mobilityRERC State of the Science Conference: considerations for developing an evidence base for wheeled mobility and seating service delivery

Service delivery for complex rehabilitation technology: a scoping review

PURPOSE

Complex rehabilitation technologies (CRT) support independence for individuals with disabilities by enabling mobility for function, employment, education, and independent living. CRT service delivery is evolving, with changes to funding, provider qualifications, consumer needs, and technological advances. This scoping review investigated service delivery processes for individuals with disabilities who have a mobility impairment, while specifically identifying best practices, barriers, and unique features of health delivery policies and practices.

METHODS

We used a framework described by Colquhoun et. al. for conducting scoping reviews, a six-step process that includes: 1) identifying the research question, 2) identifying studies, 3) selecting studies 4) data charting, 5) reporting results and 6) consultation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was also used for reporting results of the review.

RESULTS

Common categories were identified and organised into a hierarchical structure of four categories and 16 sub-categories. The primary categories included "policy", "consumer", "service delivery", and "wheeled mobility devices". The sub-categories described funding sources, consumer and professional populations, service delivery guidelines, and types of mobility devices. Analysis indicated the data were from 21 countries and 14 combinations of funding sources, and the articles were primarily descriptive studies.

CONCLUSION

This scoping review identified evidence from various countries, health systems, and stakeholder. Currently, this process does not proactively address the needs of individuals with mobility disabilities. The scoping review provides the foundation for the development of a novel policy on the provision of CRT services and devices to address these needs.Implications for RehabilitationExamination of national and international service delivery practices in diverse clinical and funding environments indicate various challenges and opportunities for improvement.CRT consumers are negatively impacted by current service delivery practices, including long wait times, lack of specialised clinical expertise, and limited consumer education opportunities.More consistent and widespread research is needed within the CRT provision industry to grow evidence-based practice related to complex rehabilitation technology and individuals with disabilities.

"Unknown world of wheelchairs" A mixed methods study exploring experiences of wheelchair and seating assistive technology provision for people with spinal cord injury in an Irish context

AIM

This study explores people living with spinal cord injury (SCI) experiences and perspectives of wheelchair and seating assistive technology service provision within an Irish context. There are few studies that examine the process of wheelchair and seating provision and the connection between satisfaction, performance, and participation.

METHOD

This mixed methods study explores participant experiences in two parts. Part one presents a thematic analysis of eight in-depth semi-structured interviews with wheelchair service users living with SCI. Part two presents the results content and frequency analysis of an on-line survey of wheelchair service user's experience and satisfaction with wheelchair and seating service provision from respondents with SCI (n = 117) taken from a larger national survey from respondents with various diagnoses (n = 273).

RESULTS

Findings from the interviews and survey revealed the meaning of wheelchair and seating assistive technology provision as essential to life following SCI. Barriers within the provision system such as wait times and funding were found to impede people's rights and freedom from initial assessment through to follow up, maintenance and repair.

CONCLUSIONS

The current implementation of wheelchair and seating assistive technology provision as described in this paper impacts the ability of individuals living with an SCI to participate as equal members of society. A review of wheelchair provision is essential to optimize access to services for appropriate wheelchairs.IMPLICATIONS FOR REHABILITATIONAs a basic human right, appropriate wheelchair and seating assistive technology provision facilitates people's optimal independence, health and well-being, social engagement, and participation in everyday life.The development of adequate wheelchair services should be a priority area for individuals with SCI who use wheelchair and seating assistive technology.National wheelchair and seating assistive technology provision policies in alignment with internationally developed best practice guidelines to provide equal access to services which include assessment, delivery, training, maintenance, and follow-up are essential.

Use of single-subject research designs in seating and wheeled mobility research: a scoping review

Background: Evidence-based practice (EBP) in seating and wheeled mobility practice is often hindered by a dearth of published research.Purpose: The purpose of this review was to explore and critically appraise the use of single-subject research designs (SSRDs) in seating and wheeled mobility studies published between January 1995 and May 2018.Study Selection: Primary source, peer-reviewed SSRDs focused on exploring the impact of a seating and wheeled mobility intervention were included in the review.Data Extraction: Relevant data extraction, determination of level of evidence, evaluation of methodological rigor, and assessment of the risk of bias were each independently performed.Data Synthesis: The review yielded 19 studies (2 Level III, 15 Level IV, and 2 Level V). A majority of these studies incorporated a withdrawal-type of SSRD and involved subjects representing patient populations with seating and wheeled mobility needs. Methodological rigor/quality features most commonly absent in the included studies included: blinding/masking, inter-rater or intra-rater reliability, >5 data points in each phase, planned replication (≥3 subjects), procedural fidelity methods, randomization, stability of the data during baseline, statistical analyses and use of subject selection criteria. The limited number of published SSRDs, combined with the lower levels of evidence (Levels III-V) provided by these studies, indicates that the use of SSRDs in seating and wheeled mobility research is in the early stages of development.Conclusions: Increasing the methodological quality and rigor as well as reporting methods in future SSRDs involving seating and wheeled mobility interventions may help to support EBP in this area.Implications for RehabilitationSingle-subject research designs (SSRDs) offer both researchers and clinicians the opportunity to contribute to the existing knowledge base in ways that reflect actual clinical practice.SSRDs provide flexibility in adapting and modifying seating and wheeled mobility-related assistive technology devices to meet the individual needs of specific subjects.SSRDs preserve individual responses to seating and wheeled mobility-related assistive technology devices.SSRDs may help to enhance evidence-based practice (EBP) in seating and wheeled mobility practice by spanning the divide between research and practice.Increasing the methodological quality and rigor as well as reporting methods in future SSRDs may help to support EBP in seating and wheeled mobility practice.

How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.