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

Abstract

BackgroundFor people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization’s service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls.MethodsThis study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only.Results167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list (p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a “wheelie”. The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist (p = 0.019).ConclusionsWheelchair provision according to World Health Organization’s 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages.

Wheelchair user’s voice: a pilot study in Indonesia

“…This could be due to several factors, such as the provision of a wheelchair that did not meet their needs, it did not fit properly to their body, lack of user and maintenance training, environmental barriers, or due to differences in the population. These findings are aligned with those of the study published by Toro et al [17] in Indonesia that suggested the positive impact of the WHO 8-steps in wheelchair provision.…”

“…Our study population included subjects with a diverse set of disabilities, with Polio being most common (Table 2). The study by Toro et al [17] had similar conditions as our study in terms of the application of the WHO 8-Steps and also happened in Indonesia. However, their findings determined no significant differences in wheelchair skills between baseline and endline.…”

“…The average total score in the study by Kirby et al [31] on the questionnaire version was 84.8%. In the study done by Toro et al [17] in Indonesia, the participants who received wheelchair services with the WHO 8-Steps had scores of 70.6% for adults and 77.7% for adults and proxy. One reason why our results are different from the studies by Hosseini et al [29] and Kirby et al [30] might be because all of the participants from these studies had spinal cord injury, relied exclusively on a manual wheelchair for mobility, and therefore might have had more training and practice.…”

“…These results suggest additional wheelchair skills training may be necessary when a wheelchair user receives a replacement or a new wheelchair. As Toro et al [17] emphasized, the wheelchair skills included in the WHO WSTP only include seven basic skills, that consist of pushing, turning, moving up and down slopes, moving up and down steps with assistance, and doing a partial wheelie. Our results suggested that almost all of the participants who had service providers following the WHO guidelines were able to push and turn.…”

“…Meanwhile, because the study was cross-sectional and investigated a group who received a single type of wheelchair, it does not provide conclusive evidence of the relative value of providing wheelchairs through WHO’s 8-step approach, nor provide reliable insight into whether it was the wheelchair or other factors which led the improvements. The first study we are aware of that investigated the impact of the WHO’s 8-Step service approach was in Indonesia, and compared a group receiving wheelchairs through the 8-Step process to a waitlist control group at baseline and a 6-month follow-up [17]. Subjects who received new wheelchairs reported significant increases in physical health, environmental health, and satisfaction with their mobility devices as compared to the waitlist control group.…”