Visagie S.1, Mlambo T.2, Van der Veen J.3, Nhunzvi C.2, Tigere D.3, Scheffler E.1
1Stellenbosch University, Faculty of Medicine & Health Sciences, Centre for Rehabilitation Studies, Cape Town, South Africa, 2University of Zimbabwe, Department of Rehabilitation, College of Health Sciences, Harare, Zimbabwe, 3Christian Blind Mission, Regional Office, Cape Town, South Africa
Background: Providing wheelchairs without comprehensive support services might be detrimental to user satisfaction and function. World Health Organization (WHO) has developed guidelines on wheelchair provision. At the time of the study no evidence of the impact of these guidelines was available.
Purpose: This study compares wheelchair user satisfaction and function before and after implementation of comprehensive wheelchair services, based on the WHO guidelines on wheelchair service provision in less resourced settings, in Zimbabwe.
Methods: A pre-and post-test study with qualitative component was done. Quantitative data was collected with the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and the Functioning Everyday with a Wheelchair Questionnaire. Data was collected from 55 consecutively sampled wheelchair users, who received a new wheelchair in the study period. A two-sample test of proportions was used to determine if a statistically significant difference in the percentage of satisfied participants between the pre- and post-test ratings occurred. Qualitative data was collected through two audio recorded focus groups and two case studies and is presented through narrative examples.
Results: The proportion of adult users who were satisfied significantly increased for all wheelchair and service delivery aspects (p = 0,008), except follow-up (p = 0.128). The same was true for childrens post-test ratings on all variables assessed (p = 0.04), except training in the use of the device (p = 0.052). The biggest improvement in satisfaction figures were for comfort needs (44.3%), indoor mobility (43.2%), outdoor mobility (37.2%), safe and 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 qualitative data further illustrated user satisfaction with wheelchair features and services and being included in the process.
Conclusion(s): Significant positive changes in user satisfaction with the wheelchair, wheelchair services and function were recorded. Despite fewer resources and using more basic technology satisfaction levels were similar to that of wheelchair users from resourced settings. Since the programme was based on the WHO wheelchair guidelines one might conclude that service provision in accordance with these guidelines does result in satisfactory wheelchair services and improved user function in less resourced settings. It is recommended that the Zimbabwean government and partner organisations continue to support and develop wheelchair services along these guidelines.
Implications: Physiotherapists working in clinical settings should be trained in wheelchair service delivery according to the WHO wheelchair guidelines. Those in management roles should ensure that comprehensive wheelchair service delivery is integrated in rehabilitation programmes and monitored and evaluated accordingly.
Funding acknowledgements: Both the CMSP and the research were funded by USAID (project number SPANS 025 CBM/Zimbabwe)
Topic: Disability & rehabilitation
Ethics approval: Joint Research Ethics Committee (JREC/323/13), University of Zimbabwe, College of Health Sciences, and the Medical Research Council of Zimbabwe (MRCZ/A/1813).
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