Wheelchair provision guidelines: web annex B: systematic review data tables and appendices

Wheelchair provision guidelines Web Annex B Systematic review data tables and appendices Wheelchair provision guidelines Web Annex B Systematic review data tables and appendices Wheelchair provision guidelines. Web Annex B. Systematic review data tables and appendices ISBN 978-92-4-007455-2 (electronic version) © World Health Organization 2023 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/). Suggested citation. Web Annex B. Systematic review data tables and appendices. In: Wheelchair provision guidelines. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see https://www.who.int/publications/book-orders. To submit requests for commercial use and queries on rights and licensing, see https://www.who.int/copyright. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. This publication forms part of the WHO guideline entitled Wheelchair provision guidelines. It is being made publicly available for transparency purposes and information, in accordance with the WHO handbook for guideline development, 2nd edition (2014). Web-Annex B: Data Tables and Appendices iii Contents Section WB.1: Figures and data tables 1 References 106 Section WB.2: Appendices 112 Appendix WB.1: Search strategies 112 Appendix WB.2: Critical appraisal of studies in Review Question A 116 Appendix WB.3: Critical appraisal of studies in Review Question B 125 Appendix WB.4: Critical appraisal of studies in Review Question C 127 Appendix WB.5: Critical appraisal of studies in Review Question D 131 Appendix WB.6: Critical appraisal of studies in Review Question E 134 Appendix WB.7: Critical appraisal of studies in Review Question F 144 Appendix WB.8: List of excluded studies 149

Web-Annex B: Data Tables and Appendices 1 Section WB.1: Figures and data tables Figure WB.1: Meta-analysis on mobility and/or posture and/or function comparing wheelchair task training versus control Wheelchair Provision Guidelines 2 Figure WB.2: Subgroup meta-analysis comparing wheelchair task training versus control on mobility and/or posture and/or function outcomes by mode of training delivery Web-Annex B: Data Tables and Appendices 3 Figure WB.3: Subgroup meta-analysis comparing wheelchair task training versus control on mobility and/or posture and/or function outcomes by type of wheelchair Wheelchair Provision Guidelines 4 Figure WB.4: Meta-analysis comparing wheelchair task training versus control on secondary complications of training Figure WB.5: Meta-analysis comparing wheelchair task training versus control on empowerment and self-esteem Web-Annex B: Data Tables and Appendices 5 Figure WB.6: Meta-analysis comparing wheelchair task training versus control on inclusion, participation and/or quality of life Figure WB.7 Key to symbols used to interpret Findings for tables Symbols Meaning Symbols Meaning Increased/improved in a positive manner (i.e., increased mobility) Increased in a negative manner (i.e., cost) Decreased/ improved in a positive manner (i.e., time to perform tasks) Decreased in a negative manner (i.e., decreased mobility) Satisfactory/ satisfied Presence of negative outcomes (i.e., adverse events) No complications/ negative outcomes Not satisfied/ not meeting service needs Inconsistent findings ? Inconclusive findings No difference/ no change Note Wheelchair Provision Guidelines 6 Table WB.1: Characteristics of included studies Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Reviews Systematic reviews Bray et al. 2014 United Kingdom NHS service provision of manual and powered wheelchairs Number of studies=20 N/A Children/young people aged 18 or under with a long-term need for mobility equipment for management of physical disability, their caregivers and healthcare professionals managing the children N= 20 Satisfaction with the service (themes from opinion evidence) Time and/or Cost for people who use wheelchairs (from economic evidence) None N/A At present NHS wheelchair services in the UK are not meeting all of children’s needs and service development is required. The lack of economic evidence in this field highlights the lack of appropriate methods to measure cost- effectiveness. Establishing the cost-effectiveness of interventions is a priority to promote efficient services Scoping reviews Graham et al. 2020 New Zealand Tele-wheelchair assessment described as 'synchronous video and audio facilities for communication between a remote-specialist assessor and a wheelchair user'. Number of studies= 9 In-person wheelchair assessment N/A N= 9 Mobility and/or Posture and/or Function (Functional ability and Goal Satisfaction Scores (GAS) Time and/or Cost for people who use wheelchairs (length of consultation time and travel costs) Satisfaction with service 9 Surveys, self-report None N/A Tele-wheelchair assessment may be a feasible delivery format of wheelchair and seating assessment and achieve good outcomes for wheelchair clients, however, further research is required to determine its effectiveness, examine adoption issues and ensure consumer and professional safety. Web-Annex B: Data Tables and Appendices 7 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings measures or interviews) Secondary complications including falls and /or injuries (adverse events) Randomised Controlled Trials (RCTs) Hansen, Tresse & Gunnarsson 2004 Sweden N= 60 wheelchair users received the standard intervention and the active intervention. The active intervention consisted of a one-hour OT- initiated check- up of the wheelchair, following a compiled checklist for safety, comfort and positioning, manoeuvrability, and transportation, within three months of randomisation. N= 81 wheelchair users received the standard intervention , whereby an OT made a follow-up visit a few weeks after wheelchair delivery to confirm function a user satisfaction. If satisfactory, no further visits were scheduled. N= 141 individuals >16 years of age using a manually propelled wheelchair. N/A Satisfaction w/chair (questionnaire) Secondary complications including falls and /or injuries (questionnaire) Disruption in use including due to wheelchair breakdown (OT- registered actions) The accident rate, extent of pressure sores, number and extent of repairs, reconditioning, adjustments as well as user satisfaction were measured initially and at one year. Most wheelchairs will develop defects. If suitability to the user is also considered, almost all wheelchairs will become inappropriate and inadequate. However, the user and carer are often unable to determine when action is needed. An active, structured check-up seems to reduce accidents. Further research should focus on determination of a suitable interval between check-ups. Quasi-experimental studies Hoenig et al. 2005 USA N= 53 old and physically disabled patients N= 31 patients received N= 84 patients N/A Secondary complications including falls and Empowerment, self-esteem Dependent variables were measured at 2 New wheelchair owners (old and physically disabled patients) used the wheelchair Wheelchair Provision Guidelines 8 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings received the intervention, which took 1.0 to 1.5 hours and included five components: (1) a PT/OT with wheelchair expertise; (2) a structured assessment; (3) an individually fitted wheelchair and orders for additional OT/PT, equipment, or home modifications if needed; (4) wheelchair training; (5) follow up. standard care. /or injuries (shoulder pain worse than previous) Satisfaction with the wheelchair (Wheelchair comfort) (wheelchair confidence) weeks, 3 months, and 6 months after receipt of the wheelchair. more often if they received it from an expert therapist using a multifactorial intervention. Pre-post studies Armstrong, Reisinger & Smith 2007 Afghanistan N= 100 received CIR-Whirlwind Wheelchair and three subject visits for initial wheelchair fitting and training. Training included wheelchair use and maintenance, and wheelchair skills activities. Subject’s original wheelchair. N= 100 adult manual wheelchair users N/A Mobility and/or Posture and/or Function (distance travelled with the wheelchair; wheelchair skills activities; subject comments) Satisfaction with wheelchair (wheelchair performance; Disruption in use including wheelchair breakdown (wheelchair durability; subject comments) Outcomes measures obtained at Visit 1, 2 and 3, and then follow-up at 3 and 10 weeks. The study wheelchair was rated favourably by the subjects in all of five categories. Adjustments made to the wheelchairs during the study were typical for maintaining or improving the fit or function of a manual wheelchair. With the exception of brake handles, the need to repair or replace components on the wheelchairs was minimal. The subjects’ proficiency at wheelchair skill Web-Annex B: Data Tables and Appendices 9 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings subject comments) activities increased throughout the study. Cohort studies Divanoglou et al. 2019 Botswana N= 19 participated in a 7-day active rehabilitation (AR) training program, consisting of 10 training sessions (16 hours total) on wheelchair skills, cardiorespiratory fitness, strengthening and ball sports, and 6 workshops. N/A N= 19 adults with spinal cord injury (SCI). N/A Mobility and/or Posture and/or Function (Spinal Cord Independence Measure Self- Report -SCIM-SR; Queensland Evaluation of Wheelchair Skills: QEWS) Inclusion, participation and/or quality of life (Moorong Self-Efficacy Scale – MSES) Empowerment, self-esteem (Wheelchair Skills Test Questionnaire 4.3 – WST-Q Participants were evaluated at baseline and at the end of the programme, and at 5 months follow- up. There is a potential for improvement and a great need for structured training and rehabilitation after discharge for individuals with SCI in Botswana. Participants achieved substantial improvements in their physical independence that are comparable with those in the early period after injury. Community peer-based programmes in low-resource countries can play a crucial role in promoting healthy and independent active living by providing ongoing support, education and skills training.   Toro, Eke & Pearlman 2016 Indonesia N= 142 participants in the wheelchair group. Participants received a physical and interview assessment to identify their needs. The most appropriate wheelchair from those available was prescribed, N= 167 participants in the waitlist group. N= 311 participants who came to UCPRUK to receive services for a new wheelchair. N/A Mobility and/or Posture and/or Function (Craig Handicap Assessment Recording Technique Short Form – CHART-SF; Wheelchair Skills Test) Secondary complications including falls and/or injuries Inclusion, participation and/or quality of life (World Health Organization Quality of Life- BREF – WHOQOL-BREF) Disruption in use including due to wheelchair Measures were collected at baseline and follow-up. Average time between baseline and follow-up was 193 ± 27 days). Wheelchairs fitted according to the WHO 8-Step approach in Indonesia resulted in greater satisfaction with mobility for Children with proxies and Adults with proxies. Adults that received wheelchairs reported a better quality of life than those on the waiting list. Wheelchair skills were found to be a confounding factor which could influence mobility measurements. Wheelchair Provision Guidelines 10 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings delivered, and fitted. Training was provided related to handling, transfers, and basic maintenance. (physical assessment) Questionnaire – WST-Q) Satisfaction with w/chair (Functional Mobility Assessment – FMA) breakdown (need for repair) Verza et al. 2006 Italy N= 54 patients received care at the MS Rehabilitation Centre in Padua, Italy, under the Assistive Device Evaluation and Prescription Protocol. N/A N= 54 people with MS who use assistive devices. N/A None Wheelchair abandonment (data from assistive technologies database: Number of wheelchairs obtained and abandoned) Pre- intervention data collected January 1997 to December 1999. Post- intervention data collected January 2000 to December 2002. An interdisciplinary approach to evaluation and prescription of assistive technology that directly involves the patient and family decreases the rate of device abandonment by subjects with MS. However, a small number of individuals will still abandon equipment even when a thorough assessment is performed. Cross-sectional studies Bazant et al. 2017 Kenya; Philippines Wheelchair training based on the WHO 2008 Guidelines N/A N= 420 adult wheelchair users in Kenya. N= 432 adult wheelchair users in the Philippines. N/A Secondary complications including falls and/or injuries (survey instrument) Mobility and/or Posture and/or Function (survey instrument) None N/A Assessing the fit of the wheelchair while the user propelled the wheelchair and training in wheelchair use are services associated with positive wheelchair use outcomes. Serious falls may be an unintended consequence of increased mobility. Efforts to provide wheelchairs and services need to include plans for wheelchair maintenance Web-Annex B: Data Tables and Appendices 11 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings and repair and follow-up with wheelchair recipients. Beaumont-White & Ham 1997 UK GP and therapist referral for wheelchair needs and provision of powered wheelchairs with additional information sheet or booklet N/A N= 40 indoor powered wheelchair users (N= 36 current users; N= 4 recent ex- users). N/A Satisfaction with w/chair (the past – user survey) Percentage of eligible population receiving referral and access to wheelchair services (the past – user survey; the present – wheelchair services) Disruption in use including due to wheelchair breakdown (the past – user survey) N/A The study identified various areas needing further development both within the service and from manufacturers. Graham et al. 2021 New Zealand Telehealth Wheelchair Assessment Service (TWAS) using technology (e.g., video- conferencing) to connect a wheelchair-user and local non- specialist therapist with a remote specialist assessor. N/A N= 47 wheelchair users N/A Satisfaction with w/chair (QUEST) Satisfaction with service (QUEST) Time and/or Cost for people who use wheelchairs (QUEST) Inclusion, participation and/or quality of life (QUEST) N/A Telehealth assessment was largely viewed as valuable and a means to positively impact the quality of service delivery and wider health outcomes by all stakeholders. Post et al. 1997 Netherland s Dutch service delivery system which included domestic and car adaptations based on medical assessments and N/A N= 318 adults with spinal cord injury. N/A Satisfaction with service (availability of services) Mobility and/or Posture and/or N/A Satisfaction with available services was acceptable, but satisfaction with service delivery procedures was very low. Satisfaction with available services did have a significant relationship with Wheelchair Provision Guidelines 12 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings the provision of adaptive equipment Function (availability of services; satisfaction with available services; functional health status – SIP68) Satisfaction with w/chair (availability of services) functional health status when the influence of the type of injury was taken into account. Satisfaction with available services also had a significant relationship with life satisfaction, after the influence of functional health status was taken into account. Salatino et al. 2016 Italy Powered wheelchair effectiveness in real life (POWER) nine- step protocol and wheelchair service and provision N/A N= 79 power wheelchair users. N/A Satisfaction with w/chair (QUEST) Satisfaction with service (QUEST) Time and/or Cost for people who use wheelchairs (SCAI) Time and/or Cost for people who assist people who use wheelchairs (SCAI) Wheelchair abandonment (interview) Empowerment, self-esteem (PIADS) N/A The surveyed outcomes of the provision were generally positive, and the economic impact was also good insofar as it has led to significant savings in social costs. Štefanac, Grabovac & Fristedt 2018 Croatia Wheelchair services to the members of the Croatian Paraplegic and Tetraplegic Alliance which consisted of wheelchair assessment, wheelchair selection process, N/A N= 104 wheelchair users. N/A Satisfaction with service (self- administered questionnaire) Satisfaction with the wheelchair (self-administered questionnaire) Percentage of eligible population receiving referral None N/A Satisfaction with the wheelchair dimensions and comfort allowed participants to become more involved in their important activities of everyday living and increased their feelings safety when using a wheelchair. Inclusion in the wheelchair selection process and wheelchair skills training increased feelings of safety when using their Web-Annex B: Data Tables and Appendices 13 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings wheelchair education and skills training and fitting process, repairs and knowledge about availability of wheelchair services in community and access to wheelchair services (self- administered questionnaire) wheelchairs. However, many participants were not included in some or all parts of the wheelchair process, which reflected negatively on their performance in the activities of everyday living, feelings of safety and satisfaction with the wheelchair and services. Suzuki, Lockerte & Braun 2000 USA The Honolulu Wheelchair Seating Clinic at REHAB included a one- to 2-hour assessment by the physical therapist; assessment findings inform the specific funding-source criteria and recommendation s are made for the appropriate and necessary equipment N/A N= 26 clients serviced by a formal seating clinic. N/A Satisfaction with service (survey) Time and/or Cost for people who use wheelchairs (cost and comment from user) None N/A Clients were satisfied with the clinic and therapist, but pointed out that improvement was needed in following-up on equipment orders and fitting Case series Leochico & Valera 2020 Philippines N= 2 patients participated in a 30-minute telerehabilitation session. N/A N= 2 wheelchair recipients (Patient A: 28 year old female; Patient B: 28 year old male) N/A Time and/or Cost for people who use wheelchairs (qualitative data) Satisfaction with service (Telepractice Questionnaire None Pre and post measures were obtained at baseline (prior to videocall) and at the end of the session. Post-telerehabilitation perceptions improved based on qualitative feedback. Perceived benefits included no fatigue from travel, no stress in waking up early and waiting in line outside the clinic, reduced expenses, instant and direct Wheelchair Provision Guidelines 14 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings scores; qualitative data) Mobility and/or Posture and/or Function (qualitative data) communication with a doctor, and less burden on the family. Telerehabilitation using locally available low-cost technology is feasible in the background of limited resources in a developing country. Mixed methods D’Innocenzo et al. 2021 Indonesia Puspadi is staffed by service providers trained to provide services using the WHO 8- Steps service provision model; N= 118 users from the WHO 8-steps group. N= 24 users from the standard of care (SOC) group (Bunga Bali Foundation, and the Social Department ) N= 142 wheelchair users aged 16 years or older. N/A Mobility and/or Posture and/or Function (WST-Q) Satisfaction with w/chair (International Society of Wheelchair Professionals Minimum Uniform Data Set – ISWP- MUD) Disruption in use including due to wheelchair breakdown (Breakdown and Adverse Consequences Questionnaire – BAC-Q) Data were collected at baseline and at follow-up 3 to 6 months after provision. The results indicated that the training performed did not successfully impact wheelchair skills in the long term. Gowran et al. 2020 Ireland Irish wheelchair services which are described as ad-hoc, non- uniform access to services, assessments, delivery processes, follow up, reviews, repairs and maintenance and limited education programmes on wheelchair and seating assistive N/A Phase 1: N= 8 wheelchair users. Phase 2 (online survey): N= 273 wheelchair users/ their representatives / their parents. N/A Satisfaction with service (phase 1 interviews; phase 2 survey) Time and/or Cost for people who use wheelchairs (phase 2 survey) Inclusion, participation and/or quality of life (phase 1 interviews) Disruption in use including due to wheelchair breakdown (phase 1 interviews; phase 2 survey) N/A The service provision system has negative impacts on daily balance and temporal order for people who use wheelchair and seating assistive technology. Participants experienced a reduction in perceived independence following barriers during the wheelchair and seating provision process. Web-Annex B: Data Tables and Appendices 15 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Phase 1: N= 8 wheelchair users. Phase 2 (online survey): N= 273 wheelchair users/ representatives/ their parents. Visagie et al. 2016 Zimbabwe N= 55 participants took part in the comprehensive mobility support project (CMSP), which is underpinned by the WHO wheelchair guidelines and eight service steps model. N/A N= 55 wheelchair users who accessed the seating clinics where the CMSP was implemented. N/A Satisfaction w/chair (QUEST 2.0 for adults; QUEST 2.1 for children) Satisfaction w/service (QUEST 2.0 for adults; QUEST 2.1 for children) Mobility and/or Posture and/or Function (Functioning every day with a Wheelchair (FEW) Questionnaire) Inclusion, participation and/or quality of life (focus group discussion) Pre-post measures at baseline and 3- 5 months after receiving a new wheelchair. Statistically significant improvement in satisfaction with all except two categories (adult satisfaction with follow- up and child satisfaction with training) of wheelchair features, service delivery and function was observed. Wheelchair users in low- resource settings can experience similar satisfaction levels with wheelchairs, services and function as wheelchair users from resourced settings, despite fewer resources and using more basic technology. Qualitative studies Williams et al. 2017 Kenya; Philippines Wheelchair service based on the WHO 2008 Guidelines N/A N= 23 wheelchair users in Kenya. N= 24 wheelchair N/A Satisfaction with service (interviews) Satisfaction with w/chair (interviews) Secondary complications Wheelchair abandonment (interviews) N/A Participants identified difficulties repairing and maintaining wheelchairs, dissatisfaction with services and discussed a need for training for family members. Wheelchair Provision Guidelines 16 Author and year Study location Service delivery description and participant/study numbers Comparison description and participant numbers Wheelchair users and/or other participants in the study No. of studies Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings users in the Philippines. (interviews, adverse events) Web-Annex B: Data Tables and Appendices 17 Table WB.2: Reviews on time and/cost for people who use wheelchairs Author and year JBI appraisal score Time and/cost for people who use wheelchairs measures Results Interpretation Bray et al. 2014 9/11 (high) Qualitative information/opinion evidence Theme 1 from opinion evidence ‘Wheelchair services do not consistently meet all needs of service users, and parents are resigned to this’ - Participants highlighted issues around lack of information provision with regards to choice of wheelchairs, potential wheelchair benefits and funding available to families]. The evidence highlighted the financial burden placed on families having to pay for their own essential wheelchairs, maintenance and adaptations Economic evaluation One economic evaluation unpublished study on the NHS Primary Care Trust paediatric wheelchair services reported that to meet unmet service demands it would cost an extra £108,000 and provided an additional 10.7 to 14 QALYs, resulting in a cost per QALY of between £7,700 and £9,800. Graham et al. 2020 8/11 (moderate) Length of consultation time One study found no significant difference in length of consultation times in central and remote areas (Lemaire, Boudrias & Greene 2001). One study reported that planning of tele-wheelchair assessment took longer but shorter in relation to travel time saved (Barlow, Liu & Sekulic 2009) Tele-wheelchair assessment resulted in no difference in length of consultation time. Client travel cost Cost saving noted with tele-wheelchair assessment. Average = CA$324.96 (SD = 268.68); however no statistical comparison with control Tele-wheelchair assessments seem to save on travel costs of wheelchair users Wheelchair Provision Guidelines 18 Table WB.3: Cross sectional studies on time and/cost for people who use wheelchairs Author and year JBI appraisal score Time and/cost for people who use wheelchairs measures Results Interpretation Graham et al. 2021 3/6 (moderate) Timeframe Reduced timeframe from a wheelchair user’s service request to their needs being met (52/92, 57%) The Telehealth Wheelchair Assessment Service (TWAS) reduced time from service request to service received as reported by over half of the participants Travel time Reduced travel time for health professionals ((86/92, 94%) Reduced travel time for wheelchair users (79/92, 86%) The Telehealth Wheelchair Assessment Service (TWAS) reduced travel time for both health professionals and wheelchair users as reported by majority of the participants Salatino et al. 2016 3/6 (moderate) Siva Cost Analysis Instrument (SCAI) to measure additional social cost: social cost of the intervention, presumed social cost of non-intervention, and additional social cost [the difference between the former and the latter Estimated average saving per user was $38,568 when provided with a powered wheelchair vs no powered wheelchair Provision of a powered wheelchair did not lead to social cost savings in the case of only 11 people, whereas it led to savings of up to €10,000 ($10,676) in 15 cases, between €20,000 ($21,353) and €30,000 ($32,030) in 10, and there were some cases in which savings exceeded €100,000 ($106,765) The Powered wheelchair effectiveness in real life (POWER) nine-step protocol service resulted in remarkable savings in providing powered wheelchairs Web-Annex B: Data Tables and Appendices 19 Table WB.4: Case series on time and/cost for people who use wheelchairs Author and year JBI appraisal score Time and/cost for people who use wheelchairs measures Results Interpretation Leochico & Valera 2020 6/8 (moderate) Qualitative feedback Their perceived benefits included no fatigue from travel, no stress in waking up early and waiting in line outside the clinic, reduced expenses, instant and direct communication with a doctor, and less burden on the family. The 30minute telerehabilitation session provided to two paraplegic patients was reported to reduce expenses and was less burden to the family. Table WB.5: Mixed methods study on time and/cost for people who use wheelchairs Author and year MMAT appraisal score Time and/cost for people who use wheelchairs measures Results Interpretation Gowran et al. 2020 17/22 (high) Survey/Questionnaire Participants’ wait times are between one day and 4 years during different stages of the wheelchair and seating assistive technology service delivery process Largest percentage for wait time for appointment is 19.3% for 1-2 months Largest percentage for wait time for funding is unsure Largest percentage for wheelchair and seating delivery is 22.8% for 3-6 months The Irish wheelchair services characterised by an ad hoc, non-uniform wheelchair services and limited education and training, had long wait times for appointment, funding and wheelchair delivery Wheelchair Provision Guidelines 20 Table WB.6: Reviews on satisfaction with the service Author and year JBI appraisal score Satisfaction with the service measures Results Interpretation Bray et al. 2014 9/11 (high) Qualitative information from opinion evidence Theme 1 from opinion evidence ‘Wheelchair services do not consistently meet all needs of service users, and parents are resigned to this’ - Specific wheelchair service issues included long waiting times, poor maintenance procedures, strict eligibility criteria and differing opinions of needs. There appeared to be consensus that services were doing the best they could, and thus there was resignation to current standards of provision. Qualitative information from Policy and Not For Profit Organisation (NFPO) literature Theme 2 for policy and NFPO literature ‘Joint-working and multi-agency approach’ - The need for joined-up working between health, social care, education and NFPOs was a recurrent theme throughout the literature, with a general aim to improve services and to extend the scope of provision. This included pooling of budgets and outsourcing training/tuition. Theme 5 for policy and NFPO literature ‘Aftercare and information’ - Maintenance and review procedures need attention, with clear and defined minimum standards for reviews. Better quality information for service users regarding support, additional funding/grants, tuition and local service changes was recommended. Graham et al. 2020 8/11 (moderate) Surveys, self-report measures or interviews. Among different stakeholders: Collectively, qualitative and descriptive findings suggest that tele-wheelchair assessment is viewed as acceptable by wheelchair users and assessors with some concerns among remote specialist assessors (Khoja, Casebeer & Yiung 2005, Lemaire, Boudrias & Greene 2001, Malagodi et al 1998, Schein et al. 2010, Barlow, Liu &Sekulic 2009, Saptono 2011) Among wheelchair users: - 90%) reported feeling as or more satisfied and confident (Lemaire, Boudrias & Greene 2001) - Service satisfaction was significantly better after tele-wheelchair compared to no assessment (t(39) =13.92, p < 0.05) (Schein et al 2010) - Service satisfactions was found to be equivalent between tele- and in-person-wheelchair assessment for both wheelchair users (F(2,26) = 0.53, p = 0.59) and assessors (F(2,21) = 0.06, p= 0.95) (Barlow, Liu & Sekulic 2009) - No statistically significant difference between in-person vs tele-wheelchair in any of the 10 item score at the end of the study, except for the ‘transportation’ item which showed a mean difference of 0.49 (95% 0.98 to 0.07), p= 0.02 (Schein et al. 2010b) Tele-wheelchair assessments have inconsistent satisfaction findings Web-Annex B: Data Tables and Appendices 21 Table WB.7: RCTs on satisfaction with the service Author and year JBI appraisal score Satisfaction with the service measures Results Interpretation Hansen, Tresse & Gunnarsson 2004 10/11 (high) User satisfaction questionnaire using a Visual Analog Scale Number of adult manual wheelchair users reporting wheelchair satisfaction in first and second measures were not significantly different in intervention group and control groups (intervention: improved= 24, unchanged=3, worse=30; control: improved=27, unchanged=11, worse=37) (p=0.91) The one-hour OT-initiated check-up of the wheelchair, following a compiled checklist for safety, comfort and positioning, manoeuvrability and transportation did not show any difference in satisfaction measure between groups of wheelchair users. Table WB.8: Cross sectional studies on satisfaction with the service Author and year JBI appraisal score Satisfaction with the service measures Results Interpretation Graham et al. 2021 3/6 (moderate) Quebec User Evaluation of Satisfaction with Technology (QUEST) More than half of adult wheelchair users reported being “quite” to “very satisfied” with their recent wheelchair services as part of the Telehealth Wheelchair Assessment Service (TWAS) Post et al. 1997 5/6 (high) Satisfaction from available services General satisfaction with available service: 45% of respondents gave a maximum or nearly maximum score (4.5 or 5.0); mean and SD of 3.8 +/- 1.20) 48.6% indicated that a request for a particular service had been denied, although most respondents got what they wanted in the end (whether or not by paying for it themselves). Significant differences were found between the participants who had no complaints about their wheelchairs (n=166) and the others (n=141); those with no complaints had a mean of 4.0 in the Satisfaction Services and the others had a mean score of 3.6, (Z=3.97, P<0.001) Overall, the majority of the adults with SCI were satisfied with the services offered by the Dutch service delivery system which included domestic and car adaptations based on medical assessments and the provision of adaptive equipment. Satisfaction from service delivery procedure In general, satisfaction with service delivery procedures was low; mean score 2.3 +/- 0.89 Significant differences were found between the participants who had no complaints about their wheelchairs (n=166) and the others (n=141); those with no complaints had a mean of 2.4 on the Satisfaction Procedures against 2.2 for the others (Z=2.37, P=0.018). Complaints were about the way the participants were treated (especially by Joint Medical Service professionals), the number of organisations and officials involved, and the amount of time required by these procedures Wheelchair Provision Guidelines 22 Author and year JBI appraisal score Satisfaction with the service measures Results Interpretation Overall, the majority of the adults with SCI were not satisfied with the service delivery procedures of the Dutch service delivery system which included domestic and car adaptations based on medical assessments and the provision of adaptive equipment. Salatino et al. 2016 3/6 (moderate) Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) v 2.0 QUEST average score on satisfaction on the services (delivery, repairs, professional services, and follow-ups) was 4.2/5 (‘quite satisfied” or “very satisfied’) The Powered wheelchair effectiveness in real life (POWER) nine-step protocol service was found to be satisfactory by the participants Stefenac, Grabovac & Fristedt 2018 3/6 (moderate) Questionnaire Wheelchair assessment - Participants with whom the wheelchair assessment was done responded feeling safer when using their wheelchairs when compared to the participants with whom the wheelchair assessment was not done (n=44;77%;χ2=8.97;df=1;p=0.003) - Participants who were assessed only by non-medical professionals (n=36;61%), responded feeling safer in using their wheelchairs when compared to those participants who were assessed by medical professionals (n=21;37)(χ2=22.26;df=1;p<0.001) Wheelchair selection process - 49 participants (86%) were satisfied with the wheelchair selection process. - Participants supported by non-medical professionals (n=36;63%) felt more included in the wheelchair selection process compared to persons supported by medical staff. Wheelchair education and skill training - In 40 cases (89%), participants were very or somewhat satisfied, while 5 persons (11%) were not satisfied with the wheelchair education and wheelchair skills training - No difference was found in satisfaction levels between participants met by medical compared to non-medical professionals (χ2=0.36;df=2;p=0.833) - Most participants received wheelchair education and wheelchair skills training (n=26;58%) lasting less than 15 minutes, 12 participants between 15–60 minutes and 7 participants for more than one hour. Medical professionals spent mostly less than 15 minutes on these processes, while non- medical professionals mainly spent between 30–60 minutes on same processes Fitting process, repairs and knowledge about availability of wheelchair services in community - 38/ 44 participants were satisfied with the fitting process. Eighty-two participants (78%) had to make repairs with their wheelchairs, most often done by laypersons (54 cases) compared to 28 cases repaired by non-medical professionals. Nevertheless, majority of participants (n=65;79%) were satisfied with the repairs done. Web-Annex B: Data Tables and Appendices 23 Author and year JBI appraisal score Satisfaction with the service measures Results Interpretation The adult members of the Croatian Paraplegic and Tetraplegic Alliance who participated in the study were generally satisfied with the comprehensive wheelchair services. Suzuki, Lockerte & Braun 2000 2/6 (low) Survey/Questionnaire 25 (100%) of 25 respondents said they would recommend this seating clinic to other people in wheelchairs Responses to ‘what was found most helpful about the evaluation process’ question: - 13 comments concerned the therapist’s kindness and competence, 8 were complimentary about the assessment process, 5 mentioned that they were pleased to learn new ways to operate their equipment (which resulted in greater mobility), and 5 noted the helpfulness of having the vendor attend the assessment session to tell them about the latest equipment. - Nine respondents wrote something under the request for other comments or suggestions. Of these, 6 were positive (e.g., ‘‘keep up the good work’’ and ‘‘I’m grateful for your clinic’’) and 3 concerned the need for better follow-up by the vendor and clinic once equipment arrived. The Honolulu Wheelchair Seating Clinic at REHAB had positive feedback relating to clients’ satisfaction to the service and with additional recommendations for improvement. Table WB.9: Mixed methods studies on satisfaction with the service Author and year MMAT appraisal score Satisfaction with the service measures Results Interpretation Gowran et al. 2020 17/22 (high) Interviews The long waiting times throughout the process appeared to be a major cause of concern and affected by cancellations. The Irish wheelchair services characterised by an ad hoc, non-uniform wheelchair services and limited education and training was not found to be a satisfactory wheelchair service among wheelchair users. Survey/Questionnaire Just over half of the respondents reported that they were satisfied; a fourth of the participants reported dissatisfaction, with the remaining participants undecided. Some expressed satisfaction with their experience, praising the health professionals. The majority criticised the service providers, in particular the Health Service Executive (HSE), the unit responsible for health and personal social service provision for everyone living in Ireland with public funds. Majority of the participants expressed dissatisfaction with their experience of the whole process, describing it as an “Utter nightmare,” with many referencing the waiting time, stating “I believe the process was too long particularly as I am totally reliant on a wheelchair.” Some participants described the impact that unsatisfactory wheelchair service provision has on their lives as a human rights issue. - ‘The HSE has taken away power, choice and control from the very individuals that should have gained independence from these services. We have a right to a wheelchair that doesn’t make things Wheelchair Provision Guidelines 24 more painful and endangers our lives further’ - Many participants described their dissatisfaction with the long wait time for repairs, especially relating to the unavailability of “critical replacement parts” and their lack of mobility while repairs were being made Many described satisfactory service with caution highlighting the inconsistent and “hit and miss” standards of repair services received. Visagie et al. 2016 16/22 (high) QUEST 2.0 for adults and QUEST 2.1 for children Adult participants’ satisfaction with the wheelchair service significantly improved (p<0.01) in terms of service delivery, repairs and servicing and professional service but not with follow up services (p=0.128). Children’s satisfaction with the wheelchair scores significantly improved (p<0.01) in terms of advice with wheelchair selection, waiting time, repairs and servicing but not with training in use (p=0.052). The comprehensive wheelchair services based on the World Health Organization guidelines on wheelchair service provision in less resourced settings improved participants’ satisfaction with almost all the services except for follow up service among adults and training in use among children. Table WB.10: Qualitative study on satisfaction with the service Author and year JBI appraisal score Satisfaction with the service measures Results Interpretation Williams et al. 2017 8/10 (high) Interviews One Kenyan man received written booklets that helped him understand how to better manoeuvre his wheelchair. Some participants thought that new wheelchair recipients could benefit from training but that they themselves had figured out what they needed to know. Yet, even these experienced users had problems with some types of wheelchairs. Participants added that organizations should provide training to family members and that training should be provided on wheelchair maintenance. The Wheelchair service based on the WHO 2008 Guidelines could be more satisfactory among wheelchair users if a comprehensive training was provided. Web-Annex B: Data Tables and Appendices 25 Table WB.11: Pre-post study on satisfaction with the wheelchair Author and year JBI appraisal score Satisfaction with the wheelchair measures Results Interpretation Armstrong, Reisinger & Smith 2007 3/6 (moderate) Qualitative feedback Comments from the participants - No clothing guards: the open frame design of the wheelchair does not protect the user against dirt and moisture picked up by the rear wheels. - Push rim too close to wheel: proximity of the push rim to the rear wheel does not provide sufficient clearance for fingers. - Push rim diameter too small: the overall diameter of the rear wheel push rim. - Back too short: low back may not provide sufficient support and is not conducive for attendant propulsion. - Difficulties in traveling over gravel – front casters sink into loose gravel. - Weak brakes – brakes required reshaping and adjustment to function well. - Caster wheel availability – although this comment occurred only twice, the caster wheel is the one component that is not currently available locally. The adjustable wheelchair provided in the Center for International Rehabilitation (CIR) Whirlwind project had favourable feedback from adult wheelchair users except for some issues noted above. Table WB.12: Cohort studies on satisfaction with the wheelchair Author and year JBI appraisal score Satisfaction with the wheelchair measures Results Interpretation Toro, Eke & Pearlman 2016 6/8 (moderate) Satisfaction on mobility based on the Functional Mobility Assessment (FMA) Satisfaction with the means of mobility based on the FMA significantly improved in children with proxies (p < 0.001) and adults with proxies (p = 0.021) who received a wheelchair as compared to the waiting list The World Health Organization 8-steps in wheelchair service provision significantly improved satisfaction based on mobility among children and adults with proxies. Beaumont- White & Ham 1997 0/6 Past User Survey/Questionnaire 21 (78%) replied that the wheelchair was in working order and 18 (67%) said the wheelchair was meeting their needs. The wheelchairs provided by the GP and therapist referral for wheelchair needs and provision of powered wheelchairs service satisfied the wheelchair users. Wheelchair Provision Guidelines 26 Table WB.13: Cross sectional studies on satisfaction with the wheelchair Author and year JBI appraisal score Satisfaction with the wheelchair measures Results Interpretation Graham et al. 2021 3/6 (moderate) Quebec User Evaluation of Satisfaction with Technology (QUEST) More than half of adult wheelchair users reported being “quite” to “very satisfied” with their wheelchairs as part of the Telehealth Wheelchair Assessment Service (TWAS) Post et al. 1997 5/6 (high) Complaints from the participants Complaints about wheelchairs: 35.9% regarding to manual wheelchairs, 47.5% regarding to electric wheelchairs and 35.6% regarding to other wheelchairs. Complaints were about the weight, the quality, cannot be easily manoeuvred and too ugly. Complaints regarding electric wheelchair were electronical problems, low maximum speed and their size, especially their width that makes it impossible to enter, for example, many shops and houses of friends Complaints were mostly from complete tetraplegics (66.7%) and the remaining from other groups (Chi-square 13.81, P=0.003). Overall, the majority of the adults with SCI were not satisfied with the wheelchairs provided as part of the Dutch service delivery system which included domestic and car adaptations based on medical assessments and the provision of adaptive equipment. Salatino et al. 2016 3/6 (moderate) Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) v 2.0 QUEST average score on satisfaction on the wheelchairs was 4.3/5 (‘quite satisfied” or “very satisfied’) The powered wheelchairs provide in the Powered wheelchair effectiveness in real life (POWER) nine- step protocol service and wheelchair provision was found to be satisfactory by the participants. Stefenac, Grabovac & Fristedt 2018 3/6 (moderate) Questionnaire Participants involved in both wheelchair assessment and selection process, were more satisfied with respect to comfort of their wheelchairs (n=50;88%;χ2=14.05;df=1 ;p<0.001) and dimensions such as size (n=42;74%;χ2=7.29; df=1;p=0.007), width (n=38;67%;χ2=10.84;df=1;p=0.001), depth (n=46;81%;χ2=4.27;df=1;p=0.039) and the ease of adjustment of wheelchairs (n=39;70%;χ2=8.63;df=1;p=0.003) than participants not involved in both processes The comprehensive wheelchair services to the members of the Croatian Paraplegic and Tetraplegic Alliance resulted in satisfaction with their wheelchairs in terms of comfort, dimensions and ease of adjustment. Web-Annex B: Data Tables and Appendices 27 Table WB.14: Mixed methods studies on satisfaction with the wheelchair Author and year JBI appraisal score Satisfaction with the wheelchair measures Results Interpretation D’Innocenzo et al. 2021 14/22 (moderate) International Society of Wheelchair Professionals Minimum Uniform Data Set (ISWP-MUD) Mean and SD satisfaction of the 8-Steps group was 4.06 +/- 1.04 at baseline and 4.15 +/- SD 0.99 at endline. Mean and SD satisfaction of the standard of care (SOC) group was 3.88 +/- 0.83) at baseline and 4.28 +/- 0.64) at endline. No significant differences were found for the participants’ satisfaction rate about the device between both time points. No significant differences were found across all types of wheelchairs. The WHO 8 Steps group’s satisfaction with the wheelchair was not significantly different with the usual wheelchair. Visagie et al. 2016 16/22 (high) Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0 for adults and QUEST 2.1 for children Adult participants’ satisfaction with the wheelchair scores significantly improved (p<0.01) in terms of dimensions, weight, ease of adjustment, safety, durability, ease to use, comfort and effectiveness. Children’s satisfaction with the wheelchair scores significantly improved (p<0.01) in terms of size, weight, ease to push, aesthetics, ease to use, set up time, reliability and meeting their needs. The comprehensive wheelchair services based on the World Health Organization guidelines on wheelchair service provision in less resourced settings improved participants’ satisfaction with their manual wheelchairs after 3 and 5 months . Table WB.15: Qualitative study on satisfaction with the wheelchair Author and year JBI appraisal score Satisfaction with the wheelchair measures Results Interpretation Williams et al. 2017 8/10 (high) Interviews Participants reported that replacement parts were difficult to obtain. Some wheelchairs seemed poorly made and non-functional. Tires were a source of frustration, and users expressed preference for either inflatable or solid rubber tires. The Wheelchair service based on the WHO 2008 Guidelines provided wheelchairs that were not satisfactory to the wheelchair users. Wheelchair Provision Guidelines 28 Table WB.16: Review on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Graham et al. 2020 8/11 (moderate) Functional ability and Goal Achievement Scores (GAS) Patient-reported functional ability and goal achievement related to wheelchair prescription was reported to be similar between in-person- and tele-wheelchair assessment. Tele-wheelchair assessment is no different with in person assessment in terms of mobility and function Table WB.17: Pre-post study on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Armstrong, Reisinger & Smith 2007 3/6 (moderate) Distance travelled using the wheelchair; subject comments No significant change in travel using the study wheelchair is evident; average daily distance travelled remained between 2.5 km and 3.0 km throughout the study. No significant changes are evident in the daily activities as reported by the subjects. The Center for International Rehabilitation (CIR) Whirlwind project which included the provision of adjustable wheelchair and training of the participants did not have an effect on the distance usually travelled by the participants. Wheelchair skills activities (1 (cannot perform activity) to 5 (mastered activity)) Generally, the overall abilities of the subjects to perform the six wheelchair skill activities (wheelchair balancing, travel up incline, travel down incline, travel across incline, travel up step, travel down step) increased considerably over the 10 weeks of the field study. The Center for International Rehabilitation (CIR) Whirlwind project which included the provision of adjustable wheelchair and training of the participants improved the six wheelchair skills. Web-Annex B: Data Tables and Appendices 29 Table WB.18: Cohort studies on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Divanoglou et al. 2019 4/8 (moderate) Spinal Cord Independence Measure Self-Report: SCIM-SR Overall physical independence on completion of the programme was significantly higher compared to baseline (p = 0.019, d = 0.79) as indicated by their total SCIM-SR scores. Improvements were observed primarily in the mobility subscale where participants achieved an average of 14% improvement in mobility in room and toilet during the programme (p = 0.011, d = 0.85), which was further increased to 20% at 5 months follow-up (p = 0.005, d = 0.93). Active Rehabilitation training programme for community-dwelling individuals with SCI improved participants’ mobility and independence. Queensland Evaluation of Wheelchair Skills: QEWS Total QEWS scores on completion were significantly higher compared to baseline (p = 0.001; d = 0.86). Participants improved their ability to maintain balance on the back wheels (p = 0.003; d = 0.87), ascend and descend a gutter (p = 0.045; d = 0.72) and covered longer distances during a 6-minute push test (p = 0.003; d = 0.71). Authors’ note: A ceiling effect was observed in the first item (negotiating an indoor circuit) which was expected given that the recruitment requirements for the programme mandated that the participants were able to push a manual wheelchair independently. Active Rehabilitation training programme for community-dwelling individuals with SCI improved participants’ wheelchair skills Toro, Eke & Pearlman 2016 6/8 (moderate) Craig Handicap Assessment Recording Technique Short Form: CHART-SF Children with proxies (those not able to independently propel their wheelchairs) in the waitlist group reported a decrease in mobility and the children with proxies in the wheelchair group did not (p = 0.023) The World Health Organization 8-steps in wheelchair service provision did not contribute to the mobility of children with proxies in the waitlist group. Wheelchair Skills Test Questionnaire: WST-Q For participants in the wheelchair group who had a wheelchair at baseline, no significant differences between baseline and follow up were found in WST-Q capacity and performance scores for children with proxies and adults. 28 % of adults who received a wheelchair reported been able to go over a step and 45 % reported being able to go down a step. Only 11 % (6/53) reported that they were able to perform and hold a “wheelie” as well as turn while holding one. All Children (n = 4) reported not being able to perform a wheelie. The World Health Organization 8-steps in wheelchair service provision did not significantly improve wheelchair skills of children and adults in the wheelchair group. Wheelchair Provision Guidelines 30 Table WB.19: Cross sectional studies on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Bazant et al. 2017 6/6 (high) Activities of daily living (ADL) Wheelchair-related training was significantly associated with high ADL performance in Kenya (OR 3.2, 95%CI 1.3 to 8.4) but not in Philippines (OR 0.7, 95%CI 0.3 to 1.8). Wheelchair training based on the WHO 2008 Guidelines had inconsistent findings regarding ADLs in the two groups of population. Post et al. 1997 5/6 (high) Correlation between a short version of the Sickness Impact Profile (SIP)68 and satisfaction variables Bivariate correlations of Satisfaction Services and Satisfaction Procedures with the SIP68 are 70.25 (P<0.001) and 70.09 respectively, indicating that satisfaction with available services is related to better functional health status The Dutch service delivery system which included domestic and car adaptations based on medical assessments and the provision of adaptive equipment can lead to improved functional health status if the adults with SCI are satisfied with the services and procedures. Table WB.20: Case series on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Leochico & Valera 2020 6/8 (moderate) Qualitative feedback To ensure accurate understanding and safe execution of the exercises, the patient was asked to return the demonstrations, as necessary corrections and precautions were re-emphasized. The 30minute telerehabilitation session provided to two paraplegic patients was useful in teaching exercises to paraplegics and tetraplegics Web-Annex B: Data Tables and Appendices 31 Table WB.21: Mixed methods studies on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation D’Innocenzo et al. 2021 14/22 (moderate) Wheelchair Skills Test (WST) In the WHO 8-Steps group, the mean and SD WST-Q score decreased statistically from baseline 64.7 +/- 17.9 to endline (6 months) 58.6 +/- 17.2, with an average decrease of 6.03points +/- 10.4). This difference was statistically significant p<.001, d = .577. In the standard of care (SOC) group, the mean and SD WST-Q scores were 46.48 +/- 31.50) at baseline and 34.31 +/- 25.29, at endline; no statistical comparisons were undertaken At endline, the WHO 8 Steps group, between 74% and 94% of individuals reported the ability to do basic skills, between 36% and 86% performed intermediate skills and between 2% and 29% were able to perform more advanced skills. In the SOC group, between 42% and 66% of individuals were able to do basic skills, between 16% to 58% were able to do intermediate skills. In these groups, some skills were not achieved by any of the individuals. The WHO 8 Steps service provision did not result in significant improvements in wheelchair skills mobility; however, the wheelchair users were able to perform wheelchair skills from basic to advanced skills Visagie et al. 2016 16/22 (high) Functioning Everyday with a Wheelchair Questionnaire Participants responses to the questionnaire about the wheelchair size, fit, support and functional features significantly improved (p< 0.05) from pre to post test in terms of: - Carrying out daily routine - Matching comfort needs - Matching health needs - Safe and independent operation - Reach and carrying out tasks - Transfers - Carrying out personal care tasks - Getting around indoors and outdoors - Use of personal or public transportation - The biggest improvement was shown in comfort needs (44.3%); indoor mobility (43.2%); outdoor mobility (37.2%); safe, efficient, independent operation (33.5%); and transport (31.4%). - Users reported improved independence, integration and participation, and many felt that they were now contributing to household activities rather than being a burden. The comprehensive wheelchair services based on the World Health Organization guidelines on wheelchair service provision in less resourced settings improved mobility and function of the participants. Wheelchair Provision Guidelines 32 Table WB.22: Review on secondary complications Author and year JBI appraisal score Secondary complications measures Results Interpretation Graham et al. 2020 8/11 (moderate) Adverse events No studies reported adverse events or highly unsatisfactory outcomes Table WB.23: RCT on secondary complications Author and year JBI appraisal score Secondary complications measures Results Interpretation Hansen, Tresse & Gunnarsson 2004 10/11 (high) Questionnaire on presence and absence of pressure sores and wheelchair-related accidents during the past 12 months, as well as defects that the user believed could lead to accidents (near accidents) Pressure sores related to wheelchair sitting were not significantly different in intervention group and control groups (intervention: improved= 2, unchanged=58, worse=0; control: improved=1, unchanged=78, worse=2) (p=0.16) Accidents due to wheelchair condition were significantly different in intervention group and control groups, with less accidents in the intervention group (intervention: improved= 3, unchanged=57, worse=0; control: improved=0, unchanged=80, worse=1) (p=0.03) Near accidents (from wheelchair defects) were not significantly different in intervention group and control groups (intervention: improved= 4, unchanged=52, worse=4; control: improved=4, unchanged=75, worse=2) (p=0.65) Active OT intervention using a compiled checklist for safety, comfort and positioning, manoeuvrability and transportation for wheelchair variably affected possible complications of adult manual wheelchair users. Web-Annex B: Data Tables and Appendices 33 Table WB.24: Quasi-experimental study on secondary complications Author and year JBI appraisal score Secondary complications measures Results Interpretation Hoenig et al. 2005 8/9 (high) Shoulder pain There was no statistically significant difference in shoulder pain becoming worse between the intervention and control groups (p=0.59) Wheelchair service provided by a wheelchair rehabilitation expert consisting of a structured assessment, individually fitted wheelchair and orders for additional OT/PT, equipment, or home modifications if needed; wheelchair training and follow up, does not differ with usual care in preventing shoulder pain being worse than previous, among old and physically disabled people. Table WB.25: Cohort study on secondary complications Author and year JBI appraisal score Secondary complications measures Results Interpretation Toro, Eke & Pearlman 2016 6/8 (moderate) Presence/ absence of pressure sores 279 participants reported not having a pressure sore, 23 reported having a pressure sore, and 7 had missing information at baseline. 289 participants reported not having a pressure sore, 18 reported having a pressure sore and 2 had missing information at follow up. No significant differences were found in presence/absence of pressure sores between the waiting list and the wheelchair group for all types of participants, p = 0.276. The World Health Organization 8-steps in wheelchair service provision did not significantly improve (decrease) number of pressure sores in both groups. Table WB.26: Cross sectional study on secondary complications Author and year JBI appraisal score Secondary complications among users measures Results Interpretation Bazant et al. 2017 6/6 high Falls Wheelchair-related training was significantly associated with increased odds of serious vs no falls (OR 2.5, 95% CI 1.4 to 4.5) but not with non-serious vs no falls (OR 1.7, 95%CI 0.8 to 3.5) in the Philippines No relationship with training and falls in Kenya Wheelchair training based on the WHO 2008 Guidelines had inconsistent findings regarding falls outcomes in the two groups of population. Wheelchair Provision Guidelines 34 Table WB.27: Qualitative study on secondary complications Author and year JBI appraisal score Secondary complications among users measures Results Interpretation Williams et al. 2017 8/10 (high) Interviews (adverse events) A student from the Philippines, who had paraplegia resulting from a spinal cord injury and lived in a dormitory with other persons with disabilities, described two different experiences with fitting. First, he received a hospital-type wheelchair that was too large and caused “bed sores,” so he started using crutches instead. Wheelchair service based on the WHO 2008 Guidelines had complications in one of the participants. Table WB.28: Cross sectional studies on percentage of eligible population receiving referral and access to wheelchair services Author and year JBI appraisal score Percentage of eligible population receiving referral and access to wheelchair services Results Interpretation Beaumont- White & Ham 1997 0/6 Counts/percentages from the Past User Survey Questionnaire Eighteen (67%) said they had received a home visit before the wheelchair had been issued and 11 (41%) said they had had a trial drive of the wheelchair. Some 20 (74%) had received no therapy training on the handling of the wheelchair and 17 (63%) welcomed an annual therapy visit in the future. Only 17 (63%) said they had been given a contact number for the service. Seven (26%) said they called the approved repairer (AR) when they needed repairs and 13 (48%) said they contacted the service. 23 (85%) replied that they checked the wheelchair themselves initially if there was a fault. Six (22%) transported the wheelchair in a car and 7 (26%) in a bus, all noting that transportation on hospital vehicles was disallowed. Some 24 (89%) said they welcomed an annual check and 25 welcomed a new information booklet about the wheelchair. The GP and therapist referral for wheelchair needs and provision of powered wheelchairs service did not comprehensively cover the needs of the indoor powered wheelchair users (sample of 1% of the population) Present User Survey/Questionnaire Total of 8 (47%) replies were received from the 17 Disablement Service Centres (DSCs), only 1 (13%) of which issued a locally devised sheet together with Her Majesty’s Stationery Office (HMSO) leaflet regarding the do’s and don’ts for charging batteries and also the manufacturer’s booklet. Four (50%) issued the DHSS leaflet only and 3 (38%) issued the DHSS leaflet and the manufacturer’s booklet. Total of 23 (64%) replies were received from 36 district wheelchair services across England and Wales, 4 (17%) of which had locally devised an information sheet or booklet on general maintenance, 2 (9%) of these also gave out the DHSS leaflet and the manufacturer’s booklet. Ten (43%) issued the manufacturer’s booklet alone, 3 (1%) issued DHSS leaflet alone and 6 (26%) issued both of these. The wheelchair service information sheet or booklet needs improvement in terms of content and format; the role of the referring health practitioners needs to be strengthened. Web-Annex B: Data Tables and Appendices 35 Author and year JBI appraisal score Percentage of eligible population receiving referral and access to wheelchair services Results Interpretation Stefenac, Grabovac & Fristedt 2018 3/6 (moderate) Questionnaire Only 45 participants (43%) received professional wheelchair education and wheelchair skills training, i.e. in 22 cases this was provided by medical professionals, in 14 cases by non-medical professionals and in nine participants by another person. The comprehensive wheelchair services to the members of the Croatian Paraplegic and Tetraplegic Alliance were only received by less than half of those eligible for the service. Table WB.29: RCT on disruption in use including wheelchair breakdown Author and year JBI appraisal score Disruption in use including wheelchair breakdown measures Results Interpretation Hansen, Tresse & Gunnarsson 2004 10/11 (high) Actions noted Incidence of exchange or complementing accessories significantly different in between groups with more in the intervention group (intervention= 30, control= 17; p=0.004) Exchange of wheelchair, same model not significantly different in between groups (intervention= 15, control= 12; p=0.18) Exchange of wheelchair, new model not significantly different in between groups (intervention= 13, control= 9; p=0.11) Complementary wheelchair prescribed not significantly different in between groups (intervention= 2, control= 6; p=0.28) Reconditioning of wheelchair not significantly different in between groups (intervention= 3, control= 2; p=0.45) Repair by OT significantly different in between groups with more in the intervention group (intervention= 18, control= 9; p=0.01) Repair by technician not significantly different in between groups (intervention= 3, control= 2; p=0.45) Active OT intervention using a compiled checklist for safety, comfort and positioning, manoeuvrability and transportation for wheelchair variably impacted wheelchair use among adult manual wheelchair users due to different reasons. Wheelchair Provision Guidelines 36 Table WB.30: Pre-post study on disruption in use including wheelchair breakdown Author and year JBI appraisal score Disruption in use including wheelchair breakdown measures Results Interpretation Armstrong, Reisinger & Smith 2007 3/6 (moderate) Frequency of repair for any component The frequency of repair for any specific component for all of the study wheelchairs was no greater than 4, with the exception of the brake handles. The brake components were not manufactured to specifications and were expected to be problematic. The brake handles were reshaped to improve their function as each study wheelchair was issued to each subject at Visit 1. The brake handles were repaired on 83 wheelchairs at Visit 2 and again on 21 wheelchairs during Visit 3. Repair of the brake handles was also reported 3 times by subjects at Visit 2 and 1 time at Visit 3 The adjustable wheelchair provided in the Center for International Rehabilitation (CIR) Whirlwind project had favourable results except for the brake handles which needed repair in most of the participants. Table WB.31: Cohort study on disruption in use including wheelchair breakdown Author and year JBI appraisal score Disruption in use including wheelchair breakdown measures Results Interpretation Toro, Eke & Pearlman 2016 6/8 (moderate) Frequency of repair Few participants self-reported needing repairs. The World Health Organization 8-steps in wheelchair service provision did not have significant number of wheelchair repairs needed. Table WB.32: Cross sectional study on disruption in use including wheelchair breakdown Author and year JBI appraisal score Disruption in use including wheelchair breakdown measures Results Interpretation Beaumont- White & Ham 1997 0/6 Frequency of repair Seven (26%) said they called the approved repairer when they needed repairs and 13 (48%) said they contacted the service. 23 (85%) replied that they checked the wheelchair themselves initially if there was a fault. Eight (30%) had no repairs in the last 12 months but the remainder had had either 1 (30%), 2 or 3 (30%) or more (10%) in this period. The GP and therapist referral for wheelchair needs and provision of powered wheelchairs service needed to be reviewed and improved to meet needs of users. Web-Annex B: Data Tables and Appendices 37 Table WB.33: Mixed methods study on disruption in use including wheelchair breakdown Author and year MMAT appraisal score Disruption in use including wheelchair breakdown measures Results Interpretation D’Innocenzo et al. 2021 14/22 (moderate) Breakdown and Adverse Consequences Questionnaire: BAC-Q In the WHO 8 steps group, 4 participants (28.8%) reported having wheelchairs that stopped functioning correctly or that broke at 3 to 6 months; common breakdown reported were one- or two-wheel locks malfunctioning and bearing problems; repairs included tire replacement and repairs of broken wheels. In the WHO 8 steps group, 72.7% of participants reported performing wheelchair maintenance over 6- months. In the SOC group, 2 (8%) had wheelchairs that stopped functioning or had broken wheels. In the SOC group, 9 (37.5%) participants reported performing maintenance activities, 4 (16.7%) participants reported wiping or washing the wheelchair followed by 2 (8.3%) who added air to the tires. Gowran et al. 2020 17/22 (high) Interview Once the wheelchair and seating were provided there appeared an underlying fear of the wheelchair breaking down with inadequate repair services. - Poor repair services impeded independent living and quality of life leaving users feeling “scared,” like they were “putting your [their] life on the line.” Mark explained that the repair services were seen as the biggest problem of all. Simon noted how he was “lucky” to still live at home otherwise he’d be “totally stuck.” - Jim expressed feelings of being “trapped” and “very vulnerable” depending on where he broke down. Sarah too, expressed that poor repair services affected her plans when going out, worrying that she would “come back safe. In addition, the poor repair services did not appear to be supported by any adequate loan system for a backup wheelchair while a wheelchair is being repaired. The Irish wheelchair services characterised by an ad hoc, non-uniform wheelchair services and limited education and training had poor repair services which the wheelchair users were worried about. Survey/Questionnaire Many participants described their dissatisfaction with the long wait time for repairs, especially relating to the unavailability of “critical replacement parts” and their lack of mobility while repairs were being made Wheelchair Provision Guidelines 38 Table WB.34: Cohort study on wheelchair abandonment Author and year JBI appraisal score Wheelchair abandonment measures Results Interpretation Verza et al. 2006 2/8 (low) Data from assistive technologies database: Number of wheelchairs obtained and abandoned Number of electric wheelchairs obtained=2 and abandoned=1 from 1997 to 1999; number of electric wheelchairs obtained=11 and abandoned=0 from 2000-2002 Number of manual wheelchairs obtained=12 and abandoned=3 from 1997 to 1999; number of manual wheelchairs obtained=28 and abandoned=2 from 2000-2002 The Assistive Device Evaluation and Prescription Protocol for patients with multiple sclerosis (MS) increased the number of wheelchairs obtained and reduced wheelchair abandonment from 1 to 0 (electric wheelchairs) and 3 to 2 (manual wheelchairs) Table WB.35: Cross sectional study on wheelchair abandonment Author and year JBI appraisal score Wheelchair abandonment measures Results Interpretation Salatino et al. 2016 3/6 (moderate) Counts At the time of the interview, six (7.6%) were no longer using the wheelchair (a very low abandonment rate in comparison with those observed in other published studies) The Powered wheelchair effectiveness in real life (POWER) nine-step protocol service resulted in lower abandonment numbers compared with those in other studies according to the authors of the study Table WB.36: Qualitative study on wheelchair abandonment Author and year JBI appraisal score Wheelchair abandonment measures Results Interpretation Williams et al. 2017 8/10 (high) Interviews One Kenyan woman stated that lack of spare parts and maintenance, coupled with wear and tear resulting from wheelchairs not being suited to the environment, resulted in a cycle of obtaining new wheelchairs The Wheelchair service based on the WHO 2008 Guidelines had a wheelchair that had to be replaced due to lack of parts, usage and not being suitable in the environment. Web-Annex B: Data Tables and Appendices 39 Table WB.37: Cohort on inclusion, participation and/or quality of life Author and year JBI appraisal score Inclusion, participation and/or quality of life measures Results Interpretation Divanoglou et al. 2019 4/8 (moderate) Moorong Self-efficacy Scale (MSES) No changes in the total MSES score, or in two out of three constructs of the scale (general and social constructs). Participants achieved medium size improvements in the personal function construct (includes household participation and getting out of the house) of the MSES at completion (p = 0.004, d = 0.76) and at 5-month follow-up (p = 0.04, d = 0.63) as compared to baseline A 7-day Active Rehabilitation for persons with spinal cord injury significantly improved personal function construct of the MSES but not the total MSES score. Toro, Eke & Pearlman 2016 6/8 (moderate) World Health Organization Quality of Life-BREF (WHOQOL-BREF) Bahasa Indonesia version Both male and female adults who received a wheelchair reported significantly better environment health than those adults on the waiting list as measured by the WHOQOL-BREF. Female adults who received a wheelchair reported had significantly increased physical health than those females who were on the waiting list. No significant changes were observed in the other domains: psychological and social relationships The World Health Organization 8-steps in wheelchair service provision had varying effects on different domains of quality of life. Table WB.38: Cross sectional study on inclusion, participation and/or quality of life Author and year JBI appraisal score Inclusion, participation and/or quality of life measures Results Interpretation Graham et al. 2021 3/6 (moderate) Quebec User Evaluation of Satisfaction with Technology (QUEST) The Telehealth Wheelchair Assessment Service (TWAS) enabled the adult wheelchair users’ participation in activities and spaces they valued (62/92, 67%) Wheelchair Provision Guidelines 40 Table WB.39: Mixed methods study on inclusion, participation and/or quality of life Author and year MMAT appraisal score Inclusion, participation and/or quality of life measures Results Interpretation Gowran et al. 2020 17/22 (high) Interview Importance of wheelchair and seating for daily performance was expressed by all participants in terms of “freedom,” “independence,” “quality of life” and mental health - The wheelchair enabled people to get out of the house, go to work, meet friends and socialise. For Lisa (mother), having a wheelchair enabled them to function “effectively as a family.” Without the wheelchair, Jim said he “can’t move.” This was reiterated by Mark as he explained that with the wheelchair he was able to “participate in society,” and without his specialised wheelchair he “can’t operate.” Simon expressed that his wheelchair gave him a greater “quality of life” and “independence,” stating, [you] “have to have quality of life, it has to come first.” The wheelchair provided as part of the Irish wheelchair services improved participation in society, independence and quality of life of wheelchair users. Visagie et al. 2016 16/22 (high) Focus group Users reported improved independence, integration and participation, and many felt that they were now contributing to household activities rather than being a burden. The comprehensive wheelchair services based on the World Health Organization guidelines on wheelchair service provision in less resourced settings improved independence, integration and participation in activities Table WB.40: Quasi-experimental study on empowerment and self-esteem Author and year JBI appraisal score Empowerment and self- esteem measures Results Interpretation Hoenig et al. 2005 8/9 (high) Wheelchair confidence (Likert scale) There was no statistically significant difference in wheelchair confidence between the intervention and control groups (p=0.51) Wheelchair service provided by a wheelchair rehabilitation expert consisting of a structured assessment, individually fitted wheelchair and orders for additional OT/PT, equipment, or home modifications if needed; wheelchair training and follow up, did not differ with usual care in wheelchair confidence measure among old and physically disabled people. Web-Annex B: Data Tables and Appendices 41 Table WB.41: Cohort study on empowerment and self-esteem outcomes Author and year JBI appraisal score Empowerment and self- esteem outcomes Results Interpretation Divanoglou et al. 2019 4/8 (moderate) Wheelchair Skills Test- Questionnaire (WST-Q) version 4.3 confidence scores A 14% increase in wheelchair skills confidence between baseline and completion (p = 0.092; d = 0.61), which reached a 25% improvement at 5-month follow- up (p = 0.003; d = 0.96) was found. A 7-day Active Rehabilitation (AR) training programme increased wheelchair skills confidence among community dwelling people with spinal cord injury Table WB.42: Cross sectional study on empowerment and self-esteem outcomes Author and year JBI appraisal score Empowerment and self- esteem outcomes Results Interpretation Salatino et al. 2016 3/6 (moderate) Psychosocial Impact of Assistive Devices Scale (PIADS) All three average scores were positive (1.1 for ability, 1 for adaptability, and 1 for self-esteem), which means that the powered wheelchair increased these dimensions “a little.” The Powered wheelchair effectiveness in real life (POWER) nine-step protocol service was found to increase the user’s ability, adaptability and self-esteem. Wheelchair Provision Guidelines 42 Table WB.43: Characteristics of included studies Author and year Study location Participants Service evaluation description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/ study findings Mixed methods study Di Marco et al., 2003 Australia In patients undergoing rehabilitation and outpatients attending occupational therapy for the prescription of a replacement wheelchair N= 128 All clinical and technical staff within the occupational therapy department participated in the evaluation Defining the objectives of wheelchair prescription Development of clinical guidelines Development of standards of practice and measurement tools Development of a performance monitoring tool NA Ability of service providers to carry out service delivery (focus group) Mobility and/or Posture and/or Function (focus group) Mobility and/or Posture and/or Function (Qualitative information) Time and/or Cost for people who use wheelchairs (Qualitative information) Wheelchair abandonment (Counts) Ability of service providers to make service development decisions (Qualitative information) Ability of service providers to advocate for service resources (Qualitative information) Inclusion, participation and/or quality of life (Qualitative information) Initial measurement 3 month follow up 12 month follow up It is critical for the individual with a SCI to receive a wheelchair that best matches their unique set of needs and abilities in order to enable their engagement in valued occupations. The development and utilisation of standards of practice to monitor performance in wheelchair prescription is suggested as a useful method by which service providers can meet the challenges of wheelchair prescription and demonstrate the unique values and difficulties of this intervention. For such systems to work to their fullest potential, appropriate support both from clinical staff and management within the organisation is required. Web-Annex B: Data Tables and Appendices 43 Table WB.44: Mixed methods study on mobility and/or posture and/or function Author and year MMAT appraisal score Mobility and/or Posture and/or Function Results Interpretation Di Marco et al. 2003 5/17 (low) Focus group Documentation of the goals and objectives of wheelchair prescription fostered a common understanding amongst staff about the critical and valued aspects of wheelchair prescription. It also provided an essential framework for the evaluation process, as each step related back to the definition of the goals and objectives of wheelchair prescription. The 3-month follow up proved particularly timely. It allowed the wheelchair user enough time to identify any problems with the wheelchair. These issues could then be addressed effectively before they became entrenched and more difficult to change. In situations where problems were not identified therapists could be proactive and suggest changes to improve the fit between the wheelchair user and the wheelchair. This was most evident for first time wheelchair users whose improving strength, balance and wheelchair skills led to adjustments of their wheelchair. Staff reported telephone reviews provided an opportunity to establish the wheelchair user’s level of comfort, their satisfaction and whether the wheelchair was in use. Face-to-face reviews had the added benefit of allowing prescribing therapists to assess the wheelchair user’s sitting posture and wheelchair durability issues. Table WB.45: Mixed methods study on ability of service providers to carry out service delivery Author and year MMAT appraisal score Ability of service providers to carry out service delivery Results Interpretation Di Marco et al. 2003 5/17 (low) Focus group Service delivery practices were influenced by the use of the performance monitoring tool as a routine practice in wheelchair prescription. The clinical guidelines and measurement tools within the performance monitoring tool became a guide to practice as well as a tool to monitor performance. In this way, a consistent focus was placed on the particular aspects of wheelchair prescription considered critical to the achievement of successful outcomes. These clinical tools also provided an invaluable means for enhancing staff training and education. Therapists were concerned that rigid or prescriptive guidelines may restrict the ability to meet the highly individualised needs of the wheelchair user. This issue was resolved by structuring guidelines to focus on the clinical considerations of wheelchair prescription. Wheelchair Provision Guidelines 44 Table WB.46: Mixed methods study on time and/or cost for people who use wheelchairs Author and year MMAT appraisal score Time and/or Cost for people who use wheelchairs Results Interpretation Di Marco et al. 2003 5/17 (low) Qualitative information Although this paper does not aim to present detailed outcome data, some trends were evident early and led to a number of practical cost-saving changes. In particular, through the organised review process, it was noted that there were two groups of individuals who showed a trend toward not using their wheelchair at the time of the 12 month follow up. These individuals were those who received a motorised as well as a manual wheelchair and those who experienced significant functional change following wheelchair issue. Data regarding non-use of wheelchairs at 12 months post issue was presented to an interdisciplinary team representing the spinal injury rehabilitation unit. This led to a change in unit policy to address this problem; namely, introduction of a system of long-term wheelchair loan and a stricter review process regarding each wheelchair user’s need for two wheelchairs. These changes to policy have been working successfully and have led to considerable cost savings. Table WB.47: Mixed methods study on wheelchair abandonment Author and year MMAT appraisal score Wheelchair abandonment measures Results Interpretation Di Marco et al. 2003 5/17 (low) Counts Although this paper does not aim to present detailed outcome data, some trends were evident early and led to a number of practical cost-saving changes. In particular, through the organised review process, it was noted that there were two groups of individuals who showed a trend toward not using their wheelchair at the time of the 12 month follow up. These individuals were those who received a motorised as well as a manual wheelchair and those who experienced significant functional change following wheelchair issue. Web-Annex B: Data Tables and Appendices 45 Table WB.48: Mixed methods study on ability of service providers to make service development decisions Author and year MMAT appraisal score Ability of service providers to make service development decisions measures Results Interpretation Di Marco et al. 2003 5/17 (low) Qualitative information Documentation of the goals and objectives of wheelchair prescription fostered a common understanding amongst staff about the critical and valued aspects of wheelchair prescription. It also provided an essential framework for the evaluation process, as each step related back to the definition of the goals and objectives of wheelchair prescription. Although this paper does not aim to present detailed outcome data, some trends were evident early and led to a number of practical cost-saving changes. In particular, through the organised review process, it was noted that there were two groups of individuals who showed a trend toward not using their wheelchair at the time of the 12 month follow up. These individuals were those who received a motorised as well as a manual wheelchair and those who experienced significant functional change following wheelchair issue. Data regarding non-use of wheelchairs at 12 months post issue was presented to an interdisciplinary team representing the spinal injury rehabilitation unit. This led to a change in unit policy to address this problem; namely, introduction of a system of long-term wheelchair loan and a stricter review process regarding each wheelchair user’s need for two wheelchairs. These changes to policy have been working successfully and have led to considerable cost savings. Table WB.49: Mixed methods study on ability of service providers to advocate for service resources Author and year MMAT appraisal score Ability of service providers to advocate for service resources Results Interpretation Di Marco et al. 2003 5/17 (low) Qualitative information Although this paper does not aim to present detailed outcome data, some trends were evident early and led to a number of practical cost-saving changes. In particular, through the organised review process, it was noted that there were two groups of individuals who showed a trend toward not using their wheelchair at the time of the 12 month follow up. These individuals were those who received a motorised as well as a manual wheelchair and those who experienced significant functional change following wheelchair issue. Data regarding non-use of wheelchairs at 12 months post issue was presented to an interdisciplinary team representing the spinal injury rehabilitation unit. This led to a change in unit policy to address this problem; namely, introduction of a system of long-term wheelchair loan and a stricter review process regarding each wheelchair user’s need for two wheelchairs. These changes to policy have been working successfully and have led to considerable cost savings. Wheelchair Provision Guidelines 46 Table WB.50: Mixed methods study on inclusion, participation and/or quality of life Author and year MMAT appraisal score Inclusion, participation and/or quality of life measure Results Interpretation Di Marco et al. 2003 5/17 (low) Qualitative information Both first-time users and experienced users demonstrated high levels of participation. The impact of this evaluation of wheelchair prescription practices was evidenced by improvements in: (i) service delivery practices; (ii) wheelchair user participation; and (iii) accountability and justification of service delivery practices. Table WB.51: Characteristics of included studies Author and year Study location Participants Wheelchair service and provision description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Randomised controlled trials Trefler et al. 2010 USA N= 24 elderly wheelchair users N= 12 wheelchair users received individually prescribed and fitted wheelchair systems. N= 12 wheelchair users in control group (before individually prescribed wheelchair system was provided). Mobility and/or Posture and/or Function (reach test results) Satisfaction w/chair (Quebec Users Evaluation of Satisfaction with Technology: QUEST) None Once they had received their wheelchair, the beginning of the subjects’ 3-month interval was established. This established the dates for follow-up data collection for the second visit, and the subsequent 3-month appointment for the third visit. Elderly people in institutionalized settings benefit from an individually fitted manual wheelchair system. An individually fitted wheelchair system that includes a wheelchair and seating components can enhance an elderly person’s independent mobility, forward and lateral reach quality of life, and satisfaction with technology. Quasi-experimental studies Hoenig, 2005 USA N = 84 Patients requiring standard manual wheelchair N= 53 Patients received the intervention, which took 1.0 to 1.5 hours and included five components not typically present under usual care, based on the theoretical model, current N = 31 Received standard care and standard wheelchair None Secondary complications including falls and /or injuries (wheelchair confidence) Empowerment, self-esteem Measurement at 2 weeks, 3 months, and 6 months after receiving wheelchair. New wheelchair owners used the wheelchair more often if they received it from an expert therapist using a multifactorial intervention Web-Annex B: Data Tables and Appendices 47 Author and year Study location Participants Wheelchair service and provision description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings practices in special wheelchair clinics, and available literature. Components were: (1) a PT/OT with wheelchair expertise; (2) a structured assessment; (3) an individually fitted wheelchair and orders for additional OT/PT, equipment, or home modifications if needed; (4) wheelchair training; (5) follow up. (wheelchair confidence) Mixed methods study Greenhalgh et al., 2021 USA N = 24 Female wheelchair users N/A N/A Satisfaction with w/chair (questionnaire) Satisfaction with service (focus group) Mobility and/or Posture and/or Function (focus group) Inclusion, participation and/or quality of life (questionnaire) Only one initial measurement This study of women who use mobility aids, particularly wheelchairs, reports the need for technology that conforms to the female anatomy, is easier to use, and includes gender-supportive services. Additionally, study participants desired more access to female technology providers and customizable wheelchairs to fit to their specific lifestyles. Greer, Brasure & Wilt 2012 USA 24 studies and 12 key informants None Wheelchair abandonment The major finding of this work is the limited number of studies designed to evaluate the effectiveness of the recommended practices. Research is needed to investigate and identify factors that contribute to effective wheeled mobility service delivery. The importance of Wheelchair Provision Guidelines 48 Author and year Study location Participants Wheelchair service and provision description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings funding this type of research needs to be recognized and reliable, and valid outcome measures need to be developed. Involving the individual in the prescription process may reduce the risk that the device will be abandoned. Table WB.52: Randomised controlled trial study on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or Posture and/or Function measures Results Interpretation Trefler et al. 2010 8/11 (moderate) Survey/ Questionnaire Both groups became faster over the course of the study time period; however; Group B improved more dramatically for both tests after receiving their wheelchair system. A significant difference was found across time between the groups for straight driving (p=.03) Those with a planar seat cushion had an increase in their lateral reach ranging from 45 to 70.1 mm. Forward reach increased after receipt of the wheelchair system, and as shown by Group A, continued to increase at the 3-month visit. This change over time was close to significant (p = .05) An individually fitted wheelchair system that includes a wheelchair and seating components can enhance an elderly person’s independent mobility, forward and lateral reach quality of life, and satisfaction with technology Table WB.53: Mixed methods study on mobility and/or posture and/or function Author and year MMAT appraisal score Mobility and/or Posture and/or Function Results Interpretation Greenhalgh et al. 2021 10/17 (moderate) Survey Close to one-third of women (29.2%; 7) reported usability-related difficulties related to manoeuvring themselves or specific items (i.e. groceries at the store). Web-Annex B: Data Tables and Appendices 49 Table WB.54: Mixed methods study on satisfaction with service Author and year MMAT appraisal score Satisfaction with service measure Results Interpretation Greenhalgh et al. 2021 10/17 (moderate) Semi-structured focus group Participants also reported that a desired service was not provided by their health care provider (66.7%; 16) or that the service was not provided in time (37.5%; 9). With regard to physical and mental well-being, 66.7% (16) felt their gender, generally, made it hard for them to be taken seriously. Table WB.55: RCT on satisfaction with wheelchair Author and year JBI appraisal score Satisfaction with wheelchair Results Interpretation Trefler et al. 2010 8/11 (moderate) The Quebec Users Evaluation of Satisfaction with Technology (QUEST) Both groups became more satisfied with their technology after receipt of the new wheelchair system. A statistically significant difference is seen between the groups at Visit 2 when Group A had their new wheelchair system, and the other group had yet to receive it. For Group A, the satisfaction seemed to be maintained 3 months post receipt. Both groups became more satisfied over time. Table WB.56: Mixed methods study on satisfaction with wheelchair Author and year MMAT appraisal score Satisfaction with wheelchair measure Results Interpretation Greenhalgh et al. 2021 10/17 (moderate) Semi-structured focus group With regard to mobility aid appeal, 45.8% (11) reported no satisfaction with their mobility aid, while 54.2% (13) reported a mobility aid that does not work and 62.5% (15) reported one that is difficult to use. Table WB.57: Quasi-experimental study on secondary complications Author and year JBI appraisal score Secondary complications measures Results Interpretation Hoenig et al. 2005 8/9 (high) Shoulder pain There was no statistically significant difference in shoulder pain becoming worse between the intervention and control groups (p=0.59) Wheelchair service provided by a wheelchair rehabilitation expert consisting of a structured assessment, individually fitted wheelchair and orders for additional OT/PT, equipment, or home modifications if needed; wheelchair training and follow up, does not differ with usual care in preventing shoulder pain being worse than previous, among old and physically disabled people. Wheelchair Provision Guidelines 50 Table WB.58: Mixed methods study on inclusion, participation and/or quality of life Author and year MMAT appraisal score Inclusion, participation and/or quality of life measure Results Interpretation Greenhalgh et al. 2021 10/17 (moderate) Semi-structured focus group When asked about the impact of disability on different aspects of independent living, 41.7% of participants completely agreed that technology makes life easy and convenient, while 37.5% completely disagreed that it makes life complicated. When asked if technology provided people with control over their daily lives and provided comfort, 37.5% of participants completely agreed and 33.3% agreed. Approximately 29.2% agreed and 29.2% completely disagreed that technology makes life stressful, with 29.2% completely agreeing that it brings people together. Twenty-five percent of the women in the study completely disagreed that technology creates isolation. When asked about whether technology increases confidence and personal safety, 33.3% of participants completely agreed Table WB.59: Mixed methods study on wheelchair abandonment Author and year MMAT appraisal score Wheelchair abandonment measure Results Interpretation Greer, Brasure & Wilt 2012 5/17 (low) Literature Involving the individual in the prescription process may reduce the risk that the device will be abandoned. Table WB.60: Quasi-experimental study on empowerment and self-esteem Author and year JBI appraisal score Empowerment and self- esteem measures Results Interpretation Hoenig et al. 2005 8/9 (high) Wheelchair confidence (Likert scale) There was no statistically significant difference in wheelchair confidence between the intervention and control groups (p=0.51) Wheelchair service provided by a wheelchair rehabilitation expert consisting of a structured assessment, individually fitted wheelchair and orders for additional OT/PT, equipment, or home modifications if needed; wheelchair training and follow up, did not differ with usual care in wheelchair confidence measure among old and physically disabled people. Web-Annex B: Data Tables and Appendices 51 Table WB.61: Characteristics of included studies Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Mixed methods Di Marco et al., 2003 Australia In patients undergoing rehabilitation and outpatients attending occupational therapy for the prescription of a replacement wheelchair N= 128 All clinical and technical staff within the occupational therapy department participated in the evaluation Defining the objectives of wheelchair prescription Development of clinical guidelines Development of standards of practice and measurement tools Development of a performance monitoring tool Mobility and/or Posture and/or Function Secondary complications including falls and/or injuries Satisfaction with w/chair Disruption in use including due to wheelchair breakdown Inclusion, participation and/or quality of life Satisfaction with service Time and/or Cost for people who use wheelchairs Initial measurement 3 month follow up 12 month follow up It is critical for the individual with a SCI to receive a wheelchair that best matches their unique set of needs and abilities in order to enable their engagement in valued occupations. The development and utilisation of standards of practice to monitor performance in wheelchair prescription is suggested as a useful method by which service providers can meet the challenges of wheelchair prescription and demonstrate the unique values and difficulties of this intervention. For such systems to work to their fullest potential, appropriate support both from clinical staff and management within the organisation is required. Randomised Controlled Trials (RCTs) Hansen, Tresse & Gunnarsson, 2004 Sweden N = 141 Individuals >16 years of age using a manually propelled wheelchair. N= 60 Wheelchair users received the standard intervention and the active intervention. The active intervention consisted of a one-hour OT- N= 81 Wheelchair users received the standard intervention, whereby an OT made a follow-up Disruption in use including due to wheelchair breakdown (OT- registered actions) None The accident rate, extent of pressure sores, number and extent of repairs, Most wheelchairs will develop defects. If suitability to the user is also considered, almost all wheelchairs will become inappropriate Wheelchair Provision Guidelines 52 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings initiated check-up of the wheelchair, following a compiled checklist for safety, comfort and positioning, manoeuvrability and transportation, within three months of randomisation visit a few weeks after wheelchair delivery to confirm function a user satisfaction. If satisfactory, no further visits were scheduled. Secondary complications including falls and/or injuries (questionnaire) Satisfaction with w/chair (questionnaire) reconditioning, adjustments as well as user satisfaction were measured initially and at one year. and inadequate. However, the user and carer are often unable to determine when action is needed. An active, structured check-up seems to reduce accidents. Further research should focus on determination of a suitable interval between check-ups. Case series Leochico & Valera, 2020 Philippines N = 2 Patient A was a 28-year-old female. Patient B was a 28-year-old male. N = 2 Towards the end of the visit, the wheelchair assessor provided verbal and written recommendations to address pertinent wheelchair and clinical problems observed during the follow-up. Specific home instructions were given on proper wheelchair care and use (i.e., transfer, propulsion, and pressure- relief techniques), strengthening exercises, and follow-up schedule either face-to-face or via telerehabilitation, depending on the evaluation. N/A Mobility and/or Posture and/or Function (telerehabilitation survey and observations) Wheelchair longevity (telerehabilitation survey and observations) Satisfaction with service (telerehabilitation survey and observations) Time and/or Cost for people who use wheelchairs Before, during, and after telerehabilitati on session As take-away message, telerehabilitation using locally available low-cost technology is feasible in the background of limited resources in a developing country. Rehabilitation providers should be aware of how telerehabilitation can be tailored to the needs and technical capacities of their healthcare staff and patients, while being creative with available resources and compliant with ethical principles of telemedicine at the same time. Web-Annex B: Data Tables and Appendices 53 Table WB.62: Case series study on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or Posture and/or Function Results Interpretation Leochico & Valera 2020 6/8 (moderate) Telerehabilitation observations/ demo-return demo On follow-up through telerehabilitation, patient A had no new neurologic symptoms and her sacral pressure ulcers had partially resolved based on pictures that were sent to the wheelchair assessor. It was learned that patient A seldom carried out the home exercise program taught to her during her inpatient rehabilitation at PGH as she admitted to have forgotten some of the exercises and did not want to bother her family to assist her in the exercises. It was observed that she continued to have difficulty in transferring to and from the wheelchair due to improper technique. Hence during the telerehabilitation session, the wheelchair assessor demonstrated the step-by-step process of transferring from bed to wheelchair using a sliding board. Practical home exercises, such as seated push-ups and strengthening of upper limb muscles with make-shift weights, were also demonstrated real-time on video. To ensure accurate understanding and safe execution of the exercises, the patient was asked to return the demonstrations, as necessary corrections and precautions were re-emphasized. In terms of wheelchair propulsion, the patient initially had difficulty negotiating it through the limited space at home. Hence, environmental modifications, such as the removal of clutter and rearranging the furniture, were recommended to help her navigate more easily within the limited home space. Meanwhile, patient B had no new deficits, and he continued to be functional at home and in the community with his wheelchair. He demonstrated effective pressure-relief techniques and had no problem in manoeuvring the wheelchair inside the house. Table WB.63: Mixed methods study on mobility and/or posture and/or function Author and year JBI appraisal score Mobility and/or Posture and/or Function Results Interpretation Di Marco et al. 2003 5/17 (low) Focus group The 3-month follow up allowed the wheelchair user enough time to identify any problems with the wheelchair. These issues could then be addressed effectively before they became entrenched and more difficult to change. In situations where problems were not identified therapists could be proactive and suggest changes to improve the fit between the wheelchair user and the wheelchair. This was most evident for first time wheelchair users whose improving strength, balance and wheelchair skills led to adjustments of their wheelchair. Staff reported telephone reviews provided an opportunity to establish the wheelchair user’s level of comfort, their satisfaction and whether the wheelchair was in use. Face-to-face reviews had the added benefit of allowing prescribing therapists to assess the wheelchair user’s sitting posture and wheelchair durability issues. Wheelchair Provision Guidelines 54 Table WB.64: RCT on secondary complications Author and year JBI appraisal score Secondary complications measures Results Interpretation Hansen, Tresse & Gunnarsson 2004 10/11 (high) Questionnaire on presence and absence of pressure sores and wheelchair- related accidents during the past 12 months, as well as defects that the user believed could lead to accidents (near accidents) Pressure sores related to wheelchair sitting were not significantly different in intervention group and control groups (intervention: improved= 2, unchanged=58, worse=0; control: improved=1, unchanged=78, worse=2) (p=0.16) Accidents due to wheelchair condition were significantly different in intervention group and control groups, with less accidents in the intervention group (intervention: improved= 3, unchanged=57, worse=0; control: improved=0, unchanged=80, worse=1) (p=0.03) Near accidents (from wheelchair defects) were not significantly different in intervention group and control groups (intervention: improved= 4, unchanged=52, worse=4; control: improved=4, unchanged=75, worse=2) (p=0.65) Active OT intervention using a compiled checklist for safety, comfort and positioning, manoeuvrability and transportation for wheelchair variably affected possible complications of adult manual wheelchair users. Table WB.65: Mixed methods study on secondary complications including falls and/or injuries Author and year JBI appraisal score Secondary complications including falls and/or injuries Results Interpretation Di Marco et al. 2003 5/17 (low) Focus group The initial prescribing therapist was responsible for coordinating periodic follow up at 3 months and 12 months post wheelchair issue. All staff involved in the evaluation expressed a belief that systematic follow up made a significant impact on service delivery as it provided an opportunity to improve the fit between the wheelchair user and the wheelchair. The 3-month follow up proved particularly timely. It allowed the wheelchair user enough time to identify any problems with the wheelchair. These issues could then be addressed effectively before they became entrenched and more difficult to change. In situations where problems were not identified therapists could be proactive and suggest changes to improve the fit between the wheelchair user and the wheelchair. Web-Annex B: Data Tables and Appendices 55 Table WB.66: RCT on satisfaction with wheelchair Author and year JBI appraisal score Satisfaction with wheelchair Results Interpretation Hansen, Tresse & Gunnarsson 2004 10/11 (high) User satisfaction questionnaire using a Visual Analog Scale Number of adult manual wheelchair users reporting wheelchair satisfaction in first and second measures were not significantly different in intervention group and control groups (intervention: improved= 24, unchanged=3, worse=30; control: improved=27, unchanged=11, worse=37) (p=0.91) Surprisingly, the user satisfaction measured with VAS did not increase more in the active intervention group than in the standard intervention group. This could either be because active intervention did not increase user satisfaction or because of the insensitivity and low power of the study design. We therefore assume that the absence of effect on user satisfaction was due to high user satisfaction at baseline indicating unawareness of the wheelchair's deterioration and of the possibilities of a better and safer situation. High initial satisfaction leaves very little room for improvement. Table WB.67: Mixed methods study on satisfaction with wheelchair Author and year JBI appraisal score Satisfaction with wheelchair Results Interpretation Di Marco et al. 2003 5/17 (low) Focus group The initial prescribing therapist was responsible for coordinating periodic follow up at 3 months and 12 months post wheelchair issue. All staff involved in the evaluation expressed a belief that systematic follow up made a significant impact on service delivery as it provided an opportunity to improve the fit between the wheelchair user and the wheelchair. The 3-month follow up proved particularly timely. It allowed the wheelchair user enough time to identify any problems with the wheelchair. These issues could then be addressed effectively before they became entrenched and more difficult to change. In situations where problems were not identified therapists could be proactive and suggest changes to improve the fit between the wheelchair user and the wheelchair. This was most evident for first time wheelchair users whose improving strength, balance and wheelchair skills led to adjustments of their wheelchair. Staff reported telephone reviews provided an opportunity to establish the wheelchair user’s level of comfort, their satisfaction and whether the wheelchair was in use. Wheelchair Provision Guidelines 56 Table WB.68: RCT on disruption in use including due to wheelchair breakdown Author and year JBI appraisal score Disruption in use including due to wheelchair breakdown Results Interpretation Hansen, Tresse & Gunnarsson 2004 10/11 (high) OT-registered actions Of 74 inspected wheelchairs in the active intervention group, 73 (99%, 95% confidence interval 96-100%) were in need of attention. There was a significantly higher rate of actions (any type of action) in the active intervention group, compared with the standard intervention group Incidence of exchange or complementing accessories significantly different in between groups with more in the intervention group (intervention= 30, control= 17; p=0.004) Exchange of wheelchair, same model not significantly different in between groups (intervention= 15, control= 12; p=0.18) Exchange of wheelchair, new model not significantly different in between groups (intervention= 13, control= 9; p=0.11) Complementary wheelchair prescribed not significantly different in between groups (intervention= 2, control= 6; p=0.28) Reconditioning of wheelchair not significantly different in between groups (intervention= 3, control= 2; p=0.45) Repair by OT significantly different in between groups with more in the intervention group (intervention= 18, control= 9; p=0.01) Repair by technician not significantly different in between groups (intervention= 3, control= 2; p=0.45) The present study found that the most common defects were simple and easily fixed. Table WB.69: Case series study on satisfaction with service Author and year JBI appraisal score Satisfaction with service Results Interpretation Leochico & Valera 2020 6/8 (moderate) Telerehabilitation survey and observations Prior to telerehabilitation sessions, the patients expressed mixed feelings about the method of follow-up, as reflected in their survey responses (Table WB.2). In addition, patient A expressed that telerehabilitation might only be applicable for “mild” or “easy” cases due to lack of face-to-face examination, while patient B thought that the system might be technically difficult to use (Table WB.1). Although they had apprehensions as it was their first time to consult a physician through videocall, both patients agreed to give it a try. During telerehabilitation, the session went smoothly with patient A, while we encountered technical difficulties with patient B due to slow internet speed, for which we resorted to other techniques, such as phone call, text messaging, and online asynchronous techniques like chat messaging. Post-telerehabilitation, however, their perceptions seemed to have improved based on their qualitative feedback (Table WB.1), even though numerically their responses to the Telepractice Questionnaire were mostly “3” or “neutral” (Table WB.2). Web-Annex B: Data Tables and Appendices 57 The patients relayed an overall positive telerehabilitation experience. Their perceived benefits included no fatigue from travel, no stress in waking up early and waiting in line outside the clinic, reduced expenses, instant and direct communication with a doctor, and less burden on the family. Table WB.70: Mixed methods study on satisfaction with the service Author and year JBI appraisal score Satisfaction with service Results Interpretation Di Marco et al. 2003 5/17 (low) Focus group The initial prescribing therapist was responsible for coordinating periodic follow up at 3 months and 12 months post wheelchair issue. All staff involved in the evaluation expressed a belief that systematic follow up made a significant impact on service delivery as it provided an opportunity to improve the fit between the wheelchair user and the wheelchair. The 3-month follow up proved particularly timely. It allowed the wheelchair user enough time to identify any problems with the wheelchair. These issues could then be addressed effectively before they became entrenched and more difficult to change. In situations where problems were not identified therapists could be proactive and suggest changes to improve the fit between the wheelchair user and the wheelchair. This was most evident for first time wheelchair users whose improving strength, balance and wheelchair skills led to adjustments of their wheelchair. Staff reported telephone reviews provided an opportunity to establish the wheelchair user’s level of comfort, their satisfaction and whether the wheelchair was in use. Face-to-face reviews had the added benefit of allowing prescribing therapists to assess the wheelchair user’s sitting posture and wheelchair durability issues. Table WB.71: Case series study on wheelchair longevity Author and year JBI appraisal score Wheelchair longevity Results Interpretation Leochico & Valera 2020 6/8 (moderate) Telerehabilitation observations Patient B: It was observed through telerehabilitation that his current foldable wheelchair already had worn- out non-removable pneumatic tires, which made wheelchair propulsion particularly on uneven terrains outside the house difficult. Hence, an advanced wheelchair (i.e., active wheelchair consisting of welded rigid frame with fewer movable parts, anti-tippers, and quick-release removable pneumatic tires) was recommended. Wheelchair Provision Guidelines 58 Table WB.72: Case series study on satisfaction with service Author and year JBI appraisal score Satisfaction with service Results Interpretation Leochico & Valera 2020 6/8 (moderate) Telerehabilitation survey and observations Their perceived benefits included no fatigue from travel, no stress in waking up early and waiting in line outside the clinic, reduced expenses, instant and direct communication with a doctor, and less burden on the family. Table WB.73: Mixed methods study on time and/or cost for people who use wheelchairs Author and year JBI appraisal score Time and/or Cost for people who use wheelchairs Results Interpretation Di Marco et al. 2003 5/17 (low) Qualitative information Although this paper did not aim to present detailed outcome data, some trends were evident early and led to a number of practical cost-saving changes. In particular, through the organised review process, it was noted that there were two groups of individuals who showed a trend toward not using their wheelchair at the time of the 12 month follow up. These individuals were those who received a motorised as well as a manual wheelchair and those who experienced significant functional change following wheelchair issue. Data regarding non-use of wheelchairs at 12 months post issue was presented to an interdisciplinary team representing the spinal injury rehabilitation unit. This led to a change in unit policy to address this problem; namely, introduction of a system of long-term wheelchair loan and a stricter review process regarding each wheelchair user’s need for two wheelchairs. These changes to policy have been working successfully and have led to considerable cost savings. Table WB.74: Mixed methods study on inclusion, participation and/or quality of life Author and year JBI appraisal score Inclusion, participation and/or quality of life Results Interpretation Di Marco et al. 2003 5/17 (low) Qualitative information Both first-time users and experienced users demonstrated high levels of participation. The impact of this evaluation of wheelchair prescription practices was evidenced by improvements in: (i) service delivery practices; (ii) wheelchair user participation; and (iii) accountability and justification of service delivery practices. Web-Annex B: Data Tables and Appendices 59 Table WB.75: Characteristics of included studies for Question E Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Randomised controlled trials Best et al. 2005 USA Community-based manual wheelchair users N=20 (15 men, 5 women) Age 21–77y half with musculoskeletal and half with neurologic disorders. Wheelchair skills training program (WSTP) version 3.1 consisting of 1-hour individualized sessions delivered by OT N= 10 Standard care N= 12 (2 dropped out) Mobility and/or posture and/or function (Wheelchair Skills Test (WST)) Secondary complications among users (presence or absence of adverse events) Satisfaction with training (feedback) Empowerment and self-esteem (feedback) Pre-test, post training (at least 5 days after) The WSTP group had significantly greater improvements in total WST score than the control group (P<.005). There were no adverse incidents, and the WSTP participants’ comments were all positive. Best et al. 2016 Canada Community-living manual wheelchair (MWC) users N=28 (22 men, 6 women) mean MWC experience is 13y; mean age, 49y Peer-led wheelchair training program consisting of six 1.5- hour sessions of a peer- led self-efficacy enhanced wheelchair training program (WheelSee) N= 16 Standard care N=12 Mobility and/or posture and/or function (Wheelchair Skills Test (WST)) and (Life Space Assessment (LSA)) Empowerment and self-esteem ( Wheelchair Use Confidence Scale (WheelCon) version 3.0) Inclusion, participation and/or quality of life (Wheelchair Outcome Measure (WhOM)) Pre-test, post training (immediately after training) A peer-led MWC training program improves wheelchair use self-efficacy in adult MWC users and had a positive influence on other wheelchair-related outcomes. WheelSee may offer a promising intervention strategy to accommodate the training needs of community-living MWC users. Giesbrecht and Miller 2019) Canada Older adult manual wheelchair users N = 18 (13 men, 6 women) 50-84 years mHealth wheelchair skills training program; 1hr of both instruction and orientation to mHealth mobile training application, then participated in 4 weeks monitored home Nine commercially available problem solving and fine motor skill games Mobility and/or posture and/or function (Wheelchair Skills Test: Capacity (WST-C) and (Life Space Assessment (LSA)) Empowerment and self-esteem (Wheelchair Use Confidence Scale (WheelCon) version 3.0) Inclusion, participation and/or Pre-test, post training (4 weeks after training) Manual wheelchair users who participate in online, application-based training programs can improve wheelchair safety and mobility, as well as confidence and health related quality of life. Wheelchair Provision Guidelines 60 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings training program (EPIC Wheels Program) N= 10 N= 8 Secondary complications among users (Wheelchair Skills Test: Safety (WST- S)) quality of life (Health Utility Index Mark 3) Kirby et al 2015b USA Power wheelchair users or expected to use powered wheelchairs for at least 4 hours/week N=116 Wheelchair Skills Training Program (WSTP) version 4.1 consisting of five 30- minute individual training sessions with a targeted frequency of 1–2 sessions per week. Training was conducted in different places including participants’ homes or another participant-specific environment. Participan ts were also encouraged to practice between formal training sessions N= 54 Standard care N= 62 Mobility and/or posture and/or function (Wheelchair Skills Test (WST):Capacity and Performance), Goal achievement (Goal- Attainment Score (GAS) relating to wheelchair skills) and (Life Space Assessment (LSA)) Secondary complications among users (injury rate; number of injuries) Satisfaction with training (questionnaire) Empowerment and self-esteem (Wheelchair Confidence Score (WheelCon)) Pre-test, post training (immediately after training), after 3 months; LSA and WheelCon assessed only after 3 months Powered wheelchair users who receive formal wheelchair skills training demonstrate modest transient post-training improvements in their WST- Q performance scores, they have substantial improvements on individualized goals that they set and they are positive about training. Kirby et al 2016 USA Community- dwelling manual wheelchair users; veterans with spinal cord injury (SCI) N= 106 Wheelchair Skills Training Program (WSTP), version 4.1 Each training session was 30-45mins, covering representative skills of wheelchair use. Each participant received 5 sessions. N= 53 Education session, focussed on health promotion for people with SCI 30-45mins, covering general wellness, nutrition, pressure ulcer Mobility and/or posture and/or function (Wheelchair Skills Test (WST) Inclusion, participation and/or quality of life (Craig Handicap Assessment and Reporting Technique (CHART)). Pre-test, post training (4-5 weeks after pre-test) and after 12 months Individualized wheelchair skills training in the home environment improves the advanced wheelchair skills capacity of experienced community-dwelling veterans with SCI by 30% over baseline scores although it has only a small impact on participation levels. Web-Annex B: Data Tables and Appendices 61 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings management, exercise and prevention of respiratory complications/ infections. Each participant received 5 sessions from nurse on SCI unit. N= 53 MacPhee et al 2004 Canada Manual wheelchair users involved in an initial rehabilitation program at the Nova Scotia Rehabilitation Centre Site of the Queen Elizabeth II Health Sciences Centre N= 44 Wheelchair Skills Training Program (WSTP), version 2.4. Training consisted of six 30-minute training session between pre and post-training WST evaluation. The first 20 minutes of each session was dedicated to learning skills according to the training curriculum. Practice took place in a blocked manner (i.e., repeatedly) until a particular skill was successfully completed or abandoned. The last 10 minutes of each training session consisted of practicing all skills successfully completed to that point (including those passed Conventional training or typical rehabilitation during in patient stay of 5 weeks (about 15 hours) N= 26 Mobility and/or posture and/or function (Wheelchair Skills Test (WST) Secondary complications among users (presence or absence of adverse events) Empowerment and self-esteem (Psychosocial Impact of Assistive Devices Scale (PIADS); self- esteem construct) Inclusion, participation and/or quality of life (Psychosocial Impact of Assistive Devices Scale (PIADS); adaptability construct) Satisfaction with the service (feedback) Pre-test, post training (1 week after training for intervention group and 4 weeks or before discharge; whichever came first for the control group) The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs. Wheelchair Provision Guidelines 62 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings in the pretraining WST evaluation), randomly, with no skill attempted twice in a row. N= 18 Miller et al 2019 Canada Older adults using manual wheelchairs at least 1 hour/day aged 64.5years N= 40 (24 men, 16 women) Peer-led Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU) program consisting of 90-minute peer-led sessions of customized training (in pairs) according to participants’ goals. N= 18 Six 90-minute professional- led didactic information sessions (in pairs). Topics covered include maintenance, physical activity, nutrition but NOT wheelchair skills N= 22 Mobility and/or posture and/or function (Wheelchair Skills Test (WST) and Life-Space Assessment (LSA)) Empowerment and self-esteem (Wheel- chair Use Confidence Scale for Manual Wheelchair Users- ShortForm (WheelCon-M-SF)) Inclusion, participation and/or quality of life (Wheel- chair Outcome Measure (WhOM) and disability component of the Late Life Function and Disability Index (LLFDI)) Pre-test, post training (after 3-6 weeks) and 6 months after training WheelSeeU did not have a statistically significant greater effect on objective wheelchair skills compared to an active control group except for satisfaction with participation (WhOM). Mountain et al 2014 Canada People with stroke, who use a powered wheelchair N= 17 Wheelchair Skills Training Program (WSTP) version 4.1 Five 30-minute sessions covering representative skills of wheelchair use N= 9 No information about control provided N= 8 Mobility and/or posture and/or function (Wheelchair Skills Test (WST) None Pre-test, post training (3 days after training for the intervention group and 2 weeks after pre-test for the control group). Wheelchair skills training programs for people with stroke improves powered wheelchair skills to a significantly greater extent (30%) than participants who do not receive training (0%). Ozturk and Ocsular 2011 Turkey Community- dwelling manual wheelchair users N= 32 Wheelchair Skills Training Program (WSTP) version 4.1 Five 30-45 minute sessions (about 4 weeks). No information about control provided N= 10 Mobility and/or posture and/or function (Wheelchair Skills Test (WST) Pre-test, post training (after the 4 week training) Wheelchair skills training programs for wheelchair users improves both wheelchair skill performance and safety Web-Annex B: Data Tables and Appendices 63 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings N= 14 Secondary complications among users (Wheelchair Skills Test Safety (WST- S) when using manual wheelchair. Rice et al 2017 USA Paediatric manual wheelchair users N = 12 Transfer training consisting of two sets of level transfers (from wheelchair to a padded bench and back to wheelchair = one set) with educational training consisting of a video and feedback session N= 7 Transfer training consisting of two sets of level transfers (from wheelchair to a padded bench and back to wheelchair = one set) at three time points for a total of six transfer sets, with no transfer education. N= 5 Mobility and/or posture and/or function (Transfer Assessment Instrument (TAI)) Empowerment and self-esteem (Self- Perception Profile for Children (SPPC) focusing on social competence (social success) and global- self-worth) Pre-test, post training and after 3 months Transfer performance improved significantly in the intervention group (transfer with education on proper transfer technique), however there were no changes in self-perception related variables three months later. Rigot et al 2021 USA Wheelchair users of >40hours/week Web-based, direct-to- user transfer training program covering wheelchair set-up, body set-up, and flight/landing; 1 hour to complete N= 34 Waitlist; after 6 months N= 38 Mobility and/or posture and/or function (Transfer Assessment Instrument (TAI-Q) version 4)) Pre-test, post training (immediately after training); additional measurement times for the control group (6 month pre- test, immediate post training Direct-to-user web-based training and repeated transfer self-assessments are effective at increasing transfer quality for at least1 month post training Wheelchair Provision Guidelines 64 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings and 1 month post training) Routhier et al 2012 Canada Adult manual wheelchair users N= 39 French- Canadian version of the Wheelchair Skills Training Program (WSTP) in addition to standard care N= 19 Standard care (inpatient rehabilitation in a Canadian rehab setting); about 15 hours of training in different formats N= 20 Mobility and/or posture and/or function (Wheelchair Skills Test (WST)) Secondary complications among users (presence or absence of adverse events) Pre-test, post training (1 week after training for training group but 3-5 weeks for the control group) and after 3 months WSTP training improves wheelchair skills immediately after training, particularly at the community-skills level. Follow up data showed minimal decline but not significant due to reduction in sample size (loss to follow up). Sakakibara et al 2013 Canada Community-living older adults at least 65 years old who would need wheelchairs (manual) N = 20 Wheelchair Skills Training Program (WSTP) protocol; two 1 hour training sessions N= 10 Single socialization contact N= 10 Mobility and/or posture and/or function (Wheelchair Skills Test (WST)) Empowerment and self-esteem (Wheelchair Confidence Score (WheelCon)) Pre-test, post training (5-7 days after pre- test) Two 1-hour WSTP training sessions improve confidence with using a manual wheelchair among older adults who are inexperienced with using a manual wheelchair Van Der Scheer et al 2016 Netherla nds Inactive, community- dwelling manual wheelchair users with long-term SCI N= 29 16-week low-intensity wheelchair training, consisting of supervised wheelchair propulsion on a treadmill in a rehabilitation centre, twice a week, 30 min per session. N= 14 Usual care N= 15 Mobility and/or posture and/or function (Wheelchair Skill Performance based on time and ability scores and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) None Pre-test, post training (8 weeks after training) and after 16 weeks Low intensity wheelchair exercise for 16 weeks, twice a week, for 30 min per session does not lead to substantial training effects on wheelchair skill performance inactive manual wheelchair users with long-term SCI. Worobey et al 2016 USA Manual wheelchair users with spinal cord injury Wheelchair Skills Training Program (WSTP) version 4.2 Two 1-hour active control sessions scheduled 1 to Mobility and/or posture and/or function (Wheelchair Skills None Pre-test, post training (1 month after training) Group training can improve capacity to complete advanced-level manual wheelchair skills and Web-Annex B: Data Tables and Appendices 65 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings N = 114 Six 90-minute group WSTP N= 55 3 weeks apart rehabilitation therapist, USA counsellor, or peer counsellor N= 59 Test (WST)- capacity and performance) Goal achievement (Goal- Attainment Score (GAS)) facilitate achievement of individually set goals. Lower skill levels at baseline and increased attendance were correlated with greater improvement. Worobey et al 2018 USA Manual and power wheelchair users who could transfer independently (participants of National Veterans Wheelchair Game) N= 87 Web-based transfer training module; a 60- minute online module based on the principles of the in-person training N= 44 Individualized, in-person transfer training session; 60 minute individualized transfer training session taught by a trained physical therapist to focus on each participant’s transfer skill deficits. N= 11 Waitlist control group (WLCG) N= 32 Mobility and/or posture and/or function (Transfer Assessment Instrument (TAI) version 3 and feedback) None Pre-test, post training (1-2 days after training) Both web-based and in- person transfer skills training produced improvements in transfer technique among independent wheelchair users, compared with a group that had not received training. Worobey et al 2021 USA Manual and power wheelchair users with spinal cord injury N= 188 (91 manual WC users; 97 power WC users) Group Wheelchair Maintenance Training consisting of two 90- minute structured wheelchair maintenance training program classes with 4- Waitlist control group (WLCG) N= 92 (manual WC users=42; power WC users=50) Mobility and/or posture and/or function (Wheelchair Maintenance Training Questionnaire None Pre-test, post training (1 month post training), after 6 and 12 months post training Group wheelchair skills training is effective at improving capacity to complete maintenance and performance of maintenance activities for MWC and PWC users, even Wheelchair Provision Guidelines 66 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings 7 wheelchair users per class. Each class was taught by 2 trainers who received training from content experts. 96 (manual WC users=49; power WC users=47) (WMT-Q) capacity (ability to complete) and performance (frequency of completion)) in a cohort of experienced wheelchair users. Other experimental studies Pre-post studies Beaudoin et al. 2021 Canada Adult manual wheelchair users N= 19 Peer-led community- based wheelchair skills training program consisting of six, two- hour training sessions administered once or twice a week in a community centre and public locations surrounding the centre (e.g., park, sidewalks). N/A Mobility and/or posture and/or function (Wheelchair Skills Test Questionnaire (WST-Q)) Empowerment and self-esteem (Wheelchair Confidence (WheelCon)) Inclusion, participation and/or quality of life (Wheel- chair Outcome Measure (WhOM) and Satisfaction With Life Scale (SWLS)) Satisfaction with the service (qualitative interviews) Pre-test, post- test (immediately after the training), and after 3 months Peer-led community-based manual wheelchair training influenced manual wheelchair skills, self- efficacy and satisfaction with participation but not quality of life. Charlton et al. 2021 Australia Adult manual wheelchair users with lower limb amputation in a rehabilitation setting N= 11 Shortened versions of the Wheelchair Skills Training Program (WSTP): Version 5.0 consisting of 45 minutes for three consecutive weeks facilitated by one or two occupational therapists or allied health assistants N/A Mobility and/or posture and/or function (Wheelchair Skills Test Questionnaire (WST-Q), Goal attainment scale (GAS) and Functional Satisfaction with the service (qualitative interviews) Pre-test and post test The Wheelchair Skills Training Program can improve wheelchair performance, confidence and frequency to support enhanced safety, independence and quality of life for people with lower limb amputations Web-Annex B: Data Tables and Appendices 67 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Independence Measure (FIM)) Choi et al. 2020 Korea Adults w manual wheelchair users with spinal cord injury N= 4 Training using the completed wheelchair training structure; total of 10 sessions, 30min/session Mobility and/or posture and/or function (Wheelchair Skill Test Questionnaire (WST-Q) Version 5.0) None Pre-test, post- training ( Comparing the scores of the pre-post evaluation showed that all subjects improved in wheelchair skills capacity and confidence Eshraghi, Sawatzky & Mortenson 2021 Canada Adult manual wheelchair users N = 20 Peer-led, manual wheelchair maintenance skills training programme (n= 5 mentors; n= 15 mentees) N/A Mobility and/or posture and/or function (The 3- cone test) Empowerment and self-esteem (Manual wheelchair maintenance confidence questionnaire) Pre-test, post training (4-6 weeks after the training) No significant improvement was observed with the 3- cone test but confidence in performing wheelchair maintenance and instructing others to perform maintenance significantly improved. MacGillivray et al. 2018 Canada Adults with mobility disability with access with powered wheelchair N= 17 Five 30-min individualized one-on- one Wheelchair Skills Training Program (v4.1) sessions at a targeted frequency of 1–2 sessions/week. Trainers helped participants to create powered wheelchair mobility- related goals (5-10). N/A Mobility and/or posture and/or function (Goal satisfaction relating to mobility using Wheel-chair Outcome Measure (WhOM)) None Pre-test, post training (immediately after the training) and after 3 months Goal satisfaction score improved immediately following training and was maintained 3 months post- training compared to baseline scores. Results also show that goal satisfaction scores following the WSTP improved years after initially learning how to operate a powered wheelchair. The most commonly cited goals related to foundational skills of manoeuvring and backing up Wheelchair Provision Guidelines 68 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Morgan et al. 2017 USA Adult manual wheelchair users with spinal cord injury N= 6 Motor learning approach to training wheelchair propulsion biomechanics; nine 90- minute training sessions; training sessions were conducted two or three times per week (3-5 weeks) N/A Mobility and/or posture and/or function (Wheelchair Skills Test) None Pre-test and post- training (after the 3-5 weeks) Wheelchair skills as measured by the WST also showed no significant difference Mountain et al. 2010 USA Adults with stroke learning to use powered wheelchairs N=10 5 training sessions, each of which was up to 30 minutes in duration, aimed at improving the wheelchair skills that the participant had difficulty performing during WSTP 1 N/A Mobility and/or posture and/or function (Wheelchair Skills Test (WST) version 3 with some modifications) Satisfaction with the service (feedback) Pre-test, post training (immediately after the training) All participants improved their wheelchair skills with only 2.5 hours of training. Rice et al. 2020 USA Adult manual wheelchair users with spinal cord injury N= 18 1:1, 45 minute, in- person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control. Mobility and/or posture and/or function (Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST)) Secondary complications among users (Falls incidence and Spinal Cord Injury Fall Concerns Scale (SCI-FCS) Inclusion, participation and/or quality of life (Community Participation Indicators and the World Health Organization Quality of Life: short version (WHOQOL-BREF)) Pre-test and post-training (after 12 weeks) All outcomes improved after the 12 weeks of intervention. Web-Annex B: Data Tables and Appendices 69 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Sarigul-Klijn et al. 2017 USA People with chronic stroke with severe arm impairment learning to drive a bimanual wheelchair N= 5 6 training days spaced over two weeks of practice navigation of a figure eight track with a 14 m long path designated with masking tape on the floor, using a Lever- Actuated Rehabilitation and Ambulation (LARA) (for bimanual propulsion of a wheelchair) N/A Mobility and/or posture and/or function (speed in driving the wheelchair) Secondary complications among users (Pain using Visual Analog Scale Mobility and/or posture and/or function (VAS)) Empowerment and self-esteem (Intrinsic Motivation Inventory (IMI)) Pre-test, post training (immediately after the training) The participants significantly increased their speed and competence over the six training sessions, and participants did not experience any pain or pain during the sessions. Sawatzky et al. 2012 Canada Children manual wheelchair users with spinal cord problems N= 6 Wheelchair Skills Training Program consisting of 9 hours training over two days. N/A Mobility and/or posture and/or function (modified version of Wheelchair Skills Test (WST) version 3.2 Secondary complications among users (pain and fatigue from Impact Questionnaire) Empowerment and self-esteem (Impact Questionnaire) Inclusion, participation and/or quality of life (Activity Scale for Kids (ASK) Performance) Pre-test, post training (immediately after the training) and one and four months after for the ASK and Impact Questionnaire There was a significant increase in wheelchair skills. No change in participation was measured with the Activity Skills for Kids. The Impact Questionnaire suggests the skill training allowed participants to do more, with less pain and fatigue post-training. Sawatzky, Mortenson & Wong 2018 Canada Adult manual wheelchair users N= 11 30-min training session where participants learned how to use a rear-mounted power assist; 1) put on and take off the motor and the battery from their wheelchairs and 2) stop and start the power assist in the indoor and outdoor modes. N/A Mobility and/or posture and/or function (modified version of Wheelchair Skills Test 4.2 (WST)) Empowerment and self-esteem (shortened version of Wheelchair Confidence Score (WheelCon)) Satisfaction with the service (survey feedback) Pre and post training (immediately after training) No significant differences were noted with either WheelCon-M or WST scores. Wheelie skills were unaffected when the device was in place, but not activated by participants. Overall, participants were positive about their training and rated their experience with either Strongly Agree Wheelchair Provision Guidelines 70 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Participants navigated a 7 task obstacle course or Agree to most of our questions. Tasiemski, Wilski & Urbański 2021 Morocco Persons with disabilities using manual wheelchairs N= 19 Wheelchair Skills and Empowerment Camp in Morocco; training in activities of daily living and wheelchair skills, carried out in environments and contexts resembling those encountered during everyday life activities N/A Mobility and/or posture and/or function (Queensland Evaluation of Wheelchair Skills (QEWS) Satisfaction with the Chair (Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), Version 2.0) Pre and post training (after 10 days) Participants advanced their general wheelchair mobility as assessed through a practical test (QEWS), especially their ability to ascend and descend a ramp. Quasi-experimental studies Hasdai, Jessel & Weiss 1998 Israel Children with disabilities (progressive muscular dystrophy (PMD) or cerebral palsy) N= 22 Computer simulator (elementary computer game that required many of the skills necessary for controlling a powered wheelchair); one group with experience in using a powered wheelchair; twice a week of 30-45 mins up to 12 weeks Computer simulator (elementary computer game that required many of the skills necessary for controlling a powered wheelchair); one group without any experience in using a powered wheelchair Mobility and/or posture and/or function (Functional evaluation rating scale and time to complete the maze from the simulator program) None None Children with cerebral palsy and PMD who had no prior operating experience showed a marked improvement in their driving performance after training with the simulator. After training with the simulator, the maze scores of the inexperienced group significantly increased. Hoenig et al. 2005 USA Community- dwelling, cognitively intact patients (older adults and elderly) prescribed a 1.0 to 1.5 hours of intervention which included a training in use of wheelchairs; multi modal training consisting of verbal and written instructions on Usual care N= 31 Satisfaction with wheelchair (wheelchair comfort; four level Likert scale ranging from very comfortable to Empowerment and self-esteem (Wheelchair confidence in home, out-of-doors, public places and unfamiliar places; scale of 1-5 (1 Outcomes were measured at 2 weeks, 3 months, and 6 months after The intervention group had greater usage of the wheelchair at all time points and across most levels of usage (e.g., daily and weekly). Individuals who used their wheelchair Web-Annex B: Data Tables and Appendices 71 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings standard manual wheelchair N=84 wheelchair use in diverse situations, coping with disability, and community resources; and hands- on practice in the clinic using the wheelchair with common obstacles (ramp, curb, bathroom doorway). If necessary, additional instruction was provided on loading and unloading the wheelchair from the automobile. N= 53 very comfortable, from last 2 weeks)) Secondary complications among users (shoulder pain; yes vs no response to shoulder pain being worse previously) is not at all confident and 5 completely confident)) receipt of the wheelchair more frequently were more likely to report shoulder pain Cohort studies Chang et al. 2020 China People with spinal cord injury N= 130 Two periods of rehabilitation (first 45- days and then within 2 years) for people with SCI; 90 training and practice sessions, with each session lasting for 1–2 hours which included wheelchair skills training N/A Mobility and/or posture and/or function (wheelchair skills as part of basic life skills) Inclusion, participation and/or quality of life (activities of daily living as part of basic life skills) Retrospective data from 2013 to 2017 Results revealed significant outcome improvement with the first rehabilitation period. The outcome showed a sustained effect for a mean of 1.5 years after discharge from the first rehabilitation period, and those with SCI acquired additional significant improvement in basic life skills and their applications in family and social life during the second rehabilitation period Divanoglou et al. 2019 Botswan a Community dwelling people with spinal cord injury N= 19 7-day Active Rehabilitation (AR) training programme with 10 training sessions totalling 16 hours which included N/A Mobility and/or posture and/or function (Wheelchair Skills Test Questionnaire Empowerment and self-esteem (WST-Q confidence scores) Inclusion, participation and/or Prospective data collection from beginning, end of programme Participants achieved substantial improvements in their physical independence that are Wheelchair Provision Guidelines 72 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings wheelchair skills training (WST-Q) version 4.3 comprising questions related to capacity and confidence and Queensland Evaluation of Wheelchair Skills practical test (QEWS)) quality of life (Moorong Self-efficacy Scale (MSES)) and after 5 months comparable with those in the early period after injury Taylor et al. 2015 USA Children (12 yrs. and over) and adults with traumatic spinal cord injury N= 1,376 (n= 1,296 received the wheelchair training) SCI Rehabilitation focusing on activities/interventions related to wheeled mobility training (e.g., propulsion, wheelies, curbs elevator management, wheelchair positioning) and related adapted equipment (e.g., gloves, dorsal wrist splints), and equipment evaluation (assessment/prescriptio n, fit-ting, mat evaluation). N/A Satisfaction with wheelchair (interview questions) None Prospective data collection from beginning up to 12 months of follow up Most patients were satisfied with the wheelchair’s fit and function. Case-control study Webster et al. 2001 USA Patients with unilateral neglect N= 40 Computer-Assisted Training (CAT) program of 5 modules with 12 to 20 sessions of training, lasting approximately 45 minutes each; modules 4 & 5 were on wheelchair skills and obstacle avoidance Patients who participated in a previous study of unilateral neglect with no additional training of any kind Mobility and/or posture and/or function (real-life wheelchair obstacle course (WCOC)) Secondary complications None Not specified Trained subjects performed better on the WCOC than control group and had fewer incident reports than control subjects during their hospitalization Web-Annex B: Data Tables and Appendices 73 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings N= 20 N= 20 among users (falls and accidents) Cross-sectional studies Bazant et al. 2017 Kenya and Philippin es Adult manual wheelchair users N= 852 (n= 420 Kenya and n=432 Philippines) (only 112 (26.7%) from Kenya and only 74 (17.1%) from the Philippines received training) Training based on WHO 2008 Guidelines N/A Mobility and/or posture and/or function (Activities of Daily Living) Secondary complications among users (falls) None Survey conducted from December 2014 to June 2015 in Kenya and from February to May 2015 in the Philippines Wheelchair-related training was associated with high ADL performance in Kenya. Wheelchair training was associated with serious vs no falls but not non-serious vs no falls in the Philippines Hall et al. 2005 Canada People who are 65 years old and older with mobility limitations using powered wheelchairs N= 12 1st training protocol: Baycrest (twelve 1-hr sessions for 3 weeks to meet the skills needed for the Power-Mobility In door Driving Assessment (PIDA)) 2nd training protocol: Sunnybrook (six 1-hr sessions for 2 weeks to meet the skills needed for the Power-Mobility In door Driving Assessment (PIDA)) Mobility and/or posture and/or function (Power- Mobility In door Driving Assessment (PIDA) None Post training The two power mobility driving protocols had similar outcomes among wheelchair users although one of them was longer in duration (Baycrest) Kirby et al 2015 Canada Adult wheelchair users discharged from rehab centre N=42 (only 23 (54.8% of 42) received training)) Wheelchair Skills Training Program (WSTP) N/A None Satisfaction with the service (interview survey) Upon discharge of patients Participants who underwent the wheelchair training enjoyed the training and would recommend it to others. Stefenac, Grabovac & Fristedt 2018 Croatia Adult members of the Croatian Paraplegic and Tetraplegic Alliance Wheelchair education and skills training consisted of wheelchair adjustment and positioning, transfers and driving the N/A None Satisfaction with the service (survey questionnaire) No details Majority of the participants were very satisfied with the training. No difference was found between groups trained by medical and non-medical participants. Wheelchair Provision Guidelines 74 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings N= 104 (n=70 male and n=34 female) (only 45 (43%) received professional wheelchair training) wheelchair in different environments (elevator, ramps, roads and private and public transports) Participants of the training felt safer compared with those who did not do the training. Case studies/series Adelola, Cox & Rahmana 2009 Ireland Children with cerebral palsy learning to drive a wheelchair N=2 Computer generated virtual functional driving tasks (forward, left-turn, right-turn and collision-avoidance) repeated each three times N/A Mobility and/or posture and/or function (wheelchair driving ability based on Induction Factor(IF)) None Pre-training, post-training and after seven weeks Both participants retained their driving abilities acquired while playing the virtual game Harrison et al. 2002 UK Novice adult powered wheelchair users with neurologic conditions (Traumatic Brain Injury (TBI), Brainstem Haemorrhage, Brainstem cerebrovascular accident (CVA) and TB Meningitis) N= 6 Two virtual reality technology/environmen t focused on manoeuvrability or route-finding components of the study N/A Mobility and/or posture and/or function (Time taken for all tasks, distance travelled in tasks, number of collisions in tasks and number of separate manoeuvres in all tasks and stopped as opposed to completing a task in one smooth movement). None After task training Two virtual environments represent a potentially useful means of assessing and training novice powered wheelchair users. Kenyon et al. 2017 USA Young children with multiple, severe impairments N=3 Individualised power mobility training; custom-made attendant control unit designed to allow shared control was N/A Mobility and/or posture and/or function (Paediatric Evaluation of Disability Inclusion, participation and/or quality of life (Dimensions of Mastery Questionnaire) Pre-training and post training Three young children with multiple and severe physical impairments demonstrated improved performance of power mobility following a 12- Web-Annex B: Data Tables and Appendices 75 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings used during training sessions to selectively modify the direction and motion of the power mobility device and respond to the learning and safety needs of each participant; training was provided one time per week for 60 minutes over a 12-week period N= 3 Inventory– Computer Adaptive Test (PEDI-CAT)) week intervention program using an alternative power mobility device Loomis & Boersma 1982 Canada Adults with right cerebrovascular accident (CVA) N= 4 Verbal mediation (saying the task aloud); two 15-minute training sessions, one day apart, given to both the experimental and control subjects by the investigator. Each session consisted of four three-minute practice trials of wheelchair drill with a one-minute rest period between each trial. No verbal mediation Mobility and/or posture and/or function (number of trials required to achieve safe and independent performance; the scores achieved with regard to sequencing of the task: the amount of time required to complete wheelchair drill; and the number of purposeless movements (errors)) Satisfaction with the service (qualitative feedback) Pre-test; training session 1 (trials 1-4); training session 2 (trial 5-8); and the post-test. Verbal mediation seemed to improve participants’ performance in the wheelchair drill to be able to reach the criterion of safe and independent performance, retain correct sequencing at the post-test and with few errors. McGarry et al. 2012 Australia Children with physical disabilities N= 4 Smart Wheelchair Mobility Training Program (SWMTP) tool for children with physical disabilities; Activities were aimed at encouraging the driving Mobility and/or posture and/or function (Adapted Powered Mobility Program assessment battery) Inclusion, participation and/or quality of life (qualitative feedback) After every training Smart Wheelchair Mobility Training Program (SWMTP) improved driving skills and impacted positively on psychosocial outcomes in children with cerebral palsy. Wheelchair Provision Guidelines 76 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings skills of the children, and were based on motor learning theory; starts online then progressed to actual environment Mountain et al. 2010b Canada Long standing adult wheelchair users N = 2 Wheelchair Skills Training Programme (WSTP) version 3.2 in response to an injury and need for new wheelchair seating Mobility and/or posture and/or function (Wheelchair Skills Test (WST)) Satisfaction with the service (qualitative feedback) Even in long-standing wheelchair users, wheelchair skills training can lead to improvements in mobility and be enjoyable. Nisbet 2002 UK and Australia Children using powered wheelchairs N= 3 Use of Smart Wheelchairs with sensors and facilities for training Mobility and/or posture and/or function (Qualitative feedback) Inclusion, participation and/or quality of life (qualitative feedback) Variable The use of Smart Wheelchairs with sensors and facilities to enhance mobility enables effective training schemes to be devised for children with severe and complex disabilities, while the flexibility and ease of adaptation Case reports Gillen 2002 USA Adult with ataxia using powered wheelchair N=1 Power wheelchair training in varied environments; 10 sessions of 30 mins each N/A Mobility and/or posture and/or function (Functional Independence Measure (FIM)) None Pre-test, post- test (after training) and after 1 year Power wheelchair training improved wheelchair function after training and sustained after a year Lennon 1991 UK Elderly left hemiplegic patient N= 1 Wheelchair transfer tasks broken down into eight steps and with verbal mediation (saying tasks aloud) : (1) lock right brake; (2) right foot on the floor; (3) right footplate up; Verbal prompting Mobility and/or posture and/or function (task performance) None Pre-test and post-training Verbal mediation improved performance to tasks and can be used as an adjunct to standard physiotherapy practice for stroke patients with neglect. Web-Annex B: Data Tables and Appendices 77 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings (4) left foot on the floor; (5) left footplate up; (6) right hand on armrest and lean forwards; (7) lift your bottom up; and (8) turn and sit on the bed. Ragonesi 2012 USA 11-month-old infant with cerebral palsy N= 1 Open Exploration and Prompted mobility training; Open Exploration included using toys and verbal prompts with hand gestures and ‘hand- over-hand’ assistance to move the joystick and encourage the infant to manoeuvre the power wheelchair. Prompted Mobility consisted of calling the infant to move towards the trainer and count the number of times that infant initiated power wheelchair movement in response to the prompt; 14 consecutive weekday sessions N/A Mobility and/or posture and/or function (Success in Prompted Mobility) None First half to second half of training Infant’s mobility success improved in both first half and second half periods. Stanton 1993 USA Adult with right hemisphere damaged with severe cognitive impairment N= 1 Systematic and written transfer program with verbal mediation (saying tasks aloud) wheelchair and transfer tasks for 12 weeks post onset N/A Mobility and/or posture and/or function (Therapists’ (PT/OT) observation) None Systematic and written transfer program with verbal mediation improved patient’s ability to learn wheelchair transfers Wheelchair Provision Guidelines 78 Author and year Study location Participants Training description and participant numbers Comparison description and participant numbers Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Qualitative study Pellichero et al. 2020 Canada Older adult manual wheelchair users with various diagnoses N= 11 WheelSeeU Peer-Led Wheelchair Training Program; Peer-led Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU) program consisting of 90-minute peer-led sessions of customized training (in pairs) according to participants’ goals. N/A Mobility and/or posture and/or function (semi- structured interview) Empowerment and self-esteem (semi- structured interview) Inclusion, participation and/or quality of life (semi- structured interview) Post-training (after nine months) All participants reported positive experiences and perceived benefits regarding their participation in the WheelSeeU program Table WB.76: Pre-post studies on mobility and/or posture and/or function outcomes Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Beaudoin et al. 2021 4/6 (moderate) Wheelchair Skills Test Questionnaire (WST-Q) Statistically significant increase in WST scores from pre-test to post-test to follow up (p=<0.0001) Peer-led community-based manual wheelchair training significantly influenced wheelchair skills performance of adult manual wheelchair users Charlton et al. 2021 4/6 (moderate) Wheelchair Skills Training Questionnaire (WST-Q) version 5.0 Mean percentage increase at the completion of the WSTP of 42.3 +/-13.4. The WSTP significantly improved wheelchair performance of people with lower limb amputations Functional Independence measure (FIM) Mean mobility FIM change of 3.9 ± 0.5, with 82% (n = 9) recording a mobility FIM of 6 (could operate their wheelchair independently for a minimum of 50 m, turn around, manoeuvre the wheelchair to a table, bed and toilet, manoeuvre over rugs and over door sills and can negotiate a 3% graded ramp). Other two participants recorded a mobility FIM of five (could operate a wheelchair independently for short distances only, a minimum of 17 metres and there may be safety considerations or more time may be required to complete the task) The WSTP significantly improved functional mobility of people with lower limb amputations Choi et al. 2020 3/6 (moderate) Wheelchair Skill Test Questionnaire (WST-Q) Version 5.0 Scores of the pre-post evaluation showed that all subjects improved in capacity (no overall scores available) Training using the completed wheelchair training structure significantly improved wheelchair capacity of adult manual wheelchair users with spinal cord injury Web-Annex B: Data Tables and Appendices 79 Eshraghi, Sawatzky & Mortenson 2021 5/6 (high) The 3-cone test Mean of the 3-cone test time decreased by approximately 1.2 seconds (6%) over time. However, this difference was not statistically significant. Peer-led, manual wheelchair maintenance skills training programme did not significantly improve mobility of adult manual wheelchair users in the 3-cone test MacGillivray et al. 2018 5/6 (high) Goal satisfaction relating to mobility using Wheel-chair Outcome Measure (WhOM) Mean and SD goal satisfaction scores were 8.0±1.0 at post training and 8.3±1.2 at 3 months post training from pre-training scores of 4.7+1.9. Individualised wheelchair skills training program significantly improved goal satisfaction scores of adults with mobility disability and was maintained 3 months post-training compared to baseline scores. Morgan et al. 2017 4/6 (moderate) Wheelchair Skills Test (WST) No significant difference in WST scores from pre-test (mean and SD, 67.1 +/- 23.2) to post test (mean and SD 73.5 +/- 18.0) (p=0.08) Motor learning approach to training wheelchair propulsion did not significantly improve wheelchair skills of adult manual wheelchair users with spinal cord injury Mountain et al. 2010 5/6 (high) Wheelchair Skills Training Programme (WSTP) version 3 with some modifications Mean difference of WSTP scores from pre to post training was 46.1+/- 17.8 (p=.0002). 2.5 hours of wheelchair skills training significantly improved wheelchair skills of adults with stroke learning to use powered wheelchair Rice et al. 2020 4/6 (moderate) Transfer Assessment Instrument (TAI) No significant difference in TAI scores from pre-test (mean and SD, 7.99 +/- 0.93) to post-test (mean and SD 8.17 +/- 0.91) (p= 0.131, dz = 0.383). A 1:1, in-person intervention focused on factors associated with falls and concerns about falling and transfer and seated postural control skills did not significantly improve TAI scores of adult manual wheelchair users with spinal cord injury Function In Seating Test (FIST) Significant difference in FIST scores from pre-test (mean and SD, 43.78 +/- 6.74) to post-test (mean and SD, 45.17 +/- 7.25) (p = 0.035, dz= 0.54); likewise in individuals with self-reported AIS C and D levels, (pre: 47.00 +/- 7.28, post=48.89+/-6.47,P=0.046,dz=.93) A 1:1, in-person intervention focused on factors associated with falls and concerns about falling and transfer and seated postural control skills significantly improve FIST scores of adult manual wheelchair users with spinal cord injury. Sarigul-Klijn et al. 2017 4/6 (moderate) Speed in driving the wheelchair Mean increase in speed was 305% ± 197 SD (p=< 0.001). People with chronic stroke with severe arm impairment learning to drive a bimanual wheelchair significantly increased their speed over the six training sessions using bimanual propulsion wheelchair Sawatzky et al. 2012 5/6 (high) Modified version of Wheelchair Skills Test (WST) version 3.2 WST scores significantly increased from pre-test to post test (66 to 75), with a mean relative improvement of 13.8% +/- 9.8, p= 0.03. The WSTP significantly improved WST scores of children with spinal cord problems using manual wheelchairs Sawatzky, Mortenson & Wong 2018 4/6 (moderate) Modified version of Wheelchair Skills Test (WST) version 4.2 Mean and SD WST scores from pre-test to post training were 87.8 ± 13. 9 to 86.7±15.7 (p=0.17). No significant difference was noted in the WST scores Wheelchair Provision Guidelines 80 30-min training session on rear mounted power assist did not improve wheelchair skills of adult manual wheelchair users. Tasiemski, Wilski & Urbanski 2021 4/6 (moderate) Queensland Evaluation of Wheelchair Skills (QEWS) Improvement in ascending and descending a ramp (p=0.012; d=0.67) Improvement in total QEWS score measured at the end of the camp (p=0.002; d=0.20) Persons with disabilities using manual wheelchairs advanced their general wheelchair mobility as assessed through a practical test (QEWS), especially their ability to ascend and descend a ramp after the Wheelchair Skills and Empowerment Camp Table WB.77: Quasi experimental studies on mobility and/or posture and/or function outcomes Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Hasdai, Jessel & Weiss 1998 7/9 (high) Functional evaluation rating scale Inexperienced drivers improved their performance from baseline significantly (U= 9.5, p < .001) but still not as well as the experienced drivers (U= 19.5, p< .01) Computer simulator (elementary computer game) improved wheelchair performance of inexperienced children with disabilities using wheelchair drivers Time to complete the maze from the simulator program Inexperienced drivers improved their performance (Z= -2.93, p < .005) after the training and there was no difference with the experienced group (U= 56.5, p= 0.797).   Computer simulator (elementary computer game improved maze scores of inexperienced children with disabilities wheelchair drivers Web-Annex B: Data Tables and Appendices 81 Table WB.78: Cohort studies on mobility and/or posture and/or function outcomes Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Chang et al. 2020 3/8 (low) Basic life skills including wheelchair skills Increased median scores of the wheelchair skills factor (80%) and self-care and transfer skills (17%) in the first rehabilitation session Significant increase (p < 0.01) in wheelchair skills (43%) and self-care and transfer skills (5%) in the second rehabilitation session Two periods of rehabilitation for in-patient SCI patients significantly improved wheelchair skills and transfer skills Divanoglou et al. 2019 4/8 moderate) Wheelchair Skills Test Questionnaire (WST-Q) version 4.3 Wheelchair skills capacity improved by an average of 11% between baseline and completion (p = 0.014; d = 0.82), and by 13.5% between baseline and follow-up (p = 0.021; d = 0.77). Active rehabilitation with wheelchair skills training significantly improved wheelchair skills of community dwelling people with SCI Queensland Evaluation of Wheelchair Skills practical test (QEWS) Total QEWS score on completion was significantly higher compared to baseline (p = 0.001; d = 0.86); Participants improved their ability to maintain balance on the back wheels (p = 0.003; d = 0.87), ascend and descend a gutter (p = 0.045; d = 0.72) and covered longer distances during a 6-minute push test (p = 0.003; d = 0.71). Active rehabilitation with wheelchair skills training significantly improved wheelchair skills of community dwelling people with SCI. Table WB.79: Cross-sectional studies on mobility and/or posture and/or function outcomes Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Bazant et al. 2017 6/6 (high) Activities of daily living (ADL) Wheelchair-related training was significantly associated with high ADL performance in Kenya (OR 3.2, 95%CI 1.3 to 8.4) but not in Philippines (OR 0.7, 95%CI 0.3 to 1.8). Wheelchair training based on the WHO 2008 Guidelines had inconsistent findings regarding ADLs in the two groups of population. Hall et al. 2005 5/6 (high) Power-Mobility In door Driving Assessment (PIDA) There was no difference in post-training PIDA scores between users of specifically power wheelchairs on either training protocol provided The two training protocols had similar outcomes among elderly power wheelchair users but no baseline reference for comparison ? Wheelchair Provision Guidelines 82 Table WB.80: Case control study on mobility and/or posture and/or function outcomes Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Webster et al. 2001 3/6 (moderate) Wheelchair obstacle course (WCOC) WCOC scores of participants in the training group were significantly higher than control (F1,36 = 23.41, p = 0.00003). Computer-Assisted Training (CAT) program modules on wheelchair skills and obstacle avoidance improved WCOC scores of trained participants with unilateral neglect. Table WB.81: Case studies on mobility and/or posture and/or function outcomes Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Adelola, Cox & Rahmana 2009 4/6 (moderate) Driving ability based on Induction Factor (IF) Participant 1 retained 58% and participant 2 retained 93% of the wheelchair driving ability acquired while playing the virtual game Computer generated virtual driving training has the potential to improve wheelchair driving abilities in children with cerebral palsy learning to drive a wheelchair. Harrison et al. 2002 4/8 (moderate) Time taken for all tasks, distance travelled in tasks, number of collisions in tasks and number of separate manoeuvres in all tasks and stopped as opposed to completing a task in one smooth movement Variable findings across the measures were found among the six participants Two virtual environments represent a potentially useful means of assessing and training novice adult powered wheelchair users. Kenyon et al. 2017 4/8 (moderate) Paediatric Evaluation of Disability Inventory– Computer Adaptive Test (PEDI-CAT) including the Daily Activities Scaled Score Daily Activities Scaled Scores: No change for Participants 1 and 2 while Participant 3 demonstrated a slight score increase Power mobility training had a variable effect on the daily activities score of children with multiple, severe impairments Paediatric Evaluation of Disability Inventory– Computer Adaptive Test (PEDI-CAT) including the Mobility Scaled Score Mobility Scaled Score: all participants had increased scores on the scale Power mobility training improved mobility of children with multiple, severe impairments Web-Annex B: Data Tables and Appendices 83 Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Loomis and Boersma 1982 5/8 (moderate) Number of trials required to achieve safe and independent performance; the scores achieved with regard to sequencing of the task; and the number of purposeless movements (errors) Verbal mediation seemed to improve performance in the wheelchair drill to be able to reach the criterion of safe and independent performance, retain correct sequencing at the post-test and with few errors among adults with right cerebrovascular accident (CVA) Amount of time required to complete wheelchair drill Both verbal mediation and no verbal mediation slightly reduced the amount of time required to complete the task from pre- to post-test among adults with right cerebrovascular accident (CVA) McGarry et al. 2012 5/8 (moderate) Adapted Powered Mobility Program assessment battery Smart Wheelchair Mobility Training Program (SWMTP) improved driving skills and impacted positively on psychosocial outcomes in children with cerebral palsy Mountain et al. 2010b 4/8 (moderate) Wheelchair Skills Test (WST) Wheelchair Skills Training Programme can lead to improvements in mobility in response to specific needs of long-standing wheelchair users Nisbet 2002 4/8 (moderate) Qualitative feedback) “She has learned she can control others and communicate with them” – “Jenny is much less passive than she was before she could move around in her wheelchair” – “The way in which she has learned...shows me she has more capacity to learn than I had thought” The Smart Wheelchairs with sensors and facilities enhance mobility enables effective training schemes to be devised for children with severe and complex disabilities Wheelchair Provision Guidelines 84 Table WB.82: Case reports on mobility and/or posture and/or function outcomes Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Gillen 2002 6/8 (moderate) Functional Independence Measure (FIM) Power wheelchair training improved indoor and outdoor power wheelchair mobility scores on the FIM and was sustained after a year, in an adult with ataxia using powered wheelchair Lennon 1991 7/8 (high) Task performance (8 wheelchair tasks) Verbal mediation improved wheelchair task performance after training and even after withdrawing the verbal mediation, in a left hemiplegic elderly with neglect Ragonesi 2012 6/8 (moderate) Success in Prompted Mobility Open Exploration and Prompted Mobility training improved infant’s mobility in both first half and second half periods but findings need to be confirmed in a larger scale Stanton 1993 6/8 (moderate) Therapists’ (PT/OT) observation Systematic and written transfer program with verbal mediation improved the ability to learn wheelchair transfers safely in a left hemiplegic adult with severe cognitive impairment Table WB.83: Qualitative study on mobility and/or posture and/or function outcomes Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Pellichero et al. 2020 10/10 (high) Semi-structured interview Theme:’ Getting my life back’ with subtheme of skills mastery ‘WheelSeeU has given me back my life and it’s giving me back independence’ ‘I had no idea that there were things to learn about using a wheelchair’ The WHeelSeeU training program improved mobility and life of alder adult manual wheelchair users Web-Annex B: Data Tables and Appendices 85 Table WB.84: Pre-post studies on secondary complications Author and year JBI appraisal score Secondary complications among users measures Results Interpretation Sarigul-Klijn et al. 2017 5/6 (high) Pain using Visual Analog Scale (VAS) People with chronic stroke with severe arm impairment did not experience any pain or pain during the six training sessions using bimanual propulsion wheelchair Rice et al. 2020 4/6 (moderate) Falls incidence Fall incidence significantly decreased from pre-test (mean and SD, 1.37 +/- 1.62 falls per month) to post-test (mean and SD 0.67 +/- 0.82 falls per month) (p=0.047, dz= 0.507). Subgroup analysis based on level of injury revealed a significant decrease in fall frequency from pre-test (mean and SD 1.04 +/- 1.49) to post-test (mean and SD, 0.43 +/- 0.52) (P= 0.049, dz= 0.53) among participants with an injury level T9 and above A 1:1, in-person intervention focused on factors associated with falls and concerns about falling and transfer and seated postural control skills significantly decreased falls incidence among adult manual wheelchair users with spinal cord injury. Spinal Cord Injury Fall Concerns Scale (FCS) Concerns about falling (SCI-FCS) decreased but not significantly from pre-test (mean and SD, 22.72 +/- 5.77) to post-test (mean and SD, 21.78 +/-0.526) (p=0.103, dz= 0.421). A 1:1, in-person intervention focused on factors associated with falls and concerns about falling and transfer and seated postural control skills did not significantly improve SCI-FCS of adult manual wheelchair users with spinal cord injury Sawatzky et al. 2012 5/6 (high) Impact Questionnaire The decrease in shoulder pain and in fatigue were evident by parent comments such as, ‘We have noticed that the skills for wheeling... has made a big difference in his right shoulder pain (decreased) and fatigue level when out for walks…’ and ‘… less energy expenditure and able to manoeuvre over small transitions’. The WSTP contributed to a decrease in pain and fatigue level in children with spinal cord problems using manual wheelchairs Table WB.85: Quasi- experimental study on secondary complications Author and year JBI appraisal score Secondary complications among users measures Results Interpretation Hoenig et al. 2005 8/9 (high) Shoulder pain; yes vs no response to shoulder pain being worse previously Individuals who used their wheelchair more frequently were more likely to report shoulder pain (P=0.02) and to report implementing home modifications (P=0.01) irrespective of the grouping 1.0 to 1.5 hours of multimodal intervention which included a training in use of wheelchairs and usual care significantly increased shoulder pain among community dwelling cognitively intact older people using manual wheelchairs Wheelchair Provision Guidelines 86 Table WB.86: Cross sectional study on secondary complications Author and year JBI appraisal score Secondary complications among users measures Results Interpretation Bazant et al. 2017 6/6 high Falls Wheelchair-related training was significantly associated with increased odds of serious vs no falls (OR 2.5, 95% CI 1.4 to 4.5) but not with non-serious vs no falls (OR 1.7, 95%CI 0.8 to 3.5) in the Philippines No relationship with training and falls in Kenya Wheelchair training based on the WHO 2008 Guidelines had inconsistent findings regarding falls outcomes in the two groups of population. Table WB.87: Case control study on secondary complications Author and year JBI appraisal score Mobility and/or posture and/or function measures Results Interpretation Webster et al. 2001 3/6 (moderate) Falls and accidents Trained subjects had fewer incident reports than control subjects during their hospitalization (Χ2 1,n=38 = 5.15, p = .023). Computer-Assisted Training (CAT) program modules on wheelchair skills and obstacle avoidance resulted in fewer incident reports among participants with unilateral neglect. Table WB.88: Pre-post study on satisfaction with the wheelchair Author and year JBI appraisal score Satisfaction with the wheelchair measures Results Interpretation Tasiemski, Wilski & Urbanski 2021 4/6 (moderate) Quebec User Evaluation of Satisfaction with assistive Technology (QUEST, Version 2.0) The general user satisfaction with a newly provided wheelchair was significantly greater in comparison to the satisfaction reported while using one’s own wheelchair (p=0.024; d=0.93). Items with greater satisfaction: ease in adjusting (p=0.011; d=0.96), safety and security (p=0.014; d=0.97), durability (p=0.037; d=0.81), ease to use (p=0.045; d=0.87), and comfort (p=0.006; d=1.03). No difference on the items on dimensions, weight and effectiveness (p>0.05) The Wheelchair Skills and Empowerment Camp resulted in greater satisfaction with the new wheelchairs provided to persons with disabilities using manual wheelchairs. Web-Annex B: Data Tables and Appendices 87 Table WB.89: Quasi-experimental study on satisfaction with wheelchair Author and year JBI appraisal score Satisfaction with the wheelchair Results Interpretation Hoenig et al. 2005 8/9 (high) Wheelchair comfort in the last 2 weeks (Likert scale) No significant difference between groups (p=0.18), over time (p=0.62) and between groups over time (p=0.99) 1.0 to 1.5 hours of multimodal intervention which included a training in use of wheelchairs and usual care did not improve wheelchair comfort of community dwelling cognitively intact older people using manual wheelchairs Table WB.90: Cohort study on satisfaction with wheelchair Author and year JBI appraisal score Satisfaction with the wheelchair Results Interpretation Taylor et al. 2015 4/8 (moderate) Interview 87% of the patients with spinal cord injury were satisfied with the wheelchair’s fit and function Table WB.91: Pre-post studies on satisfaction with the training Author and year JBI appraisal score Satisfaction with the training measures Results Interpretation Beaudoin et al. 2021 4/6 (moderate) Interview feedback Six themes emerged from the qualitative analysis: “Influence of personal background”, “Possibility of continuous improvement”, “A positive social experience”, “Influence of the physical environment”, “Learning more than skills”, and “Emotions triggered by peer-led community-based manual wheelchair training Charlton et al. 2021 4/6 (moderate) Interview feedback Four themes emerged from the qualitative analysis: ‘’Motivators driving learning’’, ‘’Delivery methods, structure and profile of the WSTP’’, ‘’ Managing risk and safety’’ and ‘’ Confidence in wheelchair use’’ Mountain et al. 2010 5/6 (high) Feedback The training and testing sessions were well tolerated by the adults with stroke learning to use powered wheelchair. There were no requests to end the 2.5 hours of wheelchair skills training sessions early. Sawatzky, Mortenson & Wong 2018 4/6 (moderate) Survey feedback Overall, adult manual wheelchair users were positive about the 30-min training session on rear mounted power assist and rated their experience with either Strongly Agree or Agree to most of our questions. Wheelchair Provision Guidelines 88 Table WB.92: Cross- sectional studies on satisfaction with the training Author and year JBI appraisal score Satisfaction with the training measures Results Interpretation Kirby et al. 2015 6/6 (high) Interview survey Only 4 (17.4%) and 3 (13.6%) participants found the training to be physically or emotionally stressful and 19 (82.6%) enjoyed the wheelchair skills training. All (100%) reported that they would recommend the training to others. Overall, adult wheelchair users discharged from rehab centre who took part in the wheelchair skills training program were satisfied with training Stefenac, Grabovac & Fristedt 2018 3/6 (moderate) Questionnaire (40) 89% participants were very or somewhat satisfied, while 5 persons (11%) were not satisfied with the wheelchair education and wheelchair skills training. No difference was found in satisfaction levels between participants met by medical compared to non- medical professionals (χ2=0.36; df=2; p=0.833) The wheelchair education and skills training for adult members of the Croatian Paraplegic and Tetraplegic Alliance resulted participants feeling safer using their wheelchairs compared to the participants not involved (n=23;51%) (χ2=6.13;df=1;p=0.013). Table WB.93: Case studies on satisfaction with the training Author and year JBI appraisal score Satisfaction with the training measures Results Interpretation Loomis and Boersma 1982 5/8 (moderate) Qualitative feedback All subjects evaluated their performance of wheelchair drill as “good” and reported no frustration at either the pre- or post-test stages, or during training. Adults with right cerebrovascular accident (CVA) found the training was good. Mountain et al. 2010b 4/8 (moderate) Qualitative feedback A participant reported that she had enjoyed the training and had mastered skills – in particular ascending and descending 15 cm curbs, ascending a grassy hill and performing wheelies – that she did not think that she would be able to learn at the beginning of training. The Wheelchair Skills Training Program (WSTP) was found to be effective and enjoyable. Web-Annex B: Data Tables and Appendices 89 Table WB.94: Pre-post studies on empowerment and self-esteem outcomes Author and year JBI appraisal score Empowerment and self-esteem outcomes Results Interpretation Beaudoin et al. 2021 4/6 (moderate) Wheelchair Confidence (WheelCon) Statistically significant increase in WheelCon scores from pre-test to post-test to follow up (p=<0.0001) Peer-led community-based manual wheelchair training significantly improved confidence of adult manual wheelchair users Eshraghi, Sawatzky & Mortenson 2021 5/6 (high) Manual wheelchair maintenance confidence questionnaire There was a significant 35% increase in confidence performing wheelchair maintenance over time and a significant 43% increase in confidence instructing others to perform maintenance. Peer-led, manual wheelchair maintenance skills training programme significantly improved confidence of adult manual wheelchair users. Sarigul-Klijn et al. 2017 5/6 (high) Intrinsic Motivation Inventory (IMI) The participants significantly increased their competence over the six training sessions (p=<0.05) in the IMI sub score for competence. No significant change in the Effort and Usefulness sub scores People with chronic stroke with severe arm impairment learning to drive a bimanual wheelchair significantly increased their competence but not perception of effort and usefulness over the six training sessions using bimanual propulsion wheelchair. Sawatzky et al. 2012 5/6 (high) Impact Questionnaire Two example quotes demonstrating development of independence are from a parent, ‘… is more willing to challenge herself with obstacles independently (small inclines, doors, etc.)’ and a child, ‘… able to be more independent and confident to go out on my own’. The WSTP contributed to the development of independence and confidence in children with spinal cord problems using manual wheelchairs Sawatzky, Mortenson & Wong 2018 4/6 (moderate) Shortened version of Wheelchair Confidence Score (WheelCon) Mean and SD WheelCon scores from pre-test to post training were 80.0±20.4 to 80.1±16.1 (p=0.77); no significant differences were noted in the WheelCon test 30-min training session on rear mounted power assist did not improve confidence of adult manual wheelchair users. Table WB.95: Pre-post study on empowerment and self-esteem outcomes Author and year JBI appraisal score Empowerment and self-esteem outcomes Results Interpretation Hoenig et al. 2005 8/9 (high) Wheelchair confidence in home, out-of-doors, public places and unfamiliar places (1 being not at all confident and 5 being completely confident) 1.0 to 1.5 hours of multimodal intervention which included a training in use of wheelchairs and usual care did not significantly improve wheelchair confidence of community dwelling cognitively intact older people using manual wheelchairs Table WB.96: Cohort study on empowerment and self-esteem outcomes Wheelchair Provision Guidelines 90 Author and year JBI appraisal score Empowerment and self- esteem outcomes Results Interpretation Divanoglou et al. 2019 4/8 (moderate) Wheelchair Skills Test- Questionnaire (WST-Q) confidence scores A 14% increase in wheelchair skills confidence between baseline and completion (p = 0.092; d = 0.61), which reached a 25% improvement at 5-month follow- up (p = 0.003; d = 0.96) was found. A 7-day Active Rehabilitation (AR) training programme increased wheelchair skills confidence among community dwelling people with spinal cord injury Table WB.97: Qualitative study on empowerment and self-esteem outcomes Author and year JBI appraisal score Empowerment and self- esteem outcomes Results Interpretation Pellichero et al. 2020 10/10 (high) Semi-structured interview Theme:’ Getting my life back’ with subtheme of ‘self-efficacy’ ‘WheelSeeU gave me greater confidence’ ‘I did not do it[ascend a low curb], before, because I was scared, but today I’m going to do it. ’ Wheel-SeeU Peer-Led Wheelchair Training Program led to positive experiences and perceived benefits among older adult manual wheelchair users with different conditions Table WB.98: Pre-post studies on inclusion, participation and/or quality of life outcomes Author and year JBI appraisal score Inclusion, participation and/or quality of life measures Results Interpretation Beaudoin et al. 2021 4/6 (moderate) Wheel-chair Outcome Measure (WhOM) Statistically significant increase in WhOM scores from pre-test to post-test to follow up (p=<0.0001) Peer-led community-based manual wheelchair training significantly improved adult manual wheelchair users’ participation in selected activities Satisfaction With Life Scale (SWLS) No significant change in SWLS (p= 0.687) Peer-led community-based manual wheelchair training did not improve adult manual wheelchair users’ quality or satisfaction with life Rice et al. 2020 4/6 (moderate) World Health Organization Quality of Life: short version (WHOQOL-BREF) Physical health domain of the WHOQOL-BREF scores significantly increased from pre-test (mean and SD, 63.22 +/- 12.59) to post-test (mean and SD, 75.61 +/- 16.38) (P = 0.05, dz= 1.566); likewise with individuals with an injury level at T10 and below (Pre: 68.88 ± 18.35, Post: 81.50 ± 11.57, P = 0.026, dz= 1.32) Psychological domain significantly increased from pre-test (mean and SD, 65.56 +/- 10.18) to post-test (mean and SD, 76.17 +/- 17.62) (p=0.04, dz= 0.760) Social relationships and environment domains did not have a significant change from pre-test (social relationships mean and SD, 70.44 +/- 25.11; environment mean and SD 81.44 +/- 14.65) to post-test (social Web-Annex B: Data Tables and Appendices 91 Author and year JBI appraisal score Inclusion, participation and/or quality of life measures Results Interpretation relationships mean and SD, 67.28 +/- 26.02; environment mean and SD, 81.06 +/- 13.16) (social relationship, p=0.465, dz= 0.299; environment, p=0.438, dz= 0.036). Significant improvements were seen among individuals with self-reported AIS C and D in the WhOQOL-BREF physical health (Pre: 68.11 +/- 9.61, Post: 75.89+/- 15.76, P = 0.56, dz= .79) and psychological health (Pre: 65.22 +/- 12.53, Post: 75.78 +/- 18.85, P = 0.041, dz= 0.97) domains. A 1:1, in-person intervention focused on factors associated with falls and concerns about falling and transfer and seated postural control skills significantly improved WHOQOL-BREF physical and psychological domain scores but not social relationships and environment domain scores of adult manual wheelchair users with spinal cord injury levels T10 and below Sawatzky et al. 2012 5/6 (high) Activity Scale for Kids (ASK) Performance Overall, the scores decreased from pre-test (41 +/- 6) to post-training (32 +/- 8), but were not statistically significant. The WSTP did not significantly improve ASK scores in children with spinal cord problems using manual wheelchairs. Table WB.99: Cohort study on inclusion, participation and/or quality of life outcomes Author and year JBI appraisal score Inclusion, participation and/or quality of life measures Results Interpretation Chang et al. 2020 3/8 (low) Basic life skills including application in social life Significant increase in median scores in application in social life (7%) in the first rehabilitation session and in the second rehabilitation session (6%) Two periods of rehabilitation for in-patient SCI patients significantly improved application in social life activities Divanoglo u et al. 2019 4/8 (moderate) Moorong Self-efficacy Scale (MSES) No changes in the total MSES score, or in two out of three constructs of the scale (general and social constructs). Participants achieved medium size improvements in the personal function construct (includes household participation and getting out of the house) of the MSES at completion (p = 0.004, d = 0.76) and at 5-month follow- up (p = 0.04, d = 0.63) as compared to baseline Active Rehabilitation for persons with spinal cord injury significantly improved personal function construct of the MSES but not the total MSES score. Wheelchair Provision Guidelines 92 Table WB.100: Case studies on inclusion, participation and/or quality of life outcomes Author and year JBI appraisal score Inclusion, participation and/or quality of life measures Results Interpretation Kenyon et al. 2017 4/8 (moderate Dimensions of Mastery Questionnaire (DMQ) DMQ scores varied among the children with multiple, severe impairments McGarry et al. 2012 5/8 (moderate) Adapted Powered Mobility Program assessment battery Smart Wheelchair Mobility Training Program (SWMTP) improved driving skills and impacted positively on psychosocial outcomes in children with cerebral palsy Nisbet 2002 4/8 (moderate) Qualitative feedback) “She has learned she can control others and communicate with them” – “Jenny is much less passive than she was before she could move around in her wheelchair” – “The way in which she has learned...shows me she has more capacity to learn than I had thought” The Smart Wheelchairs with sensors and facilities enhance participation and communication with others in children with severe and complex disabilities Table WB.101: Qualitative study on inclusion, participation and/or quality of life outcomes Author and year JBI appraisal score Inclusion, participation and/or quality of life measures Results Interpretation Pellichero et al. 2020 10/10 (high) Semi-structured interview Theme:’ Getting my life back’ with subtheme of ‘autonomy’ - ‘I’m able to get out, I’m able to go wherever I want now [...] being in the wheelchair is not a limit anymore. ‘WheelSeeU came at the right time because it made me more independent. I wasn’t able to get out of my apartment before [WheelSeeU], to open the door, to manoeuvre the door, to manoeuvre the carpet’. Theme: ‘Social gains’ with subtheme of ‘social connectedness’ – ‘he felt better by the end of [WheelSeeU], and now he doesn’t even push me. I push myself through the train, through the bus [...]. That was no problem for us, I can handle that’ (while travelling). Wheel-SeeU Peer-Led Wheelchair Training Program improved overall quality of life of older adult manual wheelchair users with different conditions. Web-Annex B: Data Tables and Appendices 93 Table WB.102: Characteristics of included studies (health professionals) Author and year Study location Persons performing wheelchair service roles Training description and participant numbers Comparison description and participant numbers Wheelchair users Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Cross-sectional studies Mathis & Gowran 2021 Ireland N= 91 survey respondents (N= 90 OTs; N= 1 technical personnel) Self-directed learning methods, job shadowing, workshops, presentations, continued education and clinical seminars are the methods for obtaining wheelchair skills training outside of professional qualification training. N/A N/A Ability of service providers to carry out service delivery (online survey including confidence instructing basic mobility skills, advanced mobility skills and all wheelchair skills) None Survey conducted from October 2018 in Ireland. Health professionals in Ireland lack the skills and confidence needed to provide formal training in advanced mobility skills and desire opportunities to develop these skills. Narrative review Cooper, Trefier & Hobson 1996 USA N/A Training in general N/A N/A Ability of service providers to carry out service delivery (narrative statement) Wheelchair abandonment (narrative statement) Disruption in use including due to wheelchair breakdown (narrative statement) N/A Therapists continue to receive little seating and mobility training. Hence, inexperienced and undereducated therapists are attempting to assist consumers, with implications for technology abandonment, wasted funding, and longer time without equipment. Furthermore, the lack of special requirements to Wheelchair Provision Guidelines 94 Author and year Study location Persons performing wheelchair service roles Training description and participant numbers Comparison description and participant numbers Wheelchair users Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings become an RTS has resulted in varied service quality which is heavily dependent on the interest, experience, and training program of each RTS. The NRRTS is preparing RTSs for credentialing, which will help consumers identify who is qualified to provide services, while supporting RTSs to bill for their clinical services. Qualitative study Rusek et al. 2021 USA N= 20 licensed inpatient rehabilitation clinicians who work with manual wheelchair users (N= 12 physical therapists; N= 6 OTs; N= 1 physical therapy assistant; N= 1 OT assistant). Experience, self-directed learning and colleague collaboration and other educational resources N/A N/A Ability of service providers to carry out service delivery (semi- structured interview) None N/A A greater number of clinicians obtain their knowledge for MWC training from informal mentorship by more experienced colleagues or trial and error than those who referenced existing, research-driven resources. Few clinicians use or are aware of validated MWC training resources, such as the CPGs and WSTP. Those who were familiar, were more experienced (i.e., 10 or more years) and physical therapists. Web-Annex B: Data Tables and Appendices 95 Table WB.103: Characteristics of included studies (students) Author and year Study location Persons performing wheelchair service roles Training description and participant numbers Comparison description and participant numbers Wheelchair users Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Randomised Controlled Trials (RCTs) Coolen et al, 2004 Canada Second year OT students N= 40 Wheelchair Skills Training Program (WSTP) version 2.4 added to standard curriculum; The training was 2 to 3 hours in duration using random practice, students training in pairs and included video demonstrations n = 22 Standard wheelchair curriculum n = 18 N/A Satisfaction with the service (VAS scores and questionnaire) None Pre-test and post-training (after intervention) The Wheelchair Skills Training Programme (WSTP) is a safe and practical training program in addition to standard undergraduate OT curriculum Kirby et al. 2011 Canada N= 24 first- and second-year medical students N= 12 (13 allocated, 1 drop out) received a 4-hr workshop that included didactic, practical, community and reflective elements. N= 12 (13 allocated, 1 drop out) received no intervention. N/A Ability of service providers to carry out service delivery (post-evaluation questionnaire and follow-up questionnaire) Satisfaction with the service (post- evaluation questionnaire) None Pre-test and post-training (after intervention) and 6-months after for follow up A wheelchair workshop designed for medical students was practical, well received by students, and effective at improving students’ knowledge and skills. Although students’ attitudes were not measurably affected by the intervention, there was qualitative evidence of a positive effect. Pre-post Baird et al. 2015 USA Occupational therapy students; (across 7 different scenario simulations). N/A N/A Ability of service providers to carry out service delivery None Pre-test and post training The use of a simulator, a mock hospital suite, and clinical Wheelchair Provision Guidelines 96 Author and year Study location Persons performing wheelchair service roles Training description and participant numbers Comparison description and participant numbers Wheelchair users Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings N= ranged between 49 and 73 participants (across 7 different scenario simulations) Wheelchair transfer procedures were taught using a video- practice- assessment sequence, in which students first watched instructional videos of proper transfer techniques, then practiced transfers with peer partners, followed by a performance assessment consisting of a peer transfer. (performance assessment) Satisfaction with service (students perceptions on effectiveness) scenarios with embedded critical events were effective for teaching dependent transfers, handling skills, and clinical reasoning. Digital videos of each students’ transfers also allowed students the opportunity to review their transfers with the goal of improving their performance and reasoning Gilbert et al. 2021 USA N= 79 fourth- year medical students (however, 4 participants were excluded due to incomplete pre- or post- surveys). 2-hour educational wheelchair program consisting of (1) a disability lecture; (2) a video on the importance of proper wheelchair type and fit, wheelchair prescription, as well as recreational N/A N/A Ability of service providers to carry out service delivery (wheelchair program feedback items) None Pre-test and post training This study demonstrates that an interactive educational wheelchair program effectively increases medical students’ understanding of manual wheelchair use and comfort in treating wheelchair users. Web-Annex B: Data Tables and Appendices 97 Author and year Study location Persons performing wheelchair service roles Training description and participant numbers Comparison description and participant numbers Wheelchair users Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings wheelchair use; and (3) an interactive wheelchair experience. Smith, Best & Miller 2020 Canada N= 44 students in their final year of an entry-to- practice master of occupational therapy program two-day wheelchair skills bootcamp, based on the Wheelchair Skills Program. Curriculum included lecture, demonstration, and hands-on training in manual wheelchair skills (6.5h) and power wheelchair skills (6.5h). N/A N/A Ability of service providers to carry out service delivery (Self-Efficacy in Assessing, Training, and Spotting Manual Wheelchair skills (SEATS-M) and Self- Efficacy in Assessing, Training, and Spotting Power wheelchair skills (SEATS-P)) None Pre-test and post training Wheelchair skills training bootcamps may help prepare occupational therapy students to assess, train, spot, and document manual wheelchair and power wheelchair skills of future clients, while improving students’ wheelchair skills capacity. A bootcamp approach provides an option for integrating wheelchair skills training into the curriculum of time-intensive programs. Cross-sectional studies Toro- Hernández et al. 2020 Colombia N= 83 final year OT students from 7 universities in Colombia took the Wheelchair Service Provision Basic Knowledge Test in Spanish Entry level OT program N/A N/A Ability of service providers to carry out service delivery (ISWP Wheelchair Service Provision Basic Knowledge Test) None N/A This study evaluated the current basic wheelchair provision knowledge of final year undergraduate occupational students in Colombia. The findings are concerning as none of the students obtained the minimum threshold (70%) to pass the test, and the mean total score of the sample was statistically significantly below the passing threshold. In addition, the difference was statistically large Wheelchair Provision Guidelines 98 Author and year Study location Persons performing wheelchair service roles Training description and participant numbers Comparison description and participant numbers Wheelchair users Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings (d > .8). The assessment was the domain that had the better results while user training and fitting, the lowest. These results suggest that the current wheelchair provision education received in these OT programs do not meet the WHO guidelines on appropriate wheelchair provision. Qualitative studies Fung et al. 2020 Internatio nal (Canada, Togo, Colombia, Honduras , USA, Sudan, Romania, Philippine s, UK, Kenya, Thailand) N= 14 university representatives (OT, physical therapy, prosthetics/ort hotics fields) Academic rehabilitation programs (wheelchair service provision education) N/A N/A Ability of service providers to carry out service delivery (impact of context; current and planned wheelchair education) None Each participant took part in a semi-structured interview (duration of 56.4 ± 20.4 minutes) This study provides an in-depth description of wheelchair service provision education across rehabilitation disciplines and resource settings. It illustrates the importance of context-dependent integration of wheelchair service provision education into academic rehabilitation programs to meet the needs of wheelchair users. This work has informed the development of ISWP’s Seating and Mobility Academic Resource Toolkit (http://smart.wheelchairnetwork.or g ), the purpose of which is to assist the integration of context-relevant wheelchair service provision education in academic rehabilitation programs worldwide.   Web-Annex B: Data Tables and Appendices 99 Table WB.104: Characteristics of included studies (family and care providers) Author and year Study location Persons performing wheelchair service roles Training description and participant numbers Comparison description and participant numbers Wheelchair users Critical outcomes Important outcomes Measurement periods Authors conclusions/study findings Pre-post Kirby et al. 2004 Canada N= 24 caregivers of manual wheelchair users N= 24 caregivers of manual wheelchair users underwent the Wheelchair Skills Training Program (WSTP), version 2.4, adapted for caregivers. Training was individualised on the basis of an integrated testing-and- training protocol that took place on a single occasion (total, ≈50min). N/A N/A Ability of service providers to carry out service delivery (WSTP skill transfer) None Testing-and- training protocol: The pretraining evaluation, the training, and the initial post training evaluation were integrated and carried out in a single session.27 The caregiver was first asked to perform a skill. If the skill was not performed safely or effectively, the caregiver received immediate training before moving on to the next skill. When either mastery was apparent or the skill was abandoned, the caregiver was retested on that skill. The WSTP is a safe, practical, and effective method of improving the wheelchair-handling skills of untrained caregivers. Skill improvements are generally well retained and transfer well to the community. Such training could play an important role in the rehabilitation process. Wheelchair Provision Guidelines 100 Table WB.105: Cross sectional study on ability of service providers to carry out service delivery measures Author and year JBI appraisal score Ability of service providers to carry out service delivery measures Results Interpretation Mathis & Gowran 2021 3/6 (moderate) Survey/ Questionnaire The wheelchair skills that health professionals (N=89) reported to be “very confident” in instructing users were as follows: transfers (93%), ADLs (81%), basic mobility (80%), IADLs (67%), maintenance and repair (52%) and advanced mobility (35%) Additional wheelchair skills training for health professionals contribute to their confidence in instructing wheelchair users especially in doing transfers, teaching ADLs and basic mobility. Training methods used outside of professional qualification training which included self-directed learning methods, job shadowing, workshops, presentations, continued education and clinical seminars, enabled health professionals to be very confident in providing training to wheelchair users particularly in transfers, teaching ADLs and basic mobility. However, health professionals would like to have additional training and learn how to assess and teach advanced skills for outdoor mobility, with consideration to specialised groups. Table WB.106: Narrative review on ability of service providers to carry out service delivery measures Author and year JBI appraisal score Ability of service providers to carry out service delivery measures Results Interpretation Cooper, Trefier & Hobson 1996 2/11 (Low) None Assistive technology education of therapists and rehabilitation engineers is crucial to their success as clinicians and/or researchers. All professional degrees in the therapies should require assistive technology training, which is currently not the case. People must have appropriate training to assume their professional responsibilities. Clinicians already in practice must have either access to courses planned for preservice training or for continuing education. Therapists continue to receive little seating and mobility training. Hence, inexperienced and undereducated therapists are attempting to assist consumers, with implications for technology abandonment, wasted funding, and longer time without equipment. Web-Annex B: Data Tables and Appendices 101 Table WB.107: Qualitative Study on ability of service providers to carry out service delivery measures Author and year JBI appraisal score Ability of service providers to carry out service delivery measures Results Interpretation Rusek et al. 2021 7/10 (moderate) Semi-structured interview Theme 1: Clinician knowledge, education, and experience All participants reported receiving minimal education in school and no formal training from their employers for how to teach MWC skills and propulsion. When prompted, only physical therapists and the physical therapy assistant demonstrated awareness of either the clinical practice guidelines or WSTP. Most clinicians reported having to obtain their knowledge of MWC skills and propulsion through experience with MWUs, self-directed learning, and colleague collaboration. Nearly, all participants also utilized resources such as research articles, YouTube, the Internet, continuing education courses, and in-service presentations to increase their MWC knowledge. Lastly, a majority of clinicians reported receiving informal mentorship from more experienced therapists, building relationships with ATPs or wheelchair vendors, or collaborating with colleagues. As a whole, clinicians saw themselves as playing an integral role in the rehabilitation process for MWUs. Table WB.108: Narrative review on disruption in use including due to wheelchair breakdown Author and year JBI appraisal score Disruption in use including due to wheelchair breakdown measures Results Interpretation Cooper, Trefier & Hobson 1996 2/ 11 (low) None All people involved with wheelchairs and seating must be aware of, or become informed about the quality of products from functional and technical perspectives. In the case of a wheelchair, some components require periodic replacement. For example, the cross brace of an aluminium wheelchair often shows little signs of wear or damage before breaking. Periodic replacement, based upon usage and user body weight, can prevent the inconvenience of an untimely breakdown. Wheelchair Provision Guidelines 102 Table WB.109: Narrative review on wheelchair abandonment Author and year JBI appraisal score Wheelchair abandonment measures Results Interpretation Cooper, Trefier & Hobson 1996 2/ 11 (low) None Therapists continue to receive very little seating and mobility training in their pre-professional education. Therefore, some therapists with little training are attempting to assist consumers in making decisions, while having only minimal skills and experience. This often results in the inexperienced or undereducated therapists deferring to the Rehabilitation Technology Suppliers RTS) until they gain sufficient expertise. The down-side of this latter scenario is that the prescription can become product or vendor driven in contrast to function and consumer need driven. This can result in technology abandonment, wasting of funding to replace poorly prescribed equipment, and the consumer being without needed equipment for longer duration. Table WB.110: Randomised controlled trial on ability of service providers to carry out service delivery Author and year JBI appraisal score Ability of service providers to carry out service delivery measures Results Interpretation Kirby et al. 2011 7/11 (moderate) Survey/ Questionnaire Responses to: Do you think the Wheelchair Education Workshop will be helpful to you in clerkship or specialty training?’ - Examples of comments included the following: ‘Great to learn a bit about other health professions,’ ‘‘Feel more confident discussing issues around wheelchairs, transferring patients,’ ‘…knowing how to fold the wheelchair,’’ and ‘‘In performing the skills ourselves, we came to understand the challenges for individuals in wheelchairs.’’ Responses to: ‘Is there anything that we could have done differently in the Wheelchair Education Workshop that you think would have helped prepare you for future experiences with wheelchair users? - There were three comments about having a wheelchair user available to demonstrate skills and be involved in the discussion three about the need for more transfer practice, one on the parts of the wheelchair, one suggesting more tips from the caregiver perspective, and one suggestion for longer sessions or more of them. A multicomponent workshop improved the perspectives of undergraduate medical students in preparation for their clerkship or specialty training. Follow up questionnaire Responses to: ‘Has the Wheelchair Education Workshop been helpful to you in clerkship or specialty training since then?’ - 7/12 (58%) responded YES. Comments were: I now feel that I have a better understanding of what it means to spend a significant amount of time in a wheelchair. As such, I feel that I am able to care for my patients better than if I had not had this,’’ ‘‘This workshop has been most useful for working with patients who are in wheelchairs. Simply knowing how to turn on and off electric wheelchairs is a big help. Also, I think it sends a good message to patients when their healthcare workers know a bit about wheelchair techniques,’’ and ‘‘I have been in the situation multiple times since the workshop where I have to move a patient’s wheelchair to be able to perform a physical exam...’’ - The rest of the students did not feel that it had been useful. Comment made was ‘it would likely be valuable in the future as they gained more clinical experience’. Web-Annex B: Data Tables and Appendices 103 Table WB.111: Pre-post studies on ability of service providers to carry out service delivery measures Author and year JBI appraisal score Ability of service providers to carry out service delivery measures Results Interpretation Baird et al. 2015 5/6 (high) Survey/ Questionnaire Students’ ratings of the simulation experience with clinical scenarios revealed the training was effective in preparing them to transfer medically complex patients in an acute care environment. Gilbert et al. 2021 5/6 (high) Survey/ Questionnaire Response to the question: This wheelchair program has increased my comfort in treating patients who use wheelchairs. 59% and 29% of participants responded agreed and strongly agreed; 9% were neutral and only 2% disagreed and strongly disagreed. The 2-hour educational wheelchair program with interactive experience improved participants comfort in managing wheelchair users. Smith, Best & Miller 2020 5/6 (high) Self-Efficacy in Assessing, Training, and Spotting Manual Wheelchair skills (SEATS-M) Means and SDs for assessing domains were 84.3 +/- 11.9 at post-test from 55.5 +/- 20.9 at pre-test (p=<0.001) Mean and SDs for training domains were 76.6 +/- 10.4 at post-test from 43.1 +/- 14.8 at pre-test (p=<0.001) Mean and SDs for spotting domains were 88.7 +/- 11.9 at post- test from 53.9 +/- 20.6 at pre-test (p=<0.001) Mean and SDs for documentation domains were 67.9 +/- 17.39 at post-test from 38.5 +/- 15.8 at pre-test (p=<0.001) The wheelchair skills bootcamp, based on the Wheelchair Skills Program significantly improved students’ self-efficacy for assessing, training, spotting, and documentation Self-Efficacy in Assessing, Training, and Spotting Power wheelchair skills (SEATS-P) Mean and SDs for assessing domains were 88.5 +/- 12.7 at post-test from 57.3 +/- 20.9 at pre-test (p=<0.001) Mean and SDs for training domains were 82.9 +/- 14.0 at post-test from 49.9 +/- 15.5 at pre-test (p=<0.001) Mean and SDs for spotting domains were 88.4 +/- 13.1 at post- test from 53.1 +/- 21.4 at pre-test (p=<0.001) Mean and SDs for documentation domains were 66.1 +/- 19.1 at post-test from 37.7 +/- 15.0 at pre-test (p=<0.001) The wheelchair skills bootcamp, based on the Wheelchair Skills Program significantly improved students’ self-efficacy for assessing, training, spotting, and documentation Table WB.112: Cross sectional study on ability of service providers to carry out service delivery Author and year JBI appraisal score Ability of service providers to carry out service delivery measures Results Interpretation Toro- Hernández et al. 2020 3/6 (moderate) ISWP Wheelchair Service Provision Basic Knowledge Test The total score of the sample was significantly lower by 23.65% (95% CI, 21.34 to 25.97) than the passing threshold of 70%, t(82) = −20.32, p= 0.0005, d=2.23. The latter reflects a large effect size, above two standard deviations. The basic wheelchair provision education in entry level OT program is not enough to make the students ready to provide wheelchair service to users. Wheelchair Provision Guidelines 104 Table WB.113: Qualitative study on ability of service providers to carry out service delivery Author and year JBI appraisal score Ability of service providers to carry out service delivery measures Results Interpretation Fung et al. 2020 8/10 Semi-structured interviews Theme Evaluation and feedback: “demonstrate it made a difference” “Over the course of the years as we’ve learned about our strengths and weaknesses, we found that we were missing content on seating systems and wheelchairs. So we added more content to address that shortcoming”. In many cases, student interest and their perceived value of a wheelchair-specific course validated the importance of learning about wheelchair service provision in their professional training. Table WB.114: Randomised controlled trial on satisfaction with the service measures Author and year JBI appraisal score Satisfaction with the service measures Results Interpretation Coolen et al 2004 9/11 VAS and questionnaire Mean VAS score for the WSTP training score was 97.0% +/- 4.2%, significantly higher than the standard curriculum which was 50.1% +/-24.8%, (P.000). All students in the WSTP group indicated that the wheelchair skills training they received should be implemented into the curriculum of the OT program. Of the 20/22 students in the WSTP group who made comments regarding potential changes to the training sessions, 9 (45%) reported that they would not change the sessions, 7 (35%) recommended more practice time or longer training sessions, and 4 (20%) made other comments (e.g., having more than 1 training session, practicing in the community). Of the 20 students in the WSTP group who made comments about the length of the training sessions, 16 (80%) reported that the length of the training sessions was appropriate, 2 (10%) reported that it was too long, and 2 (10%) reported that it was too short. The Wheelchair Skills Training Programme (WSTP) is a safe and practical training program in addition to standard undergraduate OT curriculum Kirby et al. 2011 7/11 (moderate) Survey/ Questionnaire Responses to: ‘Please include any additional thoughts, ideas, or suggestions’ - Examples of comments included the following: ‘‘It was fun and useful!’’ and ‘‘I loved being a part of this and think this training should definitely be implemented in the training of health professionals.’’ Web-Annex B: Data Tables and Appendices 105 Table WB.115: Pre-post study on satisfaction with the service measures Author and year JBI appraisal score Satisfaction with the service measures Results Interpretation Baird et al. 2015 5/6 Survey/ Questionnaire Students reported that their learning experience was broader than just transfer training. It included importance of monitoring vital signs, managing equipment, and adjusting to the acute care environment, all while implementing the mechanics of a dependent transfer The simulation training using different clinical scenarios was found to be realistic and more than what the students expected. Table WB.116: Pre-post study on ability of service providers to carry out service delivery Author and year JBI appraisal score Ability of service providers to carry out service delivery measures Results Interpretation Kirby et al. 2004 5/6 (high) Wheelchair Skills Test Questionnaire for Skill Transfer Mean and SD of the skill transfer scores were 92.5 +/- 8.7 which was not significantly different with post- training scores (p=0.73); however, the post-training mean and SD significantly increased from pre-training (p=0.001) The Wheelchair Skills Training Program (WSTP) for caregivers improved caregivers’ skill transfer abilities. Wheelchair Provision Guidelines 106 References 1. Adelola IA, Cox SL, Rahman A. Virtual environments for powered wheelchair learner drivers: Case studies. Technology and Disability. 2009;21(3):97-106. 2. Armstrong W, Reisinger KD, Smith WK. Evaluation of CIR-whirlwind wheelchair and service provision in Afghanistan. Disability & Rehabilitation. 2007;29(11-12):935-48. 3. Axelson P, Minkel, J. & Chesney, D. . A guide to wheelchair selection: How to use the ANSI/RESNA wheelchair standards to buy a wheelchair: Paralyzed Veterans of America; 1994. 53 p. 4. Baird JM, Raina KD, Rogers JC, O'Donnell J, Holm MB. Wheelchair Transfer Simulations to Enhance Procedural Skills and Clinical Reasoning. American Journal of Occupational Therapy. 2015;69 Suppl 2:6912185020p1-8. 5. Bazant ES, Himelfarb Hurwitz EJ, Onguti BN, Williams EK, Noon JH, Xavier CA, et al. Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines. African Journal of Disability. 2017;6:318. 6. Beaudoin M, Best KL, Raymond E, Routhier F. Influence of Roulez avec confiance, a peer-led community-based wheelchair skills training program, on manual wheelchair users. Disability & Rehabilitation Assistive Technology. 2021:1-8. 7. Beaumont-White S, Ham RO. Powered wheelchairs: are we enabling or disabling? Prosthetics & Orthotics International. 1997;21(1):62-73. 8. Best KL, Kirby RL, Smith C, MacLeod DA. Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial. Archives of Physical Medicine & Rehabilitation. 2005;86(12):2316-23. 9. Best KL, Miller WC, Huston G, Routhier F, Eng JJ. Pilot Study of a Peer-Led Wheelchair Training Program to Improve Self-Efficacy Using a Manual Wheelchair: A Randomized Controlled Trial. Archives of Physical Medicine & Rehabilitation. 2016;97(1):37-44. 10. Bray N, Noyes J, Edwards RT, Harris N. Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework. BMC Health Services Research. 2014;14:309. 11. Chang F, Zhang Q, Xie H, Yang Y, Shen C, Shen X, et al. The effects of two periods of rehabilitation for people with spinal cord injury from Shanghai, China. Spinal Cord. 2020;58(2):216-23. 12. Charlton K, Murray C, Boucaut R, Berndt A. Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study. Australian Occupational Therapy Journal. 2021;68(6):490-503. 13. Choi WS, Lee JM, Kim TY, Kim JH, Lee JA, Choi H. Development of Adjustable Wheelchair Training Structure and Validation of Usefulness for Evaluation and Training of Manual Wheelchair Skill. Journal of Mechanics in Medicine and Biology. 2020;20(10). 14. Coolen AL, Kirby RL, Landry J, MacPhee AH, Dupuis D, Smith C, et al. Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students. Arch Phys Med Rehabil. 2004;85(7):1160-7. 15. Cooper RA, Trefler E, Hobson DA. Wheelchairs and seating: Issues and practice. Technology and Disability. 1996;5(1):3-16. 16. D'Innocenzo ME, Pearlman JL, Garcia-Mendez Y, Vasquez-Gabela S, Zigler C, Rosen P, et al. Exploratory investigation of the outcomes of wheelchair provision through two service models in Indonesia. PLoS ONE [Electronic Resource]. 2021;16(6):e0228428. 17. Di Marco A, Russell M, Masters M. Standards for wheelchair prescription. Australian Occupational Therapy Journal. 2003;50(1):30-9. 18. Divanoglou A, Trok K, Jörgensen S, Hultling C, Sekakela K, Tasiemski T. Active Rehabilitation for Web-Annex B: Data Tables and Appendices 107 persons with spinal cord injury in Botswana – effects of a community peer-based programme. Spinal Cord. 2019;57(10):897-905. 19. Eshraghi M, Sawatzky B, Mortenson WB.. Feasibility of a peer-led, manual wheelchair maintenance skills training programme to improve wheelchair efficiency, and knowledge and confidence about wheelchair maintenance: a pre–post study. Disability and Rehabilitation: Assistive Technology. 2021;16(8):918-26. 20. Frank H. Krusen MD, Frederic J. Kottke, M.D., and Paul M. Ellwood, M.D. Handbook of physical medicine and rehabilitation: W. B. Saunders.; 2005 241- p. 21. Fung K, Miller T, Rushton PW, Goldberg M, Toro ML, Seymour N, et al. Integration of wheelchair service provision education: current situation, facilitators and barriers for academic rehabilitation programs worldwide. Disability and Rehabilitation: Assistive Technology. 2020;15(5):553-62. 22. Gallagher A, Cleary G, Clifford A, McKee J, O’Farrell K, Gowran RJ. “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. Disability and Rehabilitation. 2020:1- 13. 23. Giesbrecht EM, Miller WC. Effect of an mHealth Wheelchair Skills Training Program for Older Adults: A Feasibility Randomized Controlled Trial. Archives of Physical Medicine & Rehabilitation. 2019;100(11):2159-66. 24. Gilbert C, Hsieh S, Donovan J, Dyson-Hudson T, Cabarle M, Granger S, et al. Effect of an interventional educational wheelchair program on medical students' understanding of manual wheelchair use. Pm & R. 2021;13(12):1350-6. 25. Gillen G. Improving mobility and community access in an adult with ataxia. American Journal of Occupational Therapy. 2002;56(4):462-6. 26. Gowran RJ, Clifford A, Gallagher A, McKee J, O’Regan B, McKay EA. Wheelchair and seating assistive technology provision: a gateway to freedom. Disability and Rehabilitation. 2020. 27. Graham F, Boland P, Grainger R, Wallace S. Telehealth delivery of remote assessment of wheelchair and seating needs for adults and children: a scoping review. Disability & Rehabilitation. 2020;42(24):3538-48. 28. Graham F, Boland P, Wallace S, Taylor WJ, Jones B, Maggo J, et al. Social and technical readiness for a telehealth assessment service for adults with complex wheelchair and seating needs: A national survey of stakeholders. New Zealand Journal of Physiotherapy. 2021;49(1):31-9. 29. Greenhalgh M, Rigot S, Eckstein S, Joseph J, Cooper RM, Cooper RA. A consumer assessment of women who use wheelchairs. Journal of Military, Veteran and Family Health. 2021;7(2):40-9. 30. Greer N, Brasure M, Wilt TJ. Wheeled mobility (wheelchair) service delivery: scope of the evidence. Annals of Internal Medicine. 2012;156(2):141-6. 31. Hall K, Partnoy J, Tenenbaum S, Dawson DR. Power mobility driving training for seniors: a pilot study. Assistive Technology. 2005;17(1):47-56. 32. Hansen R, Tresse S, Gunnarsson RK. Fewer accidents and better maintenance with active wheelchair check-ups: a randomized controlled clinical trial. Clinical Rehabilitation. 2004;18(6):631-9. 33. Harrison A, Derwent G, Enticknap A, Rose FD, Attree EA. The role of virtual reality technology in the assessment and training of inexperienced powered wheelchair users. Disability & Rehabilitation. 2002;24(11-12):599-606. 34. Hasdai A, Jessel AS, Weiss PL. Use of a computer simulator for training children with disabilities in the operation of a powered wheelchair. American Journal of Occupational Therapy. 1998;52(3):215- 20. 35. Hoenig H, Landerman LR, Shipp KM, Pieper C, Pieper C, Richardson M, et al. A clinical trial of a rehabilitation expert clinician versus usual care for providing manual wheelchairs. Journal of the Wheelchair Provision Guidelines 108 American Geriatrics Society. 2005;53(10):1712-20. 36. Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon M-P, Griffiths F, Nicolau B, O’Cathain A, Rousseau M-C, Vedel I. Mixed Methods Appraisal Tool (MMAT), version 2018. Registration of Copyright (#1148552), Canadian Intellectual Property Office, Industry Canada. 37. JBI critical appraisal tools (https://jbi.global/critical-appraisal-tools) accessed March 2022 38. Kenyon LK, Farris JP, Gallagher C, Hammond L, Webster LM, Aldrich NJ. Power Mobility Training for Young Children with Multiple, Severe Impairments: A Case Series. Physical & Occupational Therapy in Paediatrics. 2017;37(1):19-34. 39. Kirby RL, Crawford KA, Smith C, Thompson KJ, Sargeant JM. A wheelchair workshop for medical students improves knowledge and skills: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation. 2011;90(3):197-206. 40. Kirby RL, Keeler L, Wang S, Thompson K, Theriault C. Proportion of wheelchair users who receive wheelchair skills training during an admission to a Canadian rehabilitation center. Topics in Geriatric Rehabilitation. 2015;31(1):58-66. 41. Kirby RL, Mifflen NJ, Thibault DL, Smith C, Best KL, Thompson KJ, et al. The manual wheelchair- handling skills of caregivers and the effect of training. Archives of Physical Medicine & Rehabilitation. 2004;85(12):2011-9. 42. Kirby RL, Miller WC, Routhier F, Demers L, Mihailidis A, Polgar JM, et al. Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial. Archives of Physical Medicine & Rehabilitation. 2015;96(11):2017-26.e3. 43. 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 [Electronic Resource]. 2016;11(12):e0168330. 44. Lennon S. Wheelchair transfer training in a stroke patient with neglect: A single case study design. Physiotherapy Theory and Practice. 1991;7(1):51-5. 45. Leochico CFD, Valera MJS. Follow-up consultations through telerehabilitation for wheelchair recipients with paraplegia in a developing country: a case report. Spinal Cord Series and Cases. 2020;6(1):58. 46. Loomis JE, Boersma FJ. Training right brain-damaged patients in a wheelchair task: Case studies using verbal mediation. Physiotherapy Canada. 1982;34(4):204-8. 47. MacGillivray MK, Sawatzky BJ, Miller WC, Routhier F, Kirby RL. Goal satisfaction improves with individualized powered wheelchair skills training. Disability & Rehabilitation Assistive Technology. 2018;13(6):558-61. 48. MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. Archives of Physical Medicine & Rehabilitation. 2004;85(1):41-50. 49. Mathis K, Gowran RJ. A cross-sectional survey investigating wheelchair skills training in Ireland. Disability & Rehabilitation Assistive Technology. 2021:1-8. 50. McGarry S, Moir L, Girdler S. The Smart Wheelchair: is it an appropriate mobility training tool for children with physical disabilities? Disability & Rehabilitation Assistive Technology. 2012;7(5):372- 80. 51. Miller WC, Best KL, Eng JJ, Routhier F. Influence of Peer-led Wheelchair Training on Wheelchair Skills and Participation in Older Adults: Clinical Outcomes of a Randomized Controlled Feasibility Trial. Archives of Physical Medicine & Rehabilitation. 2019;100(6):1023-31. 52. Morgan KA, Tucker SM, Klaesner JW, Engsberg JR. A motor learning approach to training wheelchair propulsion biomechanics for new manual wheelchair users: A pilot study. Journal of Spinal Cord Medicine. 2017;40(3):304-15. Web-Annex B: Data Tables and Appendices 109 53. Mountain AD, Kirby RL, Eskes GA, Smith C, Duncan H, MacLeod DA, et al. Ability of People With Stroke to Learn Powered Wheelchair Skills: A Pilot Study. Archives of Physical Medicine and Rehabilitation. 2010;91(4):596-601. 54. Mountain AD, Kirby RL, Smith C, Eskes G, Thompson K. Powered wheelchair skills training for persons with stroke: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation. 2014;93(12):1031-43. 55. Mountain AD, Smith C, Kirby RL. Are wheelchair-skills assessment and training relevant for long- standing wheelchair users? Two case reports. Disability & Rehabilitation Assistive Technology. 2010;5(3):230-3. 56. Nisbet PD. Assessment and training of children for powered mobility in the UK. Technology and Disability. 2002;14(4):173-82. 57. Ozturk A, Ucsular FD. Effectiveness of a wheelchair skills training programme for community-living users of manual wheelchairs in Turkey: a randomized controlled trial. Clinical Rehabilitation. 2011;25(5):416-24. 58. Pellichero A, Best KL, Routhier F, Miller WC. Exploring Older Adults' Experiences and Perceptions with a Peer-Led Wheelchair Training Program. Canadian Journal of Occupational Therapy - Revue Canadienne d Ergotherapie. 2020;87(3):192-9. 59. Post MWM, Van Asbeck FWA, Van Dijk AJ, Schrijvers AJP. Services for spinal cord injured: Availability and satisfaction. Spinal Cord. 1997;35(2):109-15. 60. Ragonesi CB, Galloway JC. Short-term, early intensive power mobility training: Case report of an infant at risk for cerebral palsy. Paediatric Physical Therapy. 2012;24(2):141-8. 61. Rice LA, Dysterheft JL, Sanders E, Rice IM. Short-term influence of transfer training among full time paediatric wheelchair users: A randomized trial. Journal of Spinal Cord Medicine. 2017;40(4):396- 404. 62. Rice LA, Sung JH, Keane K, Peterson E, Sosnoff JJ. A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study. Journal of Spinal Cord Medicine. 2020;43(5):607-15. 63. Rigot SK, DiGiovine KM, Boninger ML, Hibbs R, Smith I, Worobey LA. Effectiveness of a Web-Based Direct-to-User Transfer Training Program: A Randomized Controlled Trial. Archives of Physical Medicine & Rehabilitation. 2021;04:04. 64. Routhier F, Kirby RL, Demers L, Depa M, Thompson K. Efficacy and retention of the French-Canadian version of the wheelchair skills training program for manual wheelchair users: a randomized controlled trial. Archives of Physical Medicine & Rehabilitation. 2012;93(6):940-8. 65. Rusek CT, Kleven M, Walker C, Walker K, Heeb R, Morgan KA. Perspectives of inpatient rehabilitation clinicians on the state of manual wheelchair training: a qualitative analysis. Disability & Rehabilitation Assistive Technology. 2021:1-9. 66. Sakakibara BM, Miller WC, Souza M, Nikolova V, Best KL. Wheelchair skills training to improve confidence with using a manual wheelchair among older adults: a pilot study. Archives of Physical Medicine & Rehabilitation. 2013;94(6):1031-7. 67. Salatino C, Andrich R, Converti RM, Saruggia M. An observational study of powered wheelchair provision in Italy. Assistive Technology. 2016;28(1):41-52. 68. Sarigul-Klijn Y, Lobo-Prat J, Smith BW, Thayer S, Zondervan D, Chan V, et al. There is plenty of room for motor learning at the bottom of the Fugl-Meyer: Acquisition of a novel bimanual wheelchair skill after chronic stroke using an unmasking technology. IEEE International Conference on Rehabilitation Robotics. 2017;2017:50-5. 69. Sawatzky B, Mortenson WB., Wong S. Learning to use a rear-mounted power assist for manual wheelchairs. Disability & Rehabilitation Assistive Technology. 2018;13(8):772-6. Wheelchair Provision Guidelines 110 70. Sawatzky B, Rushton PW, Denison I, McDonald R. Wheelchair skills training programme for children: a pilot study. Australian Occupational Therapy Journal. 2012;59(1):2-9. 71. Smith EM, Best KL, Miller WC. A condensed wheelchair skills training 'bootcamp' improves students' self-efficacy for assessing, training, spotting, and documenting manual and power wheelchair skills. Disability & Rehabilitation Assistive Technology. 2020;15(4):418-20. 72. Smith EM, Sakakibara BM, Miller WC. A review of factors influencing participation in social and community activities for wheelchair users. Disabil Rehabil Assist Technol. 2016;11(5):361-74. 73. Stanton KM, Pepping M, Brockway JA, Bliss L, Frankel D, Waggener S. Wheelchair transfer training for right cerebral dysfunctions: A interdisciplinary approach. Archives of Physical Medicine and Rehabilitation. 1983;64(6):276-80. 74. Štefanac S, Grabovac I, Fristedt S. Wheelchair users' satisfaction with the prescribed wheelchairs and wheelchair services in Croatia. Collegium Antropologicum. 2018;42(3):199-210. 75. Suzuki KM, Lockette G. Client satisfaction survey of a wheelchair seating clinic. Physical and Occupational Therapy in Geriatrics. 2000;17(2):55-65. 76. Tasiemski T, Wilski M, Urbanski P. One World Project's Wheelchair Skills Training Camp in Morocco - effects of a community peer-based programme. Disability & Rehabilitation Assistive Technology. 2021:1-7. 77. Taylor S, Gassaway J, Heisler-Varriale LA, Kozlowski A, Teeter L, Labarbera J, et al. Patterns in Wheeled Mobility Skills Training, Equipment Evaluation, and Utilization: Findings from the SCI Rehab Project. Assistive Technology. 2015;27(2):59-68. 78. Toro ML, Eke C, Pearlman J. The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: A cohort study in Indonesia Health systems and services in low and middle income settings. BMC Health Services Research. 2016;16(1). 79. Toro-Hernandez ML, Alvarez L, Vargas-Chaparro MC, Goldberg M. Final Year Students' Knowledge on Basic Manual Wheelchair Provision: The State of Occupational Therapy Programs in Colombia. Occupational Therapy International. 2020;2020:3025456. 80. Trefler E, Fitzgerald SG, Hobson DA, Fitzgerald SG, Bursick T, Joseph R. Outcomes of Wheelchair Systems Intervention With Residents of Long-Term Care Facilities. Assistive Technology. 2004;16(1):18-27. 81. Van Der Scheer JW, De Groot S, Tepper M, Faber W, Veeger DH, Van Der Woude LHV, et al. Low- intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels. Journal of Rehabilitation Medicine. 2016;48(1):33-42. 82. Verza R, Lopes Carvalho ML, Battaglia MA, Messmer Uccelli M. An interdisciplinary approach to evaluating the need for assistive technology reduces equipment abandonment. Multiple Sclerosis. 2006;12(1):88-93. 83. Visagie S, Mlambo T, van der Veen J, Nhunzvi C, Tigere D, Scheffler E. Impact of structured wheelchair services on satisfaction and function of wheelchair users in Zimbabwe. African Journal of Disability. 2016;5(1):222. 84. Webster JS, McFarland PT, Rapport LJ, Morrill B, Roades LA, Abadee PS. Computer-assisted training for improving wheelchair mobility in unilateral neglect patients. Archives of Physical Medicine & Rehabilitation. 2001;82(6):769-75. 85. Williams E, Hurwitz E, Obaga I, Onguti B, Rivera A, Sy TRL, et al. Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study. BMC International Health & Human Rights. 2017;17(1):22. 86. World Health Organization 2008. Guidelines on the provision of manual wheelchairs in less resourced settings. Geneva, Switzerland. Web-Annex B: Data Tables and Appendices 111 87. Worobey LA, Kirby RL, Heinemann AW, Krobot EA, Dyson-Hudson TA, Cowan RE, et al. Effectiveness of Group Wheelchair Skills Training for People With Spinal Cord Injury: A Randomized Controlled Trial. Archives of Physical Medicine & Rehabilitation. 2016;97(10):1777-84.e3. 88. Worobey LA, McKernan G, Toro M, Pearlman J, Cowan RE, Heinemann AW, et al. Effectiveness of Group Wheelchair Maintenance Training for People with Spinal Cord Injury: A Randomized Controlled Trial. Archives of Physical Medicine & Rehabilitation. 2021;24:24. 89. Worobey LA, Rigot SK, Hogaboom NS, Venus C, Boninger ML. Investigating the Efficacy of Web-Based Transfer Training on Independent Wheelchair Transfers Through Randomized Controlled Trials. Archives of Physical Medicine & Rehabilitation. 2018;99(1):9-16.e0. Wheelchair Provision Guidelines 112 Section WB.2: Appendices Appendix WB.1: Search strategies B1.1: Search strategy 1 Wheelchair Service Delivery: Questions A, B, C and D Ovid (up to 11 January 2022) Disabled Persons/ Disabled Children/ Para-athletes/ Amputees/ Patients/ ((disab* OR handicap*) ADJ3 (person* OR people* OR child* OR men OR women OR woman OR adult*)).ti,ab,kf (physical* ADJ3 (challenge* OR disab* OR handicap* Or impair* OR limitation*)).ti,ab,kf (paralymp* OR para athlete* OR paraathlete* OR wheelchair athlete*).ti,ab,kf (patient* OR client* OR user* OR consumer*).ti,ab,kf amputee*.ti,ab,kf OR/1-10 Wheelchairs/ (wheelchair* or wheel wheelchair* or buggy* or pushchair* or push wheelchair* or patient carrying wheelchair* or (mobility adj3 (technolog* or aid* or equipment or device*))).ti,ab,kf. ((scooter* or moped*) and (disab* or mobility or assistive)).ti,ab,kf. or/12-14 11 AND 15 Social Welfare/ (community service* OR social welfare).ti,ab,kf Community Health Services/ (community health service* OR community healthcare OR community health care).ti,ab,kf Social Work/ (Social work OR social service*).ti,ab,kf Delivery of Health Care/ ((healthcare or health care) adj2 (deliver* or distribut* or system or systems)).ti,ab,kf. (service* adj3 (deliver* or provid* or provis*)).ti,ab,kf. Health Services Accessibility/ (access* adj2 (healthcare or health care or service* or provider* or program* or therap* or treatment*)).ti,ab,kf. Health Services/ Health Services for Persons with Disabilities/ ((health or healthcare or health care) adj2 (service* or program)).ti,ab,kf. Patient Satisfaction/ Consumer Behavior/ ((patient or patients or consumer* or user or users) adj2 (satisf* or prefer* or behav*)).ti,ab,kf. Waiting Lists/ waiting list*.ti,ab,kf. "Quality of Health Care"/ ((health or healthcare or health care) adj2 (quality or audit*)).ti,ab,kf. "Outcome and Process Assessment, Health Care"/ Outcome Assessment, Health Care/ Patient Outcome Assessment/ Patient Reported Outcome Measures/ Web-Annex B: Data Tables and Appendices 113 "Process Assessment, Health Care"/ (donabedian model or donabedian triad or ((outcome* or process or processes) adj2 (assess* or measure* or study or studies or research)) or structure process outcome triad or patient reported outcome*).ti,ab,kf. Continuity of Patient Care/ (care adj3 continu*).ti,ab,kf. "Referral and Consultation"/ (consult* or referral* or health service* gatekeeper* or second opinion*).ti,ab,kf. Patient Care Planning/ (care plan* or care goal*).ti,ab,kf. Case Management/ case management.ti,ab,kf. Program Evaluation/ (program* adj2 (effectiv* or accept* or evaluat* or appropriat* or sustainab*)).ti,ab,kf. Follow-Up Studies/ (followup OR follow up).ti,ab,kf fitting.ti,ab,kf (assessment or evaluation).ti,ab,kf organization & administration.fs. supply & distribution.fs. or/17-59 16 AND 60 N= 4,063 Scopus (up to 11 January 2022) ( ( TITLE-ABS-KEY ( ( disab* OR handicap* ) W/2 ( person* OR people* OR child* OR men OR women OR woman OR adult* ) ) ) OR ( TITLE-ABS-KEY ( physical* W/2 ( challenge* OR disab* OR handicap* OR impair* OR limitation* ) ) ) OR ( TITLE-ABS- KEY ( paralymp* OR "para athlete*" OR paraathlete* OR "wheelchair athlete*" OR patient* OR client* OR user* OR consumer* OR amputee* ) ) ) AND ( ( TITLE-ABS-KEY ( wheelchair* OR "wheel wheelchair*" OR buggy* OR pushchair* OR "push wheelchair*" OR "patient carrying wheelchair*" OR ( mobility W/2 ( technolog* OR aid* OR equipment OR device* ) ) ) ) OR ( TITLE-ABS-KEY ( ( scooter* OR moped* ) AND ( disab* OR mobility OR assistive ) ) ) ) AND ( ( TITLE- ABS-KEY ( "community service*" OR "social welfare" OR "community health service*" OR "community healthcare" OR "community health care" OR "social work" OR "social service*" ) ) OR ( TITLE-ABS-KEY ( ( healthcare OR "health care" ) W/1 ( deliver* OR distribut* OR system OR systems ) ) ) OR ( TITLE- ABS-KEY ( service* W/2 ( deliver* OR provid* OR provis* ) ) ) OR ( TITLE-ABS-KEY ( access* W/1 ( healthcare OR "health care" OR service* OR provider* OR program* OR therap* OR treatment* ) ) ) OR ( TITLE-ABS-KEY ( ( health OR healthcare OR "health care" ) W/1 ( service* OR program ) ) ) OR ( TITLE-ABS-KEY ( ( patient OR patients OR consumer* OR user OR users ) W/1 ( satisf* OR prefer* OR behav* ) ) ) OR ( TITLE-ABS-KEY ( ( health OR healthcare OR "health care" ) W/1 ( quality OR audit* ) ) ) OR ( TITLE-ABS-KEY ( "donabedian model" OR "donabedian triad" OR ( ( outcome* OR process OR processes ) W/1 ( assess* OR measure* OR study OR studies OR research ) ) OR "structure process outcome triad" OR "patient reported outcome*" ) ) OR ( TITLE-ABS-KEY ( ( care W/2 continu* ) OR consult* OR referral* OR "health service* gatekeeper*" OR "second opinion*" OR "care plan*" OR "care goal*" OR "case management" ) ) OR ( TITLE-ABS-KEY ( program* W/1 ( effectiv* OR accept* OR evaluat* OR appropriat* OR sustainab* ) ) ) OR ( TITLE-ABS- KEY ( followup OR "follow up" OR fitting OR assess* OR evaluat* OR "waiting list*" ) ) ) *Limit to article, conference paper and conference review and review N= 7,702 Wheelchair Provision Guidelines 114 ProQuest Theses and Dissertations (up to 12 January 2022) TI,AB,SU(((disabl* OR disabilit* OR handicap*) N/2 (person* OR people* OR child* OR men OR women OR woman OR adult*)) OR (physical* N/2 (challenge* OR disabl* OR disabilit* OR handicap* OR impair* OR limitation*)) OR paralymp* OR "para athlete*" OR paraathlete* OR "wheelchair athlete*" OR patient* OR client* OR user* OR consumer* OR amputee*) AND TI,AB,SU(wheelchair* OR "wheel wheelchair*" OR buggy* OR pushchair* OR "push wheelchair*" OR "patient carrying wheelchair*" OR (mobility N/2 (technolog* OR aid* OR equipment OR device*)) OR (scooter* OR moped*) AND (disabl* OR disabilit* OR mobility OR assistive)) AND TI,AB,SU("community service*" OR "social welfare" OR "community health service*" OR "community healthcare" OR "community health care" OR "social work" OR "social service*" OR followup OR "follow up" OR fitting OR assess* OR evaluat* OR "waiting list*" OR ((healthcare OR "health care") N/1 (deliver* OR distribut* OR system OR systems)) OR (service* N/2 (deliver* OR provid* OR provis*)) OR (access* N/1 (healthcare OR "health care" OR service* OR provider* OR program* OR therap* OR treatment*)) OR ((health OR healthcare OR "health care") N/1 (service* OR program)) OR ((patient OR patients OR consumer* OR user OR users) N/1 (satisf* OR prefer* OR behav*)) OR ((health OR healthcare OR "health care") N/1 (quality OR audit*)) OR ("donabedian model" OR "donabedian triad" OR "structure process outcome triad" OR "patient reported outcome*" OR ((outcome* OR process OR processes) N/1 (assess* OR measure* OR study OR studies OR research))) OR ((care N/2 continu* OR continuat*) OR consult* OR consultat* OR referral* OR "health service* gatekeeper*" OR "second opinion*" OR "care plan*" OR "care goal*" OR "case management") OR (program* N/1 (effectiv* or accept* or evaluat* or appropriat* or sustainabl* OR sustainabilit*))) N= 533 B1.2: Search strategy 2 Wheelchair Training: Questions E and F Ovid (up to 11 January 2022) Disabled Persons/ Disabled Children/ Para-athletes/ Amputees/ Patients/ ((disab* OR handicap*) ADJ3 (person* OR people* OR child* OR men OR women OR woman OR adult*)).ti,ab,kf (physical* ADJ3 (challenge* OR disab* OR handicap* Or impair* OR limitation*)).ti,ab,kf (paralymp* OR para athlete* OR paraathlete* OR wheelchair athlete*).ti,ab,kf (patient* OR client* OR user* OR consumer*).ti,ab,kf amputee*.ti,ab,kf OR/1-10 Wheelchairs/ (wheelchair* or wheel wheelchair* or buggy* or pushchair* or push wheelchair* or patient carrying wheelchair* or (mobility adj3 (technolog* or aid* or equipment or device*))).ti,ab,kf. ((scooter* or moped*) and (disab* or mobility or assistive)).ti,ab,kf. or/12-14 11 AND 15 Inservice Training/ Patient Education as Topic/ "Task Performance and Analysis"/ Learning/ Knowledge/ Education/ education.fs. (educat* or train* or workshop* or skill* or learn* or knowledge* or program* or instruct* or class or classes or (task* adj3 (perform* or analy*))).ti,ab,kf. (followup OR follow up).ti,ab,kf Web-Annex B: Data Tables and Appendices 115 fitting.ti,ab,kf (assessment or evaluation).ti,ab,kf or/17-27 16 AND 28 N= 4,534 Scopus (up to 11 January 2022) ( ( TITLE-ABS-KEY ( ( disab* OR handicap* ) W/2 ( person* OR people* OR child* OR men OR women OR woman OR adult* ) ) ) OR ( TITLE-ABS-KEY ( physical* W/2 ( challenge* OR disab* OR handicap* OR impair* OR limitation* ) ) ) OR ( TITLE-ABS- KEY ( paralymp* OR "para athlete*" OR paraathlete* OR "wheelchair athlete*" OR patient* OR client* OR user* OR consumer* OR amputee* ) ) ) AND ( ( TITLE-ABS-KEY ( wheelchair* OR "wheel chair*" OR buggy* OR pushchair* OR "push chair*" OR "patient carrying chair*" OR ( mobility W/2 ( technolog* OR aid* OR equipment OR device* ) ) ) ) OR ( TITLE-ABS-KEY ( ( scooter* OR moped* ) AND ( disab* OR mobility OR assistive ) ) ) ) AND ( ( TITLE-ABS-KEY ( educat* OR train* OR workshop* OR skill* OR learn* OR knowledge* OR program* OR instruct* OR class OR classes OR ( task* W/2 ( perform* OR analy* ) ) ) ) OR ( TITLE-ABS-KEY ( followup OR "follow up" OR fitting OR assess* OR evaluat* ) ) ) *Limit to article, conference paper and conference review and review N= 9,633 ProQuest Theses and Dissertations (up to 12 January 2022) TI,AB,SU(((disabl* OR disabilit* OR handicap*) NEAR/2 (person* OR people* OR child* OR men OR women OR woman OR adult*)) OR (physical* NEAR/2 (challenge* OR disabl* OR disabilit* OR handicap* OR impair* OR limitation*)) OR paralymp* OR "para athlete*" OR paraathlete* OR "wheelchair athlete*" OR patient* OR client* OR user* OR consumer* OR amputee*) AND TI,AB,SU(wheelchair* OR "wheel chair*" OR buggy* OR pushchair* OR "push wheelchair*" OR "patient carrying wheelchair*" OR (mobility NEAR/2 (technolog* OR aid* OR equipment OR device*)) OR (scooter* OR moped*) AND (disabl* OR disabilit* OR mobility OR assistive)) AND TI,AB,SU(educat* OR train* OR workshop* OR skill* OR learn* OR knowledge* OR program* OR instruct* OR class OR classes OR (task* NEAR/2 (perform* OR analy*)) OR followup OR "follow up" OR fitting OR assess* OR evaluat*) N = 798 Wheelchair Provision Guidelines 116 Appendix WB.2: Critical appraisal of studies in Review Question A Critical Appraisal Scores of Reviews Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Bray et al. 2004 Graham. et al. 2020 1. Is the review question clearly and explicitly stated? Y Y 2. Were the inclusion criteria appropriate for the review question? Y Y 3. Was the search strategy appropriate? Y Y 4. Were the sources and resources used to search for studies adequate? Y Y 5. Were the criteria for appraising studies appropriate? Y Y 6. Was critical appraisal conducted by two or more reviewers independently? UC Y 7. Were there methods to minimize errors in data extraction? Y UC 8. Were the methods used to combine studies appropriate? Y Y 9. Was the likelihood of publication bias assessed? N N 10. Were recommendations for policy and/or practice supported by the reported data? Y NA 11. Were the specific directives for new research appropriate? Y Y Score and rating (1 – 4, low; 5 – 8, moderate; 9 – 11, high) *total possible score for systematic review is 11 *total possible score for scoping review is 10 (Q10 is NA) 9/11 (high) 8/10 (moderate) Web-Annex B: Data Tables and Appendices 117 Critical Appraisal Score of Randomised Controlled Trial Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Hansen, Tresse & Gunnarsson 2004 1. Was true randomization used for assignment of participants to treatment groups? Y 2. Was allocation to treatment groups concealed? Y 3. Were treatment groups similar at the baseline? Y 4. Were participants blind to treatment assignment? NA 5. Were those delivering treatment blind to treatment assignment? NA 6. Were outcomes assessors blind to treatment assignment? UC 7. Were treatment groups treated identically other than the intervention of interest? Y 8. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y 9. Were participants analyzed in the groups to which they were randomized? Y 10. Were outcomes measured in the same way for treatment groups? Y 11. Were outcomes measured in a reliable way? Y 12. Was appropriate statistical analysis used? Y 13. Was the trial design appropriate, and any deviations from the standard RCT design (individual randomization, parallel groups) accounted for in the conduct and analysis of the trial? Y Score and rating (1 – 4, low; 5 – 8, moderate; 9 -11 high); exclude two blinding items (Q4 and Q5); highest possible score is 11 10/11 (high) Wheelchair Provision Guidelines 118 Critical Appraisal Scores of Quasi and Pre-post Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Hoenig et al. 2005 (Quasi) Armstrong et al. 2007 (Pre-post) 1. Is it clear in the study what is the ‘cause’ and what is the ‘effect’ (i.e. there is no confusion about which variable comes first)? Y Y 2. Were the participants included in any comparisons similar? Y NA 3. Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest? Y NA 4. Was there a control group? Y NA 5. Were there multiple measurements of the outcome both pre and post the intervention/exposure? Y N 6. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y UC 7. Were the outcomes of participants included in any comparisons measured in the same way? Y Y 8. Were outcomes measured in a reliable way? UC UC 9. Was appropriate statistical analysis used? Y Y For quasi experimental studies Score and rating (1 – 3, low; 4 – 6, moderate; 7 – 9, high); highest possible score is 9 For pre-post experimental studies Score and rating (1 – 2, low; 3 – 4, moderate; 5 – 6, high); exclude three NA items (Q2, Q3 and Q4); highest possible score is 6 8/9 (high) 3/6 (moderate) Web-Annex B: Data Tables and Appendices 119 Critical Appraisal Scores of Cohort Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Divanoglou et al. 2019 Toro, Eke & Pearlman 2016 Verza et al. 2006 1. Were the two groups similar and recruited from the same population? NA NA NA 2. Were the exposures measured similarly to assign people to both exposed and unexposed groups? NA NA NA 3. Was the exposure measured in a valid and reliable way? NA NA NA 4. Were confounding factors identified? N Y N 5. Were strategies to deal with confounding factors stated? N Y N 6. Were the groups/participants free of the outcome at the start of the study (or at the moment of exposure)? Y Y NA 7. Were the outcomes measured in a valid and reliable way? UC UC UC 8. Was the follow up time reported and sufficient to be long enough for outcomes to occur? Y Y Y 9. Was follow up complete, and if not, were the reasons to loss to follow up described and explored? Y Y UC 10. Were strategies to address incomplete follow up utilized? N N UC 11. Was appropriate statistical analysis used? Y Y Y Score and rating (1 – 3, low; 4 – 6, moderate; 7 – 8, high); exclude NA items (Q1, Q2, Q3); highest possible score is 8 4/8 (moderate) 6/8 (moderate) 2/8 (low) Wheelchair Provision Guidelines 120 Critical Appraisal Scores of Cross Sectional Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Bazant et al. 2017 Beaumont- White & Ham 1997 Graham et a. 2021 Post et al. 1997 Salatino et al. 2016 Štefanac, Grabovac & Fristedt 2018 Suzuki, Lockerte & Braun 2000 1. Were the criteria for inclusion in the sample clearly defined? Y N Y Y Y Y Y 2. Were the study subjects and the setting described in detail? Y N Y Y Y Y N 3. Was the exposure measured in a valid and reliable way? NA NA NA NA NA NA NA 4. Were objective, standard criteria used for measurement of the condition? NA NA NA NA NA NA NA 5. Were confounding factors identified? Y N N Y N N N 6. Were strategies to deal with confounding factors stated? Y N N Y N N N 7. Were the outcomes measured in a valid and reliable way? Y UC UC UC UC N UC 8. Was appropriate statistical analysis used? Y UC Y Y Y Y Y Score and rating (1 –2, low; 3 – 4, moderate; 5 – 6, high); exclude NA items (Q3, Q4); highest possible score is 6 6/6 (high) 0/6 3/6 (moderate) 5/6 (high) 3/6 (moderate) 3/6 (moderate) 2/6 (low) Web-Annex B: Data Tables and Appendices 121 Critical Appraisal Score of Case Series Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Leochico & Valera 2020 1. Were there clear criteria for inclusion in the case series? UC 2. Was the condition measured in a standard, reliable way for all participants included in the case series? NA 3. Were valid methods used for identification of the condition for all participants included in the case series? NA 4. Did the case series have consecutive inclusion of participants? Y 5. Did the case series have complete inclusion of participants? N 6. Was there clear reporting of the demographics of the participants in the study? Y 7. Was there clear reporting of clinical information of the participants? Y 8. Were the outcomes or follow up results of cases clearly reported? Y 9. Was there clear reporting of the presenting site(s)/clinic(s) demographic information? Y 10. Was statistical analysis appropriate? Y Score and rating (1 – 4, low; 5 – 8, moderate; 9– 10, high)* (total score and final rating adjustments may vary depending on “NA” results) 6/8 (moderate) Wheelchair Provision Guidelines 122 Critical Appraisal Scores of Mixed Methods Studies Questions D'Innocenzo et al. 2021 Gowran et al. 2020 Visagie et al. 2016 Screening questions S1. Are there clear research questions? N Y Y S2. Do the collected data allow to address the research questions? Y Y Y 1. Qualitative 1.1. Is the qualitative approach appropriate to answer the research question? Y Y Y 1.2. Are the qualitative data collection methods adequate to address the research question? Y Y Y 1.3. Are the findings adequately derived from the data? Y Y Y 1.4. Is the interpretation of results sufficiently substantiated by data? Y Y CT 1.5. Is there coherence between qualitative data sources, collection, analysis and interpretation? Y Y Y 2. Quantitative randomized controlled trials 2.1. Is randomization appropriately performed? NA NA NA 2.2. Are the groups comparable at baseline? NA NA NA 2.3. Are there complete outcome data? NA NA NA 2.4. Are outcome assessors blinded to the intervention provided? NA NA NA 2.5 Did the participants adhere to the assigned intervention? NA NA NA 3. Quantitative nonrandomized 3.1. Are the participants representative of the target population? N Y Y 3.2. Are measurements appropriate regarding both the outcome and intervention (or exposure)? Y Y Y 3.3. Are there complete outcome data? Y Y N 3.4. Are the confounders accounted for in the design and analysis? N N N 3.5. During the study period, is the intervention administered (or exposure occurred) as intended? Y CT Y 4. Quantitative descriptive 4.1. Is the sampling strategy relevant to address the research question? Y Y Y 4.2. Is the sample representative of the target population? N Y Y 4.3. Are the measurements appropriate? Y Y Y 4.4. Is the risk of nonresponse bias low? CT CT CT 4.5. Is the statistical analysis appropriate to answer the research question? CT Y Y 5. Mixed methods 5.1. Is there an adequate rationale for using a mixed methods design to address the research question? CT CT Y 5.2. Are the different components of the study effectively integrated to answer the research question? Y Y Y 5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted? Y Y Y 5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? Y Y CT 5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? CT CT CT Total = 27 (NA=5; possible total of 22); 1-7, low; 8 – 15, moderate; 16 – 22, high 14 17 16/22 Web-Annex B: Data Tables and Appendices 123 Questions D'Innocenzo et al. 2021 Gowran et al. 2020 Visagie et al. 2016 (moderate) (high) (high) Legend: Y- yes; N – no; CT – can’t tell; NA – not applicable Wheelchair Provision Guidelines 124 Critical Appraisal Score of Qualitative Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Williams et al. 2017 1. Is there congruity between the stated philosophical perspective and the research methodology? Y 2. Is there congruity between the research methodology and the research question or objectives? Y 3. Is there congruity between the research methodology and the methods used to collect data? Y 4. Is there congruity between the research methodology and the representation and analysis of data? Y 5. Is there congruity between the research methodology and the interpretation of results? Y 6. Is there a statement locating the researcher culturally or theoretically? N 7. Is the influence of the researcher on the research, and vice- versa, addressed? N 8. Are participants, and their voices, adequately represented? Y 9. Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body? Y 10. Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data? Y Score and rating (1 – 4, low; 5 – 7, moderate; 8 – 10, high); highest possible score is 10 8/10 (high) Web-Annex B: Data Tables and Appendices 125 Appendix WB.3: Critical appraisal of studies in Review Question B Critical Appraisal Score of Mixed Methods Study Questions Di Marco et al. 2003 Screening questions S1. Are there clear research questions? Y S2. Do the collected data allow to address the research questions? Y 1. Qualitative 1.1. Is the qualitative approach appropriate to answer the research question? CT 1.2. Are the qualitative data collection methods adequate to address the research question? Y 1.3. Are the findings adequately derived from the data? CT 1.4. Is the interpretation of results sufficiently substantiated by data? CT 1.5. Is there coherence between qualitative data sources, collection, analysis and interpretation? CT 2. Quantitative randomized controlled trials 2.1. Is randomization appropriately performed? NA 2.2. Are the groups comparable at baseline? NA 2.3. Are there complete outcome data? NA 2.4. Are outcome assessors blinded to the intervention provided? NA 2.5 Did the participants adhere to the assigned intervention? NA 3. Quantitative nonrandomized 3.1. Are the participants representative of the target population? NA 3.2. Are measurements appropriate regarding both the outcome and intervention (or exposure)? NA 3.3. Are there complete outcome data? NA 3.4. Are the confounders accounted for in the design and analysis? NA 3.5. During the study period, is the intervention administered (or exposure occurred) as intended? NA 4. Quantitative descriptive 4.1. Is the sampling strategy relevant to address the research question? CT 4.2. Is the sample representative of the target population? CT 4.3. Are the measurements appropriate? Y 4.4. Is the risk of nonresponse bias low? N 4.5. Is the statistical analysis appropriate to answer the research question? N 5. Mixed methods 5.1. Is there an adequate rationale for using a mixed methods design to address the research question? Y 5.2. Are the different components of the study effectively integrated to answer the research question? Y 5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted? CT Wheelchair Provision Guidelines 126 Legend: Y- yes; N – no; CT – can’t tell; NA – not applicable Questions Di Marco et al. 2003 5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? CT 5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? CT Total = 27 (total possible score is 17); 1-5, low; 6 – 12, moderate; 13 – 17, high 5/17 (low) Web-Annex B: Data Tables and Appendices 127 Appendix WB.4: Critical appraisal of studies in Review Question C Critical Appraisal Score of Randomised Controlled Trials Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Trefler et al. 2010 1. Was true randomization used for assignment of participants to treatment groups? UC 2. Was allocation to treatment groups concealed? Y 3. Were treatment groups similar at the baseline? Y 4. Were participants blind to treatment assignment? NA 5. Were those delivering treatment blind to treatment assignment? NA 6. Were outcomes assessors blind to treatment assignment? UC 7. Were treatment groups treated identically other than the intervention of interest? Y 8. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y 9. Were participants analyzed in the groups to which they were randomized? UC 10. Were outcomes measured in the same way for treatment groups? Y 11. Were outcomes measured in a reliable way? Y 12. Was appropriate statistical analysis used? Y 13. Was the trial design appropriate, and any deviations from the standard RCT design (individual randomization, parallel groups) accounted for in the conduct and analysis of the trial? Y Score and rating (1 – 4, low; 5 – 8, moderate; 9 -11 high); exclude two blinding items (Q4 and Q5); highest possible score is 11 8/11 (moderate) Wheelchair Provision Guidelines 128 Critical Appraisal Score of Quasi -experimental Study Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Hoenig et al. 2005 (Quasi) 1. Is it clear in the study what is the ‘cause’ and what is the ‘effect’ (i.e. there is no confusion about which variable comes first)? Y 2. Were the participants included in any comparisons similar? Y 3. Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest? Y 4. Was there a control group? Y 5. Were there multiple measurements of the outcome both pre and post the intervention/exposure? Y 6. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y 7. Were the outcomes of participants included in any comparisons measured in the same way? Y 8. Were outcomes measured in a reliable way? UC 9. Was appropriate statistical analysis used? Y For quasi experimental studies Score and rating (1 – 3, low; 4 – 6, moderate; 7 – 9, high); highest possible score is 9 8/9 (high) Web-Annex B: Data Tables and Appendices 129 Critical Appraisal Score of Mixed Methods Studies Questions Greenhalgh et al. 2021 Greer, Brasure & Wilt 2012 Screening questions S1. Are there clear research questions? Y Y S2. Do the collected data allow to address the research questions? Y Y 1. Qualitative 1.1. Is the qualitative approach appropriate to answer the research question? Y Y 1.2. Are the qualitative data collection methods adequate to address the research question? Y Y 1.3. Are the findings adequately derived from the data? CT N 1.4. Is the interpretation of results sufficiently substantiated by data? N N 1.5. Is there coherence between qualitative data sources, collection, analysis and interpretation? N CT 2. Quantitative randomized controlled trials 2.1. Is randomization appropriately performed? NA NA 2.2. Are the groups comparable at baseline? NA NA 2.3. Are there complete outcome data? NA NA 2.4. Are outcome assessors blinded to the intervention provided? NA NA 2.5 Did the participants adhere to the assigned intervention? NA NA 3. Quantitative nonrandomized 3.1. Are the participants representative of the target population? NA NA 3.2. Are measurements appropriate regarding both the outcome and intervention (or exposure)? NA NA 3.3. Are there complete outcome data? NA NA 3.4. Are the confounders accounted for in the design and analysis? NA NA 3.5. During the study period, is the intervention administered (or exposure occurred) as intended? NA NA 4. Quantitative descriptive 4.1. Is the sampling strategy relevant to address the research question? CT CT 4.2. Is the sample representative of the target population? Y CT 4.3. Are the measurements appropriate? Y CT 4.4. Is the risk of nonresponse bias low? CT CT 4.5. Is the statistical analysis appropriate to answer the research question? Y CT 5. Mixed methods 5.1. Is there an adequate rationale for using a mixed methods design to address the research question? Y Y 5.2. Are the different components of the study effectively integrated to answer the research question? Y N Wheelchair Provision Guidelines 130 Legend: Y- yes; N – no; CT – can’t tell; NA – not applicable Questions Greenhalgh et al. 2021 Greer, Brasure & Wilt 2012 5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted? Y N 5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? N N 5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? CT CT Total = 27 (NA=10; possible total of 17); 1-5, low; 6 – 12, moderate; 13 – 17, high 10 (moderate) 5 (low) Web-Annex B: Data Tables and Appendices 131 Appendix WB.5: Critical appraisal of studies in Review Question D Critical Appraisal Score of Randomised Controlled Trial Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Hansen, Tresse & Gunnarsson 2004 1. Was true randomization used for assignment of participants to treatment groups? Y 2. Was allocation to treatment groups concealed? Y 3. Were treatment groups similar at the baseline? Y 4. Were participants blind to treatment assignment? NA 5. Were those delivering treatment blind to treatment assignment? NA 6. Were outcomes assessors blind to treatment assignment? UC 7. Were treatment groups treated identically other than the intervention of interest? Y 8. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y 9. Were participants analyzed in the groups to which they were randomized? Y 10. Were outcomes measured in the same way for treatment groups? Y 11. Were outcomes measured in a reliable way? Y 12. Was appropriate statistical analysis used? Y 13. Was the trial design appropriate, and any deviations from the standard RCT design (individual randomization, parallel groups) accounted for in the conduct and analysis of the trial? Y Score and rating (1 – 4, low; 5 – 8, moderate; 9 -11 high); exclude two blinding items (Q4 and Q5); highest possible score is 11 10/11 (high) Wheelchair Provision Guidelines 132 Critical appraisal score of case series Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Leochico & Valera 2020 1. Were there clear criteria for inclusion in the case series? UC 2. Was the condition measured in a standard, reliable way for all participants included in the case series? NA 3. Were valid methods used for identification of the condition for all participants included in the case series? NA 4. Did the case series have consecutive inclusion of participants? Y 5. Did the case series have complete inclusion of participants? N 6. Was there clear reporting of the demographics of the participants in the study? Y 7. Was there clear reporting of clinical information of the participants? Y 8. Were the outcomes or follow up results of cases clearly reported? Y 9. Was there clear reporting of the presenting site(s)/clinic(s) demographic information? Y 10. Was statistical analysis appropriate? Y Score and rating (1 – 3, low; 4 – 6, moderate; 7 – 8, high); exclude NA items (Q2, Q3); highest possible scores is 8 (total score and final rating adjustments may vary depending on “NA” results) 6/10 (moderate) Web-Annex B: Data Tables and Appendices 133 Critical appraisal score of mixed methods study Legend: Y- yes; N – no; CT – can’t tell; NA – not applicable Questions Di Marco et al. 2003 Screening questions S1. Are there clear research questions? Y S2. Do the collected data allow to address the research questions? Y 1. Qualitative 1.1. Is the qualitative approach appropriate to answer the research question? CT 1.2. Are the qualitative data collection methods adequate to address the research question? Y 1.3. Are the findings adequately derived from the data? CT 1.4. Is the interpretation of results sufficiently substantiated by data? CT 1.5. Is there coherence between qualitative data sources, collection, analysis and interpretation? CT 2. Quantitative randomized controlled trials 2.1. Is randomization appropriately performed? NA 2.2. Are the groups comparable at baseline? NA 2.3. Are there complete outcome data? NA 2.4. Are outcome assessors blinded to the intervention provided? NA 2.5 Did the participants adhere to the assigned intervention? NA 3. Quantitative nonrandomized 3.1. Are the participants representative of the target population? NA 3.2. Are measurements appropriate regarding both the outcome and intervention (or exposure)? NA 3.3. Are there complete outcome data? NA 3.4. Are the confounders accounted for in the design and analysis? NA 3.5. During the study period, is the intervention administered (or exposure occurred) as intended? NA 4. Quantitative descriptive 4.1. Is the sampling strategy relevant to address the research question? CT 4.2. Is the sample representative of the target population? CT 4.3. Are the measurements appropriate? Y 4.4. Is the risk of nonresponse bias low? N 4.5. Is the statistical analysis appropriate to answer the research question? N 5. Mixed methods 5.1. Is there an adequate rationale for using a mixed methods design to address the research question? Y 5.2. Are the different components of the study effectively integrated to answer the research question? Y 5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted? CT 5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? CT 5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? CT Total = 27 (total possible score is 17); 1-5, low; 6 – 12, moderate; 13 – 17, high 5/17 (low) Wheelchair Provision Guidelines 134 Appendix WB.6: Critical appraisal of studies in Review Question E Critical appraisal scores of randomised controlled trials (part 1) Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Best et al. 2005 Best et al. 2016 Giesbrecht & Miller 2019 Kirby et al. 2015b Kirby et al. 2016 MacPhee et al. 2004 Miller et al. 2019 Mountain et al. 2014 Ozturk & Ocsular 2011 Rice et al. 2017 a. 1 . Was true randomization used for assignment of participants to treatment groups? Y Y Y Y Y Y Y Y Y UC 2. Was allocation to treatment groups concealed? N Y N Y Y N N N N N 3. Were treatment groups similar at the baseline? Y UC Y Y Y y Y Y Y Y 4. Were participants blind to treatment assignment? NA NA NA NA NA NA NA NA NA NA 5. Were those delivering treatment blind to treatment assignment? NA NA NA NA NA NA NA NA NA NA 6. Were outcomes assessors blind to treatment assignment? Y UC Y N N UC Y Y N N 7. Were treatment groups treated identically other than the intervention of interest? Y Y Y Y Y Y Y Y Y Y 8. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y Y Y Y Y Y Y Y Y Y 9. Were participants analyzed in the groups to which they were randomized? N Y Y Y Y N Y N N Y 10. Were outcomes measured in the same way for treatment groups? Y Y Y Y Y Y Y Y Y Y 11. Were outcomes measured in a reliable way? Y Y Y Y Y Y Y Y Y Y 12. Was appropriate statistical analysis used? Y Y Y Y Y Y Y Y Y UC 13. Was the trial design appropriate, and any deviations from the standard RCT design (individual randomization, parallel groups) accounted for in the conduct and analysis of the trial? Y UC Y Y Y Y UC UC UC UC Score and rating (1 – 4, low; 5 – 8, moderate; 9 -11 high); exclude two blinding items (Q4 and Q5); 9/11 high 8/11 mod 10/11 high 10/11 high 10/11 high 8/11 mod 9/11 high 9/11 mod 7/11 mod 6/11 mod Web-Annex B: Data Tables and Appendices 135 Critical Appraisal Scores of Randomised Controlled Trials (part 2) Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Rigot et al 2021 Routhier et al 2012 Sakakiba ra 2013 Van Der Scheer et al 2016 Worobey et al 2016 Worobey et al 2018 Worobey et al 2021 1. Was true randomization used for assignment of participants to treatment groups? Y Y Y Y Y Y Y 2. Was allocation to treatment groups concealed? N N Y Y Y N Y 3. Were treatment groups similar at the baseline? Y Y UC Y Y UC Y 4. Were participants blind to treatment assignment? NA NA NA NA NA NA NA 5. Were those delivering treatment blind to treatment assignment? NA NA NA NA NA NA NA 6. Were outcomes assessors blind to treatment assignment? Y Y Y N Y N N 7. Were treatment groups treated identically other than the intervention of interest? Y Y Y Y Y Y Y 8. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y Y Y Y Y Y Y 9. Were participants analyzed in the groups to which they were randomized? N Y Y Y N Y N 10. Were outcomes measured in the same way for treatment groups? Y Y Y Y Y Y Y 11. Were outcomes measured in a reliable way? Y Y Y Y Y Y Y 12. Was appropriate statistical analysis used? Y Y Y Y Y Y Y 13. Was the trial design appropriate, and any deviations from the standard RCT design (individual randomization, parallel groups) accounted for in the conduct and analysis of the trial? UC Y Y Y Y Y Y Score and rating (1 – 4, low; 5 – 8, moderate; 9 -11 high); exclude two blinding items which are NA (Q4 and Q5); highest possible score is 11 8/11 moderat e 10/11 high 10/11 high 10/10 high 10/11 high 8/11 moderat e 9/11 high Wheelchair Provision Guidelines 136 Critical Appraisal Scores of Pre-post Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Beaudoi n et al. 2021 Charlto n et al. 2021 Choi et al. 2020 Eshragh i, Sawatzk y & Mortens on 2021 MacGilli vray et al. 2018 Morgan et al. 2017b Mountai n et al. 2010 Rice et al. 2020 Sarigul- Klijn et al. 2017 Sawatzk y et al. 2012 Sawatzk y, Mortens on & Wong 2018 Tasiems ki, Wilski & Urbansk i 2021 1. Is it clear in the study what is the ‘cause’ and what is the ‘effect’ (i.e. there is no confusion about which variable comes first)? Y Y Y Y Y Y Y Y Y Y Y Y 2. Were the participants included in any comparisons similar? NA NA NA NA NA NA NA NA NA NA NA NA 3. Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest? NA NA NA NA NA NA NA NA NA NA NA NA 4. Was there a control group? NA NA NA NA NA NA NA NA NA NA NA NA 5. Were there multiple measurements of the outcome both pre and post the intervention/exposure? N N N N N N N N N N N N 6. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? N Y Y Y Y Y Y Y Y Y Y N 7. Were the outcomes of participants included in any comparisons measured in the same way? Y Y Y Y Y Y Y Y Y Y Y Y 8. Were outcomes measured in a reliable way? Y UC UC Y Y UC Y UC UC Y UC Y 9. Was appropriate statistical analysis used? Y Y UC Y Y Y Y Y Y Y Y Y Score and rating (1 – 2, low; 3 – 4, moderate; 5 – 6, high); exclude three NA items (Q2, Q3 and Q4); 4/6 mod 4/6 mod 3/6 mod 5/6 high 5/6 high 4/6 mod 5/6 high 4/6 mod 4/6 mod 5/6 high 4/6 mod 4/6 mod Web-Annex B: Data Tables and Appendices 137 Critical Appraisal Scores for Quasi-Experimental Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Hasdai Jessel & Weiss 1998 Hoenig et al. 2005 1. Is it clear in the study what is the ‘cause’ and what is the ‘effect’ (i.e. there is no confusion about which variable comes first)? Y Y 2. Were the participants included in any comparisons similar? Y Y 3. Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest? Y Y 4. Was there a control group? Y Y 5. Were there multiple measurements of the outcome both pre and post the intervention/exposure? N Y 6. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y Y 7. Were the outcomes of participants included in any comparisons measured in the same way? Y Y 8. Were outcomes measured in a reliable way? Y UC 9. Was appropriate statistical analysis used? Y Y Score and rating (1 – 3, low; 4 – 6, moderate; 7 – 9, high); highest possible score is 9 7/9 high 8/9 high Wheelchair Provision Guidelines 138 Critical Appraisal Scores of Cohort Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Chang et al.2020 Divanoglou et al. 2019 Taylor et al. 2015 1. Were the two groups similar and recruited from the same population? NA NA NA 2. Were the exposures measured similarly to assign people to both exposed and unexposed groups? NA NA NA 3. Was the exposure measured in a valid and reliable way? NA NA NA 4. Were confounding factors identified? N N N 5. Were strategies to deal with confounding factors stated? N N N 6. Were the groups/participants free of the outcome at the start of the study (or at the moment of exposure)? Y Y Y 7. Were the outcomes measured in a valid and reliable way? N UC UC 8. Was the follow up time reported and sufficient to be long enough for outcomes to occur? Y Y Y 9. Was follow up complete, and if not, were the reasons to loss to follow up described and explored? UC Y Y 10. Were strategies to address incomplete follow up utilized? UC NA N 11. Was appropriate statistical analysis used? Y Y Y Score and rating (1 – 3, low; 4 – 6, moderate; 7 – 8, high); exclude NA items (Q1, Q2, Q3); highest possible score is 8 3/8 low 4/8 moderate 4/8 moderate Web-Annex B: Data Tables and Appendices 139 Critical Appraisal Scores of Cross Sectional Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Bazant et al 2017 Hall et al. 2005 Kirby et al. 2015 Stefenac, Grabovac & Fristedt 2018 1. Were the criteria for inclusion in the sample clearly defined? Y Y Y Y 2. Were the study subjects and the setting described in detail? Y Y Y Y 3. Was the exposure measured in a valid and reliable way? N/A N/A N/A N/A 4. Were objective, standard criteria used for measurement of the condition? N/A N/A N/A N/A 5. Were confounding factors identified? Y Y Y N 6. Were strategies to deal with confounding factors stated? Y N Y N 7. Were the outcomes measured in a valid and reliable way? Y Y Y N 8. Was appropriate statistical analysis used? Y Y Y Y Score and rating (1 –2, low; 3 – 4, moderate; 5 – 6, high); exclude NA items (Q3, Q4); highest possible score is 6 6/6 5/6 6/6 3/6 Wheelchair Provision Guidelines 140 Critical Appraisal Score of Case Control Study Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Webster et al. 2001 1. Were the groups comparable other than the presence of disease in cases or the absence of disease in controls? Y 2. Were cases and controls matched appropriately? Y 3. Were the same criteria used for identification of cases and controls? UC 4. Was exposure measured in a standard, valid and reliable way? NA 5. Was exposure measured in the same way for cases and controls? NA 6. Were confounding factors identified? N 7. Were strategies to deal with confounding factors stated? N 8. Were outcomes assessed in a standard, valid and reliable way for cases and controls? UC 9. Was the exposure period of interest long enough to be meaningful? NA 10. Was appropriate statistical analysis used? Y Score and rating (1 – 2, low; 3 – 5, moderate; 6 – 7, high); exclude NA items (Q4, Q5, Q9); highest possible score is 7 3/7 moderate Web-Annex B: Data Tables and Appendices 141 Critical Appraisal Scores of Case Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Adelola, Cox & Rahmana 2009 Harrison et al. 2002 Kenyon et al. 2017 Loomis et al. 1982 McGarry et al. 2012 Mountain et al. 2010b Nisbet 2002 1. Were there clear criteria for inclusion in the case series? N N N Y Y N N 2. Was the condition measured in a standard, reliable way for all participants included in the case series? NA NA NA NA NA NA NA 3. Were valid methods used for identification of the condition for all participants included in the case series? NA NA NA NA NA NA NA 4. Did the case series have consecutive inclusion of participants? UC UC UC UC UC UC UC 5. Did the case series have complete inclusion of participants? UC UC UC UC N UC UC 6. Was there clear reporting of the demographics of the participants in the study? Y Y Y Y Y Y Y 7. Was there clear reporting of clinical information of the participants? Y Y Y Y Y Y Y 8. Were the outcomes or follow up results of cases clearly reported? Y Y Y Y Y Y Y 9. Was there clear reporting of the presenting site(s)/clinic(s) demographic information? N N N N N N N 10. Was statistical analysis appropriate? Y Y Y Y Y Y Y Score and rating (1 – 3, low; 4 – 6, moderate; 7 – 8, high); exclude NA items (Q2, Q3); highest possible scores is 8 (total score and final rating adjustments may vary depending on “NA” results) 4/8 mod 4/8 mod 4/8 mod 5 mod 5 mod 4/8 mod 4/8 mod Wheelchair Provision Guidelines 142 Critical Appraisal Scores of Case Reports Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Gillen 2002 Lennon 1991 Ragonesi 2012 Stanton 1983 1. Were patient’s demographic characteristics clearly described? Y Y Y Y 2. Was the patient’s history clearly described and presented as a timeline? Y Y Y Y 3. Was the current clinical condition of the patient on presentation clearly described? Y Y Y Y 4. Were diagnostic tests or assessment methods and the results clearly described? N Y N Y 5. Was the intervention(s) or treatment procedure(s) clearly described? Y Y Y Y 6. Was the post-intervention clinical condition clearly described? Y Y Y Y 7. Were adverse events (harms) or unanticipated events identified and described? Y N N N 8. Does the case report provide takeaway lessons? N Y Y N Score and rating (1 – 3, low; 4 – 6, moderate; 7 – 8, high); highest possible score is 8 6/8 moderate 7/8 high 6/8 moderate 6/8 moderate Web-Annex B: Data Tables and Appendices 143 Critical Appraisal Score of Qualitative Study Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Pellichero et al. 2020 1. Is there congruity between the stated philosophical perspective and the research methodology? Y 2. Is there congruity between the research methodology and the research question or objectives? Y 3. Is there congruity between the research methodology and the methods used to collect data? Y 4. Is there congruity between the research methodology and the representation and analysis of data? Y 5. Is there congruity between the research methodology and the interpretation of results? Y 6. Is there a statement locating the researcher culturally or theoretically? Y 7. Is the influence of the researcher on the research, and vice- versa, addressed? Y 8. Are participants, and their voices, adequately represented? Y 9. Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body? Y 10 Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data? Y Score and rating (1 – 4, low; 5 – 7, moderate; 8 – 10, high); highest possible score is 10 10 high Wheelchair Provision Guidelines 144 Appendix WB.7: Critical appraisal of studies in Review Question F Critical Appraisal Scores of Reviews Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Cooper, Trefier & Hobson 1996 (health professionals) 1. Is the review question clearly and explicitly stated? N 2. Were the inclusion criteria appropriate for the review question? N 3. Was the search strategy appropriate? UC 4. Were the sources and resources used to search for studies adequate? UC 5. Were the criteria for appraising studies appropriate? N 6. Was critical appraisal conducted by two or more reviewers independently? N 7. Were there methods to minimize errors in data extraction? UC 8. Were the methods used to combine studies appropriate? Y 9. Was the likelihood of publication bias assessed? N 10. Were recommendations for policy and/or practice supported by the reported data? Y 11. Were the specific directives for new research appropriate? UC Score and rating (1 – 4, low; 5 – 8, moderate; 9 – 11, high) 2/11 (low) Web-Annex B: Data Tables and Appendices 145 Critical Appraisal Scores of Randomised Controlled Trials Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Coolen et al. 2004 (students) Kirby et al. 2011 (students) 1. Was true randomization used for assignment of participants to treatment groups? Y Y 2. Was allocation to treatment groups concealed? N N 3. Were treatment groups similar at the baseline? Y Y 4. Were participants blind to treatment assignment? NA NA 5. Were those delivering treatment blind to treatment assignment? NA NA 6. Were outcomes assessors blind to treatment assignment? N N 7. Were treatment groups treated identically other than the intervention of interest? Y Y 8. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? Y Y 9. Were participants analyzed in the groups to which they were randomized? Y UC 10. Were outcomes measured in the same way for treatment groups? Y Y 11. Were outcomes measured in a reliable way? Y UC 12. Was appropriate statistical analysis used? Y Y 13 Was the trial design appropriate, and any deviations from the standard RCT design (individual randomization, parallel groups) accounted for in the conduct and analysis of the trial? Y Y Score and rating (1 – 4, low; 5 – 8, moderate; 9 -11 high); exclude two blinding items (Q4 and Q5); highest possible score is 11 9/11 (high) 7/11 moderate Wheelchair Provision Guidelines 146 Critical Appraisal Scores of Pre-post Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Gilbert et al. 2021 (students) Baird et al. 2015 (students) Smith, Best & Miller 2020 (students) Kirby et al. 2004 (caregivers) 1. Is it clear in the study what is the ‘cause’ and what is the ‘effect’ (i.e. there is no confusion about which variable comes first)? Y Y Y y 2. Were the participants included in any comparisons similar? NA NA NA NA 3. Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest? NA NA NA NA 4. Was there a control group? NA NA NA NA 5. Were there multiple measurements of the outcome both pre and post the intervention/exposure? N N N Y 6. Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed? NA UC NA Y 7. Were the outcomes of participants included in any comparisons measured in the same way? NA NA NA UC 8. Were outcomes measured in a reliable way? UC Y Y Y 9. Was appropriate statistical analysis used? Y UC Y Y Score and rating (1 – 2, low; 3 – 4, moderate; 5 – 6, high); exclude three NA items (Q2, Q3 and Q4); highest possible score is 6 2/6 (low) 2/6 (low) 3/6 (moderate) 5/6 (high) Web-Annex B: Data Tables and Appendices 147 Critical Appraisal Scores of Cross Sectional Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Mathis & Gowran 2021 (health professionals) Toro-Hernández et al. 2020 (students) 1. Were the criteria for inclusion in the sample clearly defined? Y Y 2. Were the study subjects and the setting described in detail? Y Y 3. Was the exposure measured in a valid and reliable way? NA NA 4. Were objective, standard criteria used for measurement of the condition? NA NA 5. Were confounding factors identified? N N 6. Were strategies to deal with confounding factors stated? N N 7. Were the outcomes measured in a valid and reliable way? N UC 8. Was appropriate statistical analysis used? Y Y Score and rating (1 –2, low; 3 – 4, moderate; 5 – 6, high); exclude NA items (Q3, Q4); highest possible score is 6 3/6 (moderate) 3/6 (moderate) Wheelchair Provision Guidelines 148 Critical Appraisal Scores of Qualitative Studies Legend: Y- yes; N – no; UC – unclear; NA – not applicable Questions Reference (Author, year) Rusek et al. 2021 (health professionals) Fung et al. 2020 (students) 1. Is there congruity between the stated philosophical perspective and the research methodology? UC Y 2. Is there congruity between the research methodology and the research question or objectives? Y Y 3. Is there congruity between the research methodology and the methods used to collect data? Y Y 4. Is there congruity between the research methodology and the representation and analysis of data? Y Y 5. Is there congruity between the research methodology and the interpretation of results? Y Y 6. Is there a statement locating the researcher culturally or theoretically? N N 7. Is the influence of the researcher on the research, and vice- versa, addressed? N N 8. Are participants, and their voices, adequately represented? Y Y 9. Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body? Y Y 10. Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data? Y Y Score and rating (1 – 4, low; 5 – 7, moderate; 8 – 10, high); highest possible score is 10 7/10 (moderate) 8/10 (high) Web-Annex B: Data Tables and Appendices 149 Appendix WB.8: List of excluded studies B8.1 Wheelchair Service (QA – QD) Excluded Studies References Reasons 1. Amsterdam P. Choices in wheeled mobility. The importance of seeing the person behind the case. The Case manager. 1999;10(4):28-31. no info about wheelchair services 2. Balser AE, Howell DM, O'Brien SP. User Perspectives on the Service Delivery of Complex Power Wheelchairs. Occupational Therapy in Health Care. 2021;35(1):57- 74. no info about wheelchair services 3. Barlow IG, Liu L, Sekulic A. Wheelchair Seating Assessment and Intervention: A Comparison Between Telerehabilitation and Face-to-Face Service. International Journal of Telerehabilitation. 2009;1(1):17-28. in graham et al. 2020 review 4. Cherubini M, Melchiorri G. Descriptive study about congruence in wheelchair prescription. European journal of physical & rehabilitation medicine. 2012;48(2):217-22. no relevant follow up services 5. Edwards K, McCluskey A. A survey of adult power wheelchair and scooter users. Disability & Rehabilitation Assistive Technology. 2010;5(6):411-9. no separate findings for wheelchair users 6. 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. Disability & Rehabilitation Assistive Technology. 2020:1-9. no info about wheelchair services 7. Ghasemazdeh R, Kamali M. Assistive technology: Use and service delivery. Iranian Rehabilitation Journal. 2010;8(11):54-9. no relevant outcomes 8. Guerette P, Tefft D, Furumasu J. Paediatric powered wheelchairs: results of a national survey of providers. Assistive Technology. 2005;17(2):144-58. not wheelchair service evaluation 9. Hosack KR, Gilinsky G, Smith C, Cody P. Maximizing independent function. Rehab Management. 2010;23(2):10, 2, 4. no relevant outcomes 10. Hubbard Winkler SL, Wu S, Cowper Ripley DC, Groer S, Hoenig H. Medical utilization and cost outcomes for post stroke veterans who receive assistive technology devices from the Veterans Health Administration. Journal of Rehabilitation Research and Development. 2011;48(2):125-34. not wheelchair service 11. Isabelle S, Bessey SF, Dragas KL, Blease P, Shepherd JT, Lane SJ. Assistive technology for children with disabilities. Occupational Therapy in Health Care. 2002;16(4):29-51. no relevant outcomes 12. Karmarkar AM, Collins DM, Kelleher A, Cooper RA. Satisfaction related to wheelchair use in older adults in both nursing homes and community dwelling. Disability & Rehabilitation Assistive Technology. 2009;4(5):337-43. no relevant follow up services 13. Kettle M, Rowley C, Chamberlain MA. A national survey of wheelchair users. Clinical Rehabilitation. 1992;6(1):67-73. no info about wheelchair services 14. 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. Archives of Physical Medicine & Rehabilitation. 2019;100(9):1648-54.e9. secondary analysis of another paper (Bazant et al. 2017) 15. Lukersmith S, Radbron L, Hopman K. Development of clinical guidelines for the prescription of a seated wheelchair or mobility scooter for people with traumatic brain injury or spinal cord injury. Australian Occupational Therapy Journal. 2013;60(6):378-86. not wheelchair service 16. Mattingly D. Wheelchair selection. Orthopaedic Nursing. 1993;12(4):11-6. no relevant outcomes 17. Mohapatra BK. Users’ satisfaction with assistive devices in Afghanistan. Disability, CBR and Inclusive Development. 2019;30(2):65-72. no separate findings for wheelchair users 18. Perotti L, Klebbe R, Maier A, Eicher C. Evaluation of the quality and the provision process of wheelchairs in Germany. Results from an online survey. Disability & Rehabilitation Assistive Technology. 2020:1-10. no info about wheelchair services 19. Pimentel S. Goal setting and outcome measurement in a wheelchair service: A client-centred approach. International Journal of Therapy and Rehabilitation. no relevant outcomes Wheelchair Provision Guidelines 150 References Reasons 2008;15(11):491-8. 20. Schein RM, Schmeler MR, Saptono A, Brienza D. Patient satisfaction with telerehabilitation assessments for wheeled mobility and seating. Assistive Technology. 2010;22(4):215-22. in Graham et al. 2020 review 21. Staincliffe S. Wheelchair services and providers: Discriminating against disabled children? International Journal of Therapy and Rehabilitation. 2003;10(4):151-9. in Graham et al. 2020 review B8.2 Wheelchair Training (QE – QF) Excluded Studies References Reasons 1. Angelo J, Trefler E. A survey of persons who use integrated control devices. Assistive Technology. 1998;10(2):77-83. no separate findings for wheelchair users 2. Bernet M, Sommerhalder K, Mischke C, Hahn S, Wyss A. "Theory Does Not Get You From Bed to Wheelchair": A Qualitative Study on Patients' Views of an Education Program in Spinal Cord Injury Rehabilitation. Rehabilitation Nursing Journal. 2019;44(5):247-53. no/not wheelchair specific training 3. Best, K. L., Miller, W. C., & Routhier, F. (2015). A description of manual wheelchair skills training curriculum in entry-to-practice occupational and physical therapy programs in Canada. Disability and rehabilitation. Assistive technology, 10(5), 401– 406. no relevant outcomes 4. Best KL, Miller WHEELCHAIR, Routhier F, Eng JJ. Feasibility of the trial procedures for a randomized controlled trial of a community-based peer-led wheelchair training program for older adults. Pilot & Feasibility Studies. 2018;4:18. no relevant outcomes 5. Bonaparte JP, Kirby RL, Macleod DA. Learning to perform wheelchair wheelies: comparison of 2 training strategies. Archives of Physical Medicine & Rehabilitation. 2004;85(5):785-93. no separate findings for wheelchair users 6. Bray N, Yeo ST, Noyes J, Harris N, Edwards RT. Prioritising wheelchair services for children: a pilot discrete choice experiment to understand how child wheelchair users and their parents prioritise different attributes of wheelchair services. Pilot & Feasibility Studies. 2016;2:32. no relevant outcomes 7. Bullard, S., & Miller, S. E. (2001). Comparison of teaching methods to learn a tilt and balance wheelchair skill. Perceptual and motor skills, 93(1), 131–138. no relevant outcomes 8. 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 [Electronic Resource]. 2018;13(6):e0199251. no relevant outcomes 9. 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 [Electronic Resource]. 2018;13(6):e0199251. no relevant outcomes 10. Caro CC, da Cruz DMC. Training of the manual wheelchair skill: An integrating literature review. Brazilian Journal of Occupational Therapy. 2020;28(2):661-81. overlapping studies 11. Daoust G, Rushton PW, Racine M, Leduc K, Assila N, Demers L. Adapting the Wheelchair Skills Program for paediatric rehabilitation: recommendations from key stakeholders. BMC Paediatrics. 2021;21(1):103. no/not wheelchair specific training 12. Dysterheft JL, Rice IM, Rice LA. Influence of handrim wheelchair propulsion training in adolescent wheelchair users, a pilot study. Frontiers in Bioengineering & Biotechnology. 2015;3:68. no relevant outcomes 13. Erren-Wolters CV, van Dijk H, de Kort AC, Ijzerman MJ, Jannink MJ. Virtual reality for mobility devices: training applications and clinical results: a review. International Journal of Rehabilitation Research. 2007;30(2):91-6. overlapping of studies 14. Fung, K. H., Rushton, P. W., Gartz, R., Goldberg, M., Toro, M. L., Seymour, N., & Pearlman, J. (2017). Wheelchair service provision education in academia. African journal of disability, 6, 340. no relevant outcomes Web-Annex B: Data Tables and Appendices 151 References Reasons 15. Giesbrecht E, Best KL, Miller WHEELCHAIR. Pushing spokes for older folks: Two novel approaches for improving manual wheelchair use among older adults. Occupational Therapy Now. 2015;17(1):17-9. no relevant outcomes 16. Giesbrecht EM, Miller WHEELCHAIR. A randomized control trial feasibility evaluation of an mHealth intervention for wheelchair skill training among middle-aged and older adults. Peer J. 2017;5:e3879. no relevant outcomes 17. Giesbrecht EM, Miller WHEELCHAIR, Mitchell IM, Woodgate RL. Development of a wheelchair skills home program for older adults using a participatory action design approach. BioMed Research International. 2014;2014:172434. no/not wheelchair specific training 18. Giesbrecht EM, Miller WHEELCHAIR, Woodgate RL. Navigating uncharted territory: a qualitative study of the experience of transitioning to wheelchair use among older adults and their care providers. BMC Geriatrics. 2015;15:91. no/not wheelchair specific training 19. Graham F, Boland P, Wallace S, Taylor WJ, Jones B, Maggo J, et al. Social and technical readiness for a telehealth assessment service for adults with complex wheelchair and seating needs: A national survey of stakeholders. New Zealand Journal of Physiotherapy. 2021;49(1):31-9. no relevant outcomes 20. Harvey LA, Glinsky JV, Bowden JL. The effectiveness of 22 commonly administered physiotherapy interventions for people with spinal cord injury: A systematic review. Spinal Cord. 2016;54(11):914-23. overlapping studies 21. Hernandez-Ossa KA, Montenegro-Couto EH, Longo B, Bissoli A, Sime MM, Lessa HM, et al. Simulation System of Electric-Powered Wheelchairs for Training Purposes. Sensors. 2020;20(12):24. not wheelchair users 22. Holden MK. Virtual environments for motor rehabilitation: review. Cyberpsychology & Behavior. 2005;8(3):187-211; discussion 2. overlapping studies 23. Huang HH. Perspectives on Early Power Mobility Training, Motivation, and Social Participation in Young Children with Motor Disabilities. Frontiers in Psychology. 2017;8:2330. not wheelchair users 24. John NW, Pop SR, Day TW, Ritsos PD, Headleand CJ. The Implementation and Validation of a Virtual Environment for Training Powered Wheelchair Manoeuvres. IEEE Transactions on Visualization & Computer Graphics. 2018;24(5):1867-78. no/not wheelchair specific training 25. Johnsson C, Carlsson R, Lagerstrom M. Evaluation of training in patient handling and moving skills among hospital and home care personnel. Ergonomics. 2002;45(12):850-65. no relevant outcomes 26. Keeler L, Kirby RL, Parker K, McLean KD, Hayden JA. Effectiveness of the Wheelchair Skills Training Program: a systematic review and meta- analysis^.. Disability & Rehabilitation Assistive Technology. 2019;14(4):391-409. overlapping studies 27. Kehrer AL, Barkocy B, Downs B, Rice S, Chen SW, Stark S. Interventions to promote independent participation among community-dwelling middle-aged adults with long-term physical disabilities: a systematic review. Disability & Rehabilitation. 2021:1-12. overlapping studies 28. Kenyon LK, Hostnik L, McElroy R, Peterson C, Farris JP. Power Mobility Training Methods for Children: A Systematic Review. Paediatric Physical Therapy. 2018;30(1):2-8. overlapping studies 29. Kenyon LK, Schmitt J, Otieno S, Cohen L. Providing paediatric power wheelchairs in the USA then and now: a survey of providers. Disability & Rehabilitation Assistive Technology. 2020;15(6):708-17. no/not wheelchair specific training 30. Kirby RL, Brown BA, Connolly CM, McRae S, Phillips PL. Handling Stairs in the Seated Position for People With Unilateral Lower-Limb Amputations. Archives of Physical Medicine and Rehabilitation. 2009;90(7):1250-3. no/not wheelchair specific training 31. Kirby RL, Crawford KA, Smith C, Thompson KJ, Sargeant JM. A wheelchair workshop for medical students improves knowledge and skills: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation. 2011;90(3):197-206. no/not wheelchair specific training 32. Kirby RL, Doucette SP. Relationships Between Wheelchair Services Received and secondary analysis of Wheelchair Provision Guidelines 152 References Reasons Wheelchair User Outcomes in Less-Resourced Settings: A Cross-Sectional Survey in Kenya and the Philippines. Archives of Physical Medicine & Rehabilitation. 2019;100(9):1648-54.e9. another paper (Bazant et al. 2017) 33. Kirby RL, Smith C, Parker K, Han L, Theriault CJ, Doucette SP. Practices and views of occupational therapists in Nova Scotia regarding wheelchair-skills training for clients and their caregivers: an online survey. Disability & Rehabilitation Assistive Technology. 2020;15(7):773-80. no relevant outcomes 34. Kirby RL, Walker R, Smith C, Best K, Macleod DA, Thompson K. Manual wheelchair-handling skills by caregivers using new and conventional rear anti-tip devices: a randomized controlled trial. Archives of Physical Medicine & Rehabilitation. 2009;90(10):1680-4. no/not wheelchair specific training 35. Lam JF, Gosselin L, Rushton PW. Use of Virtual Technology as an Intervention for Wheelchair Skills Training: A Systematic Review. Archives of Physical Medicine & Rehabilitation. 2018;99(11):2313-41. no relevant outcomes 36. Linden MA, Whyatt C, Craig C, Kerr C. Efficacy of a powered wheelchair simulator for school aged children: A randomized controlled trial. Rehabilitation Psychology. 2013;58(4):405-11. not wheelchair users 37. Martins FR, Naves ELM, Morère Y, de Sá AAR. Preliminary assessment of a multimodal electric-powered wheelchair simulator for training of activities of daily living. Journal on Multimodal User Interfaces. 2021. no relevant outcomes 38. McSweeney E, Gowran RJ. Wheelchair service provision education and training in low and lower middle income countries: a scoping review. Disability & Rehabilitation Assistive Technology. 2019;14(1):33-45. overlapping studies 39. Morgan KA, Engsberg JR, Gray DB. Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives. Disability & Rehabilitation Assistive Technology. 2017;12(1):28-38. no relevant outcomes 40. Park JM, Jung HS. A study on the effects of modified wheelchair skills program (WSP) for hemiplegic clients. Assistive Technology. 2019:1-8. no control group post-test assessment 41. Rice LA, Isaacs Z, Ousley C, Sosnoff J. Investigation of the Feasibility of an Intervention to Manage Fall Risk in Wheeled Mobility Device Users with Multiple Sclerosis. International Journal of Ms Care. 2018;20(3):121-8. no separate findings for wheelchair users 42. Rushton, P. W., & Daoust, G. (2019). Wheelchair skills training for occupational therapy students: comparison of university-course versus "boot-camp" approaches. Disability and rehabilitation. Assistive technology, 14(6), 595–601. no relevant outcomes 43. Sakakibara BM, Miller WHEELCHAIR. Prevalence of low mobility and self- management self-efficacy in manual wheelchair users and the association with wheelchair skills. Archives of Physical Medicine & Rehabilitation. 2015;96(7):1360- 3. no/not wheelchair specific training 44. Smith EM, Rismani S, Ben Mortenson W, Mihailidis A, Miller WHEELCHAIR. "A Chance to Try": Exploring the Clinical Utility of Shared-Control Teleoperation for Powered Wheelchair Assessment and Training. American Journal of Occupational Therapy. 2019;73(6):7306205020p1-p11. no relevant outcomes 45. Toro-Hernández M, Alvarez L, Vargas-Chaparro M, Goldberg M, "Final Year Students’ Knowledge on Basic Manual Wheelchair Provision: The State of Occupational Therapy Programs in Colombia", Occupational Therapy International, vol. 2020, Article ID 3025456, 8 pages, 2020. no relevant outcomes 46. Toro ML, Bird E, Oyster M, Worobey L, Lain M, Bucior S, et al. Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users. Disability & Rehabilitation Assistive Technology. 2017;12(8):843-51. no/not wheelchair specific training 47. Toro ML, Eke C, Pearlman J. The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia. BMC Health Services Research. 2016;16:26. no relevant outcomes 48. Tu CJ, Liu L, Wang W, Du HP, Wang YM, Xu YB, et al. Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review. Clinical Rehabilitation. 2017;31(12):1573-82. overlapping studies Web-Annex B: Data Tables and Appendices 153 References Reasons 49. Van Boxtel, A. M., Napholz, L., & Gnewikow, D. (1995). Using a wheelchair activity as a learning experience for student nurses. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses, 20(5), 265–273. no relevant outcomes 50. Wang YT, Limroongreungrat W, Chang LS, Ke X, Tsai LC, Chen YP, et al. Immediate video feedback on ramp, wheelie, and curb wheelchair skill training for persons with spinal cord injury. Journal of Rehabilitation Research & Development. 2015;52(4):421-30. no baseline assessment in both training and control group Wheelchair provision guidelines