
- s Centre for Rehabilitation Studies, Stellenbosch University , Stellenbosch , South Africa
| | - Sam Wu
- t Geisinger Health System , Danville , CA , USA
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Keeler L, Kirby RL, Parker K, McLean KD, Hayden JA. Effectiveness of the Wheelchair Skills Training Program: a systematic review and meta-analysis .. Disabil Rehabil Assist Technol 2018; 14:391-409. [PMID: 29616832 DOI: 10.1080/17483107.2018.1456566] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To conduct a systematic review synthesizing the evidence for the effectiveness of the Wheelchair Skills Training Program (WSTP). DATA SOURCES We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to 10 October 2017. STUDY SELECTION Randomized controlled trials (RCTs) assessing the effectiveness of the WSTP. DATA EXTRACTION Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane's Risk of Bias Tool. DATA SYNTHESIS Meta-analyses (including sub-group analyses) were conducted for the Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen articles (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; p < .0001) compared to no treatment, standard care or educational controls, a relative increase over baseline of 21.2%. Subgroup analyses showed that training was more effective for new wheelchair users. Retention of training effects was suggested by the absence of significant declines between tests post-training and at follow-up. The WSTP was found to have positive effects on some other outcomes. No serious adverse events were reported. CONCLUSIONS There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes. Implications for rehabilitation A systematic review and meta-analysis of 13 randomized controlled trials on a total of 581 participants, using the Wheelchair Skills Training Program (WSTP) as the intervention, found that the WSTP increased Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores by 21.2% relative to baseline. Subgroup analyses showed that training was more effective for new wheelchair users. The WSTP was found to have positive effects on some other outcomes and no serious adverse events were reported. The WSTP warrants cautious implementation in clinical and educational settings.
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Affiliation(s)
- Laura Keeler
- a Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada
| | - R Lee Kirby
- a Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada.,b Division of Physical Medicine and Rehabilitation, Department of Medicine , Dalhousie University , Halifax , NS , Canada
| | - Kim Parker
- c Assistive Technology Program, Nova Scotia Health Authority , Halifax , NS , Canada
| | - Katie D McLean
- d Library Services , Nova Scotia Health Authority , Halifax , NS , Canada
| | - Jill A Hayden
- a Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada
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Bazant ES, Himelfarb Hurwitz EJ, Onguti BN, Williams EK, Noon JH, Xavier CA, Garcia FDS, Gichangi A, Gabbow M, Musakhi P, Lee Kirby R. Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines. Afr J Disabil 2017; 6:318. [PMID: 29134178 PMCID: PMC5675920 DOI: 10.4102/ajod.v6i0.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/03/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The World Health Organisation recommends that services accompany wheelchair distribution. This study examined the relationship of wheelchair service provision in Kenya and the Philippines and wheelchair-use-related outcomes. METHOD We surveyed 852 adult basic manual wheelchair users. Participants who had received services and those who had not were sought in equal numbers from wheelchair-distribution entities. Outcomes assessed were daily wheelchair use, falls, unassisted outdoor use and performance of activities of daily living (ADL). Descriptive, bivariate and multivariable regression model results are presented. RESULTS Conditions that led to the need for a basic wheelchair were mainly spinal cord injury, polio/post-polio, and congenital conditions. Most Kenyans reported high daily wheelchair use (60%) and ADL performance (80%), while these practices were less frequent in the Philippine sample (42% and 74%, respectively). Having the wheelchair fit assessed while the user propelled the wheelchair was associated with greater odds of high ADL performance in Kenya (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1) and the Philippines (OR 2.8, 95% CI 1.8, 4.5). Wheelchair-related training was associated with high ADL performance in Kenya (OR 3.2, 95% CI 1.3, 8.4). In the Philippines, training was associated with greater odds of high versus no daily wheelchair use but also odds of serious versus no falls (OR 2.5, 95% CI 1.4, 4.5). CONCLUSION Select services that were associated with some better wheelchair use outcomes and should be emphasised in service delivery. Service providers should be aware that increased mobility may lead to serious falls.
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Affiliation(s)
| | | | | | | | | | | | - Ferdiliza D S Garcia
- College of Allied Medical Professions, University of the Philippines, Manila, Philippines
| | | | - Mohammed Gabbow
- National Council for Persons With Disabilities, Government of Kenya, Kenya
| | - Peter Musakhi
- Ministry of East African Community (EAC), Labour and Social Protection, Government of Kenya, Kenya
| | - R Lee Kirby
- Division of Physical Medicine & Rehabilitation, Dalhousie University, Canada
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Getting a Manual Wheelchair Over a Threshold Using the Momentum Method: A Descriptive Study of Common Errors. Arch Phys Med Rehabil 2017; 98:2097-2099.e7. [DOI: 10.1016/j.apmr.2017.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 11/23/2022]
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Munera S, Goldberg M, Kandavel K, Pearlman J. Development and evaluation of a wheelchair service provision training of trainers programme. Afr J Disabil 2017; 6:360. [PMID: 28936423 PMCID: PMC5594273 DOI: 10.4102/ajod.v6i0.360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/18/2017] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Sara Munera
- El Comité de Rehabilitación, Medellin, Colombia
| | - Mary Goldberg
- Rehabilitation Science & Technology, University of Pittsburgh, United States.,Human Engineering Research Laboratories, Department of Veterans Affairs, United States
| | - Krithika Kandavel
- Rehabilitation Science & Technology, University of Pittsburgh, United States.,Human Engineering Research Laboratories, Department of Veterans Affairs, United States
| | - Jonathan Pearlman
- Human Engineering Research Laboratories, Department of Veterans Affairs, United States.,Department of Rehabilitation Science and Technology, University of Pittsburgh, United States
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Shore S. The long-term impact of wheelchair delivery on the lives of people with disabilities in three countries of the world. Afr J Disabil 2017; 6:344. [PMID: 28936417 PMCID: PMC5594261 DOI: 10.4102/ajod.v6i0.344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/20/2017] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Susan Shore
- Department of Physical Therapy, Azusa Pacific University, United States
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Fung KH, Rushton PW, Gartz R, Goldberg M, Toro ML, Seymour N, Pearlman J. Wheelchair service provision education in academia. Afr J Disabil 2017; 6:340. [PMID: 28936415 PMCID: PMC5594266 DOI: 10.4102/ajod.v6i0.340] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/21/2017] [Indexed: 12/03/2022] Open
Abstract
Background An estimated 70 million people with disabilities need wheelchairs. To address this global crisis, the World Health Organization (WHO) proposed an eight-step wheelchair service provision model to ensure service quality regardless of resource setting. The International Society of Wheelchair Professionals (ISWP) aims to facilitate the integration of the WHO eight-step model into professional rehabilitation programmes. Objective To develop an enhanced understanding of the current wheelchair service provision education provided in professional rehabilitation programmes worldwide. Methods In a cross-sectional design, an online survey was distributed to ISWP contacts of educational institutions. Quantitative responses were analysed through summary statistics and qualitative answers were analysed by content analyses. When relevant, educational institutions were stratified into resource settings. Results Seventy-two representatives of educational institutions in 21 countries completed the survey. Wheelchair content was taught in 79% of represented institutions, of which 75% of respondents reported using original course material, 10% of respondents used WHO Wheelchair Service Training Packages and 15% of respondents used other available resources. The majority of educational institutions teaching with their own wheelchair-related course material taught ≤ 20 hours. Fourteen of the 15 respondents without wheelchair education, expressed an interest in integrating wheelchair education into their academic curricula. Conclusion The majority of the educational institutions teach wheelchair education; however, there is great variability in what and how it is taught and evaluated. The results demonstrate the need for more in-depth investigation regarding the integration process of wheelchair education in educational institutions, with the ultimate goal of improving wheelchair service provision worldwide.
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Affiliation(s)
- Karen H Fung
- School of Rehabilitation, Université de Montréal, Canada.,Marie Enfant Rehabilitation Center, Sainte-Justine University Hospital Research Center, Canada
| | - Paula W Rushton
- School of Rehabilitation, Université de Montréal, Canada.,Marie Enfant Rehabilitation Center, Sainte-Justine University Hospital Research Center, Canada
| | - Rachel Gartz
- Rehabilitation Science & Technology, University of Pittsburgh, United States
| | - Mary Goldberg
- Rehabilitation Science & Technology, University of Pittsburgh, United States.,Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, United States
| | - Maria L Toro
- Department of Physiotherapy, Universidad CES, Colombia
| | | | - Jonathan Pearlman
- Rehabilitation Science & Technology, University of Pittsburgh, United States.,Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, United States
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Mhatre A, Martin D, McCambridge M, Reese N, Sullivan M, Schoendorfer D, Wunderlich E, Rushman C, Mahilo D, Pearlman J. Developing product quality standards for wheelchairs used in less-resourced environments. Afr J Disabil 2017; 6:288. [PMID: 28936410 PMCID: PMC5594264 DOI: 10.4102/ajod.v6i0.288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/27/2017] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Anand Mhatre
- Human Engineering Research Laboratories, Department of Veterans Affairs, United States
- Department of Rehabilitation Science and Technology, University of Pittsburgh, United States
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Daniel Martin
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Matt McCambridge
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Norman Reese
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Mark Sullivan
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Don Schoendorfer
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Eric Wunderlich
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Chris Rushman
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Dave Mahilo
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
| | - Jon Pearlman
- Human Engineering Research Laboratories, Department of Veterans Affairs, United States
- Department of Rehabilitation Science and Technology, University of Pittsburgh, United States
- International Society of Wheelchair Professionals, University of Pittsburgh, United States
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Williams E, Hurwitz E, Obaga I, Onguti B, Rivera A, Sy TRL, Kirby RL, Noon J, Tanuku D, Gichangi A, Bazant E. Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:22. [PMID: 28818075 PMCID: PMC5561585 DOI: 10.1186/s12914-017-0130-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Emma Williams
- Jhpiego, 1615 Thames St, Baltimore, MD 21231-3492 USA
| | | | - Immaculate Obaga
- Jhpiego, 14 Riverside (Off Riverside Drive) Arlington Block, 2nd Floor, P.O Box 66119-00800, Nairobi, Kenya
| | - Brenda Onguti
- Jhpiego, 14 Riverside (Off Riverside Drive) Arlington Block, 2nd Floor, P.O Box 66119-00800, Nairobi, Kenya
| | - Adovich Rivera
- Institute of Health Policy and Development Studies, University of Philippines, Room 105, National Institutes of Health Building, 623 Pedro Gil St., Ermita, 1000 Manila, Philippines
| | - Tyrone Reden L. Sy
- Institute of Health Policy and Development Studies, University of Philippines, Room 105, National Institutes of Health Building, 623 Pedro Gil St., Ermita, 1000 Manila, Philippines
| | - R. Lee Kirby
- Dalhousie University, c/o Room 206, Nova Scotia Rehabilitation Centre Site, 1341 Summer Street, Halifax, NS B3H 4K4 Canada
| | - Jamie Noon
- Noon Design, Box 208, Cerrillos, NM 87010 USA
| | - Deepti Tanuku
- Jhpiego, 1615 Thames St, Baltimore, MD 21231-3492 USA
| | - Anthony Gichangi
- Jhpiego, 14 Riverside (Off Riverside Drive) Arlington Block, 2nd Floor, P.O Box 66119-00800, Nairobi, Kenya
| | - Eva Bazant
- Jhpiego, 1615 Thames St, Baltimore, MD 21231-3492 USA
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Kirby RL, Mitchell D, Sabharwal S, McCranie M, Nelson AL. Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial. PLoS One 2016; 11:e0168330. [PMID: 28002472 PMCID: PMC5176312 DOI: 10.1371/journal.pone.0168330] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group. METHODS We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30-45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores. RESULTS Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021). CONCLUSIONS Individualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.
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Affiliation(s)
- R. Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Doug Mitchell
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, United States of America
| | - Sunil Sabharwal
- Veterans Administration Boston Health Care System and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark McCranie
- Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Audrey L. Nelson
- Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, College of Public Health, University of South Florida, Tampa, Florida, United States of America
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