Relationships Between Wheelchair Services Received and Wheelchair User Outcomes in Less-Resourced Settings: A Cross-Sectional Survey in Kenya and the Philippines

Objective: To explore the relationships between wheelchair services received during wheelchair provision and positive outcomes for users of wheelchairs. Design: Secondary analysis of cross-sectional data. Setting: Urban and periurban communities in Kenya and the Philippines. Participants: Adult basic manual wheelchair users (N= 852), about half of whom reported having received some wheelchair services with the provision of their current wheelchairs. Interventions: Not applicable. Main Outcome Measures: Participants completed a survey that included questions related to demographic, clinical, and wheelchair characteristics. The survey also included questions about the past receipt of 13 wheelchair services and 4 positive outcomes for users of wheelchairs. The relationships between individual services received and positive outcomes were assessed using logistic regression analyses. In addition to assessing individual services and outcomes, we analyzed a composite service score (the total number of services received) and a composite outcome score (>= 3 positive outcomes). Results: The top 3 individual services from the perspective of relationships with the composite outcome score were provider did training (P = .0009), provider assessed wheelchair fit while user propelled the wheelchair (P = .002), and peer group training received (P = .033). The composite service score was significantly related to daily wheelchair use (P<.0001), outdoor unassisted wheelchair use (P<.0001), high performance of activities of daily living (P = .046) and the composite outcome score (P = .005), but not to the absence of serious falls (P = .73). Conclusions: The receipt of wheelchair services is associated with positive outcomes for users of wheelchairs, but such relationships do not exist for all services and outcomes. These findings are highly relevant to ongoing efforts to optimize wheelchair service delivery. Crown Copyright (C) 2019 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine