A longitudinal study assessing the maintenance condition of cadres of four types of wheelchairs provided in low-resource areas.

Wheelchair breakdowns increase the risk of injury and limit the mobility of wheelchair users. In the endeavour to meet the enormous global need for wheelchairs, manufacturers of wheelchairs for low-resource settings face a cost-benefit tension between affordability and durability. Field studies are needed to provide feedback on durability. Four manufacturers provided cadres of wheelchairs to the organization providing rehabilitation to students at a boarding school for children with disabilities in a low-resource area. The Wheelchair Components Questionnaire for Condition was used to evaluate wheelchair maintenance condition at several time intervals after fitting. Because the maintenance regime was not identical for the four wheelchair types, wheelchair types were not compared. Analysis of variance indicated differences in condition across time and between wheelchair components. Tukey's simultaneous comparison of means indicated that across the entire group, brakes, seats, casters and foot rests received lower ratings than frame. Preliminary data after each iteration of this study were provided to manufactures and resulted in responsive design changes. Implications for Rehabilitation Longitudinal studies with the Wheelchair Components Questionnaire for Condition (WCQc) have enabled manufacturers to make responsive design improvements. Additional studies could be done with other wheelchair types to result in responsive positive design changes for those wheelchairs as well. The WCQc can be used in studies on wheelchair condition even when records of repair history are not reliably available, a situation which is not uncommon in low-resource areas. Data sets collected at an individual clinic uses the WCQc could focus attention on wheelchair components needing regular repair. With that data in mind, the maintenance regime could be modified to respond and in so doing improve wheelchair condition and reduce loss of mobility or risk of injury. Organizations involved in funding wheelchairs for a particular location could use data from longitudinal studies done with the WCQc at that location to inform purchasing decisions.

Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings.

PURPOSE: This study was conducted to compare the performance of three types of chairs in a low-resource setting. The larger goal was to provide information which will enable more effective use of limited funds by wheelchair manufacturers and suppliers in low-resource settings. METHODS: The Motivation Rough Terrain and Whirlwind Rough Rider were compared in six skills tests which participants completed in one wheelchair type and then a day later in the other. A hospital-style folding transport wheelchair was also included in one test. For all skills, participants rated the ease or difficulty on a visual analogue scale. For all tracks, distance traveled and the physiological cost index were recorded. Data were analyzed using repeated measures analysis of variance. RESULTS: The Motivation wheelchair outperformed Whirlwind wheelchair on rough and smooth tracks, and in some metrics on the tight spaces track. Motivation and Whirlwind wheelchairs significantly outperformed the hospital transport wheelchair in all metrics on the rough track skills test. CONCLUSION: This comparative study provides data that are valuable for manufacturers and for those who provide wheelchairs to users. The comparison with the hospital-style transport chair confirms the cost to users of inappropriate wheelchair provision. Implications for Rehabilitation For those with compromised lower limb function, wheelchairs are essential to enable full participation and improved quality of life. Therefore, provision of wheelchairs which effectively enable mobility in the cultures and environments in which people with disabilities live is crucial. This includes low-resource settings where the need for appropriate seating is especially urgent. A repeated measures study to measure wheelchair performances in everyday skills in the setting where wheelchairs are used gives information on the quality of mobility provided by those wheelchairs. This study highlights differences in the performance of three types of wheelchairs often distributed in low-resource settings. This information can improve mobility for wheelchair users in those settings by enabling wheelchair manufacturers to optimize wheelchair design and providers to optimize the use of limited funds.

International mobility technology research: a Delphi study to identify challenges and compensatory strategies.

We sought to identify logistical and ethical challenges to performing wheelchair-related research in low- and middle-income countries and to generate a list of compensatory strategies to address these challenges. Thirteen individuals with experience in the field participated in an online Delphi study. The surveys asked participants to identify research challenges, suggest strategies to address the selected challenges, and critique each other's strategies. Participants identified challenges in the use of research techniques, compensation for participation that does not result coercion, oral and written translation materials, funding for research, collaboration with local professionals, and "respect for persons." Effective international mobility research requires time, cultural sensitivity, collaboration, and careful planning. An understanding of these requirements can allow researchers to anticipate and compensate for common pitfalls of their work, thus making the research more productive and beneficial to subjects. Future research is required to verify the general effectiveness of compensatory strategies.

Current state of mobility technology provision in less-resourced countries.

This article reviews mobility technology in less-resourced countries, with reference to people with disabilities in several locations, and describes technology provision to date. It also discusses a recent collaborative study between a United States University and an Indian spinal injuries hospital of Indian wheelchair users' community participation, satisfaction, and wheelchair skills. The data suggest that individuals who received technology from the hospital's assistive technology department experienced increased community participation and improved wheelchair skills. This evidence may have already enabled the hospital to improve Indian governmental policies toward people with disabilities, and it is hoped that future research will benefit other people similarly.