Wheelchair prescription in the western region of the Eastern Cape

Duffield, Svenje (2013-12)

Thesis (MScPhysio)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Background: Access to wheelchairs is considered a basic human right. Wheelchairs enhance function, improve independence, and enables persons with disabilities to successfully live in the community. An inappropriate wheelchair may however limit function rather than promote it. Achieving an ideal match between user and technology, however is challenging. A recent audit in the Eastern Cape revealed that standard folding frame type wheelchairs were predominantly being issued and waiting list for wheelchairs is long. The need for investigation into prescription practice, from the perspective of both prescribing therapists as well as wheelchair users, was identified. Aims: To describe wheelchair prescription practice in the public sector of the Eastern Cape; and to determine whether the wheelchairs being issued address the psychosocial needs of users. Study design: A descriptive mixed-method cross-sectional study design was used. Quantitative and qualitative data from questionnaires and functional wheelchair skills tests of wheelchair users (Phase 1) and from semi-structured interviews with prescribing therapists (Phase 2) was used to describe prescription practice and investigate the psychosocial needs of wheelchair users. Methods: A small sample of convenienve according to home address was obtained that included 30 users (15 from a rural; 15 from a semi-rural setting). The Psychosocial Impact of Assistive Devices Scale (PIADS) questionnaire, Functioning Everyday with a wheelchair (FEW/FMA) scale and a self-compiled wheelchair specifications checklist (WSC) were used to determine user functionality and level of satisfaction with the wheelchair. Purposive sampling was done to identify the therapists that had prescribed the wheelchairs for the participants in the first phase of the study. A semi- structured interview was used to determine prescription practice including perceived barriers of wheelchair prescription with ten prescribing therapists. Data analysis: Qualitative data was analysed deductively and frequency of responses tabulated. Quantitative data was summarised as means and standard deviations and subgroup analysis comparisons were done using the Chi-square test and relationships between variables investigated using Pearson/ Spearman correlation or ANOVA. A p < 0.05 was deemed significant. Results: Eighty three % of wheelchairs issued were urban wheelchairs. These are generally perceived by users as sufficient to address their psychosocial needs regarding mobility and transport, however, seem to fail users in terms of accessibility and independence within their rural/ semi- rural environment. According to the WSC scores, peri-urban wheelchairs were found to be more appropriate for the users than urban wheelchairs (p < 0.01). No significant relationships were found between wheelchair fit, use of a cushion, occurrence of pressure sores and self-perceived psychosocial needs in this sample. The users experienced most difficulty with outdoor mobility (57% needed full assistance) and transport (63% needed full assistance) within their current wheelchairs. Ten prescribing therapists participated in the study. Most valued appropriate seating, are knowledgeable regarding prescription practice, but reported several barriers to this practice including budget restraints (90%), time to delivery (100%) and lack of training (40%). The need for more appropriate wheelchair designs to suit multi- level manoeuvrability of persons in rural/ semi-rural environments was also reported (60%). Conclusion: The results of this study show that wheelchair prescription in the Western Region of the Eastern Cape (WRoEC) has various challenges. Although the wheelchair users were mostly satisfied with their wheelchairs, this study identified areas for improvement in the users’ functioning, postural support and biomechanics within their wheelchairs, especially as it relates to their home environment. There is scope for improvement of wheelchair delivery to persons in the WRoEC – from on-going training of therapists and clients to more appropriate wheelchair designs for persons in rural settings. Further research in this field is recommended.

AFRIKAANSE OPSOMMING: Agtergrond: Toegang tot rolstoele word as ‘n basiese mensereg geag. Rolstoele dra by tot verbeterde funksionaliteit, groter onafhanklikheid, en bemagtig mense met gestremdhede om suksesvol in die gemeenskap te lewe. Nietemin, ‘n onvanpaste rolstoel mag funksie beperk eerder as om dit te bevorder. Om die ideale pas tussen rolstoel gebruiker en tegnologie te vind is uitdagend.’n Onlangse oudit in die Oos- Kaap het getoon dat standaard vou-raam tipe rolstoele oorwegend uitgereik word, en dat die waglys vir rolstoele lank is. Die gaping vir verdere ondersoek rakende voorskrif praktyk, vanaf beide die perspektief van die terapeute wat voorskryf asook rolstoel gebruikers, is geidentifiseer. Doel: Om rolstoel voorskrif praktryk in die publieke sektor van die Oos- Kaap te beskryf; en om vas te stel of die rolstoele wat uitgereik word die psigososiale behoeftes van gebruikers addresseer. Studie Ontwerp: ‘n Beskrywende gemengde metode deursnee studie ontwerp is gebruik. Kwantitatiewe en kwalitatiewe data van vraelyste en funksionele rolstoelvaardigheids toetse van rosltoel gebruikers (Fase 1) en van semi- gestruktureerde onderhoude met voorskrywende terapeute (Fase 2) is gebruik om voorskrif praktyk te beskryf en om die psigososiale behoeftes van gebruikers te ondersoek. Metodes: Dertig rolstoel gebruikers (15 van ‘n landelike; 15 van ‘n gedeeltelik- landelike opset) het deelgeneem in die studie. Die PIADS vraelys, “Functioning Everyday with a Wheelchair” (FMA/ FEW) skaal en ‘n self-opgestelde rolstoel spesifikasie kontrolelys (WSC) is gebruik om gebruiker funksionaliteit en tevredenheid met die rolstoel vas te stel. ‘n Semi- gestruktureerde onderhoud is gebruik om rolstoel voorskrifpraktyk insluitend persepsies van beperkinge tot die voorskrifte van rolstoele vas te stel onder tien terapeute. Dataverwerking: Kwalitatiewe data is deduktief geanaliseer en getal response is getabuleer. Kwantitatiewe data is opgesom as gemiddeldes en standaardafwykings en subgroep analise vergelyking is gedoen deur middel van die Chi- square toets. Verhoudings tussen veranderlikes is ondersoek deur middel van die Pearson/ Spearman korrelasie/ ANOVA. P < 0.05 is as statisties beduidend aanskou. Resultate: Drie-en-tagtig % van die uitgereikte rolstoele was landelike rolstoele. Hierdie stoele word oor die algemeen deur gebruikers ervaar as genoegsaam om hulle psigososiale behoeftes rakende vervoer en mobilitiet te bevredig, maar skiet nietemin tekort as dit kom by toeganklikheid en onafhanklikheid binne hulle landelike-/ semi- landelike omgewing. Volgens die WSC resultate, is die semi- landelike rolstoele meer toepaslik vir die gebruikers as die stedelike rolstoele. Geen merkwaardige verhoudings is gevind tussen rolstoel pas, gebruik van kussing, druksere en persepsie van psigososiale behoeftes nie. Die gebruikers het die meeste gesukkel met buitemuurse mobiliteit (57% het volle bystand benodig) en vervoer (63% het volle bystand benodig) in hulle huidige rolstoele. Tien terapeute het aan semi-gestruktureerde onderhoude deelgeneem. Daar is bevind dat hulle korrekte “seating” waardevol ag, kundig is rakende voorskrif praktyk, maar het talle beperkinge geidentifiseer in die praktyk insluitend: begrotings beperkings (90%), tyd tot aflewering (100%) en tekort aan opleiding in dié veld (40%). Die behoefte aan meer toepaslike rolstoel ontwerpe om multi- dimensionele beweeglikheid van persone in landelike/ semi- landelike omgewings te verseker, is ook vasgestel (60%). Gevolgtrekking: Die resultate van hierdie studie toon dat die voorskryf van rolstoele in die Westelike streek van die Oos- Kaap (WSvOK) vele uitdagings het. Alhoewel die rolstoel gebruikers grotendeels tevrede was met hulle rolstoele, het hierdie studie areas vir verbetering geidentifiseer in die gebruikers se funksionaliteit, posturale ondersteuning en biomeganika in hulle rolstoele, veral soos dit van toepassing is op hulle tuis omgewing. Daar is ruimte vir verbetering vir rolstoel lewering aan persone in die WSvOK; vanaf deurlopende opleiding vir terapeute en gebruikers, tot meer toepaslike rolstoel ontwerpe vir persone in landelike gebiede. Verdere navorsing in dié veld word aanbeveel.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/85769
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