Wheelchair prescription in the western region of the Eastern Cape

[摘要] ENGLISH ABSTRACT: Background: Access to wheelchairs is considered a basic human right. Wheelchairs enhancefunction, improve independence, and enables persons with disabilities to successfully live inthe community. An inappropriate wheelchair may however limit function rather than promoteit. Achieving an ideal match between user and technology, however is challenging. A recentaudit in the Eastern Cape revealed that standard folding frame type wheelchairs werepredominantly being issued and waiting list for wheelchairs is long. The need forinvestigation into prescription practice, from the perspective of both prescribing therapists aswell as wheelchair users, was identified.Aims: To describe wheelchair prescription practice in the public sector of the Eastern Cape;and to determine whether the wheelchairs being issued address the psychosocial needs ofusers.Study design: A descriptive mixed-method cross-sectional study design was used.Quantitative and qualitative data from questionnaires and functional wheelchair skills tests ofwheelchair users (Phase 1) and from semi-structured interviews with prescribing therapists(Phase 2) was used to describe prescription practice and investigate the psychosocial needs ofwheelchair users.Methods: A small sample of convenienve according to home address was obtained thatincluded 30 users (15 from a rural; 15 from a semi-rural setting). The Psychosocial Impact ofAssistive Devices Scale (PIADS) questionnaire, Functioning Everyday with a wheelchair(FEW/FMA) scale and a self-compiled wheelchair specifications checklist (WSC) were usedto determine user functionality and level of satisfaction with the wheelchair. Purposivesampling was done to identify the therapists that had prescribed the wheelchairs for theparticipants in the first phase of the study. A semi- structured interview was used todetermine prescription practice including perceived barriers of wheelchair prescription withten prescribing therapists.Data analysis: Qualitative data was analysed deductively and frequency of responsestabulated. Quantitative data was summarised as means and standard deviations and subgroupanalysis comparisons were done using the Chi-square test and relationships between variablesinvestigated using Pearson/ Spearman correlation or ANOVA. A p < 0.05 was deemedsignificant.Results: Eighty three % of wheelchairs issued were urban wheelchairs. These are generallyperceived by users as sufficient to address their psychosocial needs regarding mobility andtransport, however, seem to fail users in terms of accessibility and independence within theirrural/ semi- rural environment. According to the WSC scores, peri-urban wheelchairs werefound to be more appropriate for the users than urban wheelchairs (p < 0.01). No significantrelationships were found between wheelchair fit, use of a cushion, occurrence of pressuresores and self-perceived psychosocial needs in this sample. The users experienced mostdifficulty with outdoor mobility (57% needed full assistance) and transport (63% needed fullassistance) within their current wheelchairs.Ten prescribing therapists participated in the study. Most valued appropriate seating, areknowledgeable regarding prescription practice, but reported several barriers to this practiceincluding budget restraints (90%), time to delivery (100%) and lack of training (40%). Theneed for more appropriate wheelchair designs to suit multi- level manoeuvrability of personsin rural/ semi-rural environments was also reported (60%).Conclusion: The results of this study show that wheelchair prescription in the WesternRegion of the Eastern Cape (WRoEC) has various challenges. Although the wheelchair userswere mostly satisfied with their wheelchairs, this study identified areas for improvement inthe users' functioning, postural support and biomechanics within their wheelchairs, especiallyas it relates to their home environment. There is scope for improvement of wheelchairdelivery to persons in the WRoEC – from on-going training of therapists and clients to moreappropriate wheelchair designs for persons in rural settings. Further research in this field isrecommended.

[发布机构] Stellenbosch University