The wheelchair is viewed as one of the most important assistive technology devices used in rehabilitation for individuals who cannot ambulate, or have difficulty with ambulation, and is one of the most influential factors that affect activity in persons with a mobility impairment. Wheelchairs, both manual and power, are enablers of community participation and are used to enhance function, to improve independence, and to enable a person to successfully live at home and in the community (Sarsak, 2018a; Wee & Lysaght, 2009). It is estimated that more than 70 million people require wheelchairs worldwide and only 5 to 15% have access to one. In addition, there is a shortage of health and rehabilitation personnel with the knowledge and skills to provide a wheelchair that meet the user's specific needs (WHO, 2017).

Occupational therapists (OTs) help wheelchair users feel empowered, become more productive, enjoy more leisure, and enhance their functional performance in activities of daily living (ADLs), such as self-care (Sarsak, 2018a). To aid in provision of the best quality wheelchairs and service delivery, the wheelchair evaluation should be a continuous thorough process requiring re-assessment of wheelchair fit as users age and their functional conditions change (Sarsak, 2019).  

The role of occupational therapy in wheelchair service provision

OTs help clients achieve maximum independence in their daily lives and help assess clients’ goals, body structure, activities, environment, medical conditions and other factors to choose the best wheelchair, not only for current needs, but for future ones as well. OTs are healthcare professionals who apply a client/environment/occupation perspective that considers the interface between these three elements when assessing and recommending complex equipment, including wheelchairs.

Many OTs may consider wheelchair service provision as a speciality area of practice, and develop their skills as wheelchair professionals along the continuum from generalist to specialist and assistive technology professional (Schein, et al., 2010). To make the best possible fit between the wheelchair and the clients’ needs and goals, an expert OT takes various factors into consideration, such as (1) the client’s profile, (2) the physical and socio-cultural environments, and (3) the daily activities and social roles that the client performs, and (4) wheelchair characteristics (Karmarkar, 2009; Kenny & Gowran, 2014, Oyster, 2011).

OTs are wheelchair service providers with in-depth knowledge of occupational performance and participation, and bring a distinct perspective to the impact of habits, roles, and routines on the life of the individual to determine what equipment will be most beneficial in all the person’s environments, using a client-centred, participatory approach to intervention to improve function and the ability to perform ADLs that are important to the individual (RESNA, 2011). Wheelchair professionals, including OTs, apply a multifactorial assessment-intervention process that enables both caregivers and clients to use their wheelchairs more often in an independent, safe, and adequate manner (Brienza, et al., 2010).

According to the World Health Organization (WHO), the provision of wheelchairs includes eight critical steps for appropriate wheelchair services. These steps are: (1) referral, (2) assessment, (3) prescription, (4) funding and ordering, (5) product preparation, (6) fitting and adjusting, (7) user training, and (8) follow-up and maintenance/repairs. The wheelchair provision 8-Steps have a range of positive outcomes, including increased satisfaction with the mobility device and better quality of life (Toro, et al., 2016). OTs apply the WHO guidelines for the wheelchair evaluation process  integrating valid and reliable holistic documentation methods (Pearce, et al., 2016, Sarsak, 2020). Wheelchair services provided by OTs will include specific positioning equipment, mobility devices, durable medical equipment, and complex rehabilitation technology, used to optimise clients’ environmental access and their ability to safely perform daily occupations. Seating systems or equipment are designed to meet individuals’ needs for postural support and alignment, skin integrity, function, and safety. Research shows the positive impact of equipment, such as wheelchairs, on the quality of life for individuals with mobility issues (RESNA, 2011).

OTs provide wheelchair services across many practice settings, including home health, educational and rehabilitation facilities, private practice, and community-based settings. They ideally work with a multidisciplinary team that includes rehabilitation technology suppliers, technicians, and manufacturers, as well as other health care providers and representatives from funding sources, to help ensure the provision of proper equipment (Greer, et al., 2012).

The role of OT's providing wheelchair services includes, but is not limited to:

• Conducting individualised, holistic wheelchair evaluations to determine clients’ skills and priorities
• Identifying and addressing clients’ needs, interests, goals, and barriers to participation in meaningful activities, roles, and occupations
• Assessing and recommending wheelchairs and environmental modifications to increase accessibility
• Providing justification for funding sources of medically necessary equipment and wheelchair technology by completing required documentation
• Fitting and customising wheelchairs to meet clients’ current and potential future needs and goals
• Training clients, caregivers, and family members on safe and efficient wheelchair use (AOTA, 2017).

The importance of occupational therapy wheelchair services in the community

OTs recognise the value of engagement in meaningful occupations, including daily activities, which are facilitated by appropriately selected wheeled mobility and seating devices to achieve health, well-being, and participation in life. Individuals who have diverse clinical conditions, functional abilities, and mobility goals can benefit from OTs providing wheelchair services throughout their lives.

There is a need for more trained wheelchair professionals worldwide. People in developing countries often depend on the donation of wheelchairs, which are frequently of poor quality and neither suitable nor customised either for the users nor their environment. Health and rehabilitation professionals are not always trained adequately to ensure people with disabilities get a quality and custom-fitted wheelchair. Furthermore, there is a great variability and inconsistency in what and how wheelchair-related content is taught and evaluated (Sarsak, 2018b).

In my PhD dissertation entitled Functional assessment of wheeled mobility and seating interventions: relationship of self-report and performance-based assessments, I highlight that properly fitted and correctly prescribed wheelchairs benefit both the user and their caregiver, and aid in the provision of the best quality wheelchairs. In order to obtain properly fitted wheelchairs, they should be prescribed by qualified clinicians including rehabilitation professionals, such as OTs. Additionally, this study confirmed that wheelchairs received from expert clinicians lead to enhanced personal mobility and l dignity, human rights which assist wheelchair users to be productive members of their communities (Sarsak, 2014).

The World Federation of Occupational Therapists (WFOT)'s position paper on Occupational Therapy and Wheeled Mobility and Seating Devices supports the development of wheelchair service provision through establishing collaborative work with global partners, and encouraging OTs to do so.

In response to the need for competent wheelchair professionals, and to enhance the quality of service delivery to wheelchair users, from 2015 -2017 standardised training packages were developed by WHO in partnership with the United States Agency for International Development (USAID) (Fung, et al., 2017; Sarsak, 2018b). In addition, the International Society of Wheelchair Professionals (ISWP) was launched in February 2015 with a mission to serve as a global resource for wheelchair service standards and provision through advocacy, education, evidence-based practice, innovation, and a platform for information exchange. ISWP aims to professionalise wheelchair services around the world, benefitting both wheelchair users and service providers by promoting the WHO guidelines on wheelchair provision, promoting training and research activities, integrating wheelchair service provision education into academic and clinical rehabilitation programs worldwide, improving wheelchair design and manufacturing, and coordinating services (Goldberg, et al., 2018).

Conclusion 

OTs provide a variety of services to wheelchair users and their families through their use of intervention models that integrate the client, occupation, and environment. Occupational therapy education, application of current best evidence to practice, and clinical competency help wheelchair users to access their community and environment independently, safely, adequately, and freely.  The inclusion of an OT in the multidisciplinary medical rehabilitation team has a positive impact, aiming to improve the integrated planning and quality of services for wheelchair users.  

References

American Occupational Therapy Association, 2017. The role of occupational therapy in providing seating and wheeled mobility services [fact sheet]. https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/Providing-Seating-Wheeled-Mobility-Services.aspx

Brienza, D., Kelsey, S., Karg, P., Allegretti, A., Olson, M., Schmeler, M. et al., 2010. A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. Journal of the American Geriatrics Society, 58, 2308–2314. doi: 10.1111/j.1532-5415.2010.03168.x

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 (Online), 6, 1-8.

Greer, N., Brasure, M., & Wilt, T. J., 2012. Wheeled mobility (wheelchair) service delivery: scope of the evidence. Annals of Internal Medicine, 156(2), 141-146.

Goldberg, M., Pearlman, J., Rushton, P., & Cooper, R., 2018. The International Society of Wheelchair Professionals (ISWP): A resource aiming to improve wheelchair services worldwide.

Karmarkar, A. M., Collins, D. M., Kelleher, A., & Cooper, R. A., 2009. Satisfaction related to wheelchair use in older adults in both nursing homes and community dwelling. Disability and Rehabilitation: Assistive Technology, 4, 337–343. doi: 10.1080/17483100903038543

Kenny, S., & Gowran, R. J., 2014. Outcome measures for wheelchair and seating provision: a critical appraisal. British Journal of Occupational Therapy, 77(2), 67-77.

Oyster, M. L., Karmarkar, A. M., Patrick, M., Read, M. S., Nicolini, L., & Boninger, M. L., 2011. Investigation of factors associated with manual wheelchair mobility in persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 92, 484-490. doi:10.1016/j.apmr.2010.09.025

Pearce, P. F., Ferguson, L. A., George, G. S., & Langford, C. A., 2016. The essential SOAP note in an EHR age. The Nurse Practitioner, 41(2), 29–36. doi: 10.1097/01.NPR.0000476377.35114.d7

Rehabilitation Engineering & Assistive Technology Society of North America, 2011. RESNA wheelchair service provision guide. Retrieved from http://www.resna.org/sites/default/files/legacy/resources/position-papers/RESNAWheelchairServiceProvisionGuide.pdf

Sarsak, H., 2014. Functional assessment of wheeled mobility and seating interventions: Relationship of self-report and performance-based assessments (Doctoral dissertation, University of Pittsburgh).

Sarsak, H. I., 2018a. Role of wheelchairs and wheelchairs assessments: A review. Advances in Orthopedics and Sports Medicine: AOASM-101. Vol. 1

Sarsak, H. I., 2018b. Developing wheelchair training program for rehabilitation and occupational therapy students. MOJ Yoga & Physical Therapy, 3(4):79‒83. doi: 10.15406/mojypt.2018.03.00049

Sarsak, H. I., 2019. Occupational Therapy: From A to Z. Journal of Community Medicine and Public Health Care, 6(4):1-6. doi: 10.24966/CMPH-1978/100059

Sarsak, H. I., 2020. Wheelchair Evaluation Process for a Patient with Spinocerebellar Disorder: A Case Report. Annals of Clinical Case Reports, 5: 1-5.

Sarsak, H. I., 2022. Occupational Therapy and Wheeled Mobility and Seating Devices [Position statement]. https://wfot.org/resources/occupational-therapy-and-wheeled-mobility-and-seating-devices

Schein, R. M., Schmeler, M. R., Holm, M. B., Saptono, A., & Brienza, D. M., 2010. Telerehabilitation wheeled mobility and seating assessments compared with in person. Archives of Physical Medicine and Rehabilitation, 91(6), 874-878.

Toro, M. L., Eke, C., & Pearlman, J., 2016. 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,16(26), 1-12. doi 10.1186/s12913-016-1268-y

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About the Author

Dr. Hassan I. Sarsak (PhD, OT) received his Doctorate Degree in Rehabilitation Sciences with a Concentration in Occupational Therapy (OT) from the University of Pittsburgh, PA, United States in 2013.

Dr. Sarsak (pictured above) has worked in the USA, Kuwait, Saudi Arabia, and Jordan for over 15 years in a variety of clinical, academic, and research institutions including University of Pittsburgh Medical Center, University of Jordan, and Hashemite University. Throughout his career, he has provided services for all age ranges of individuals with physical, learning and mental health difficulties. In 2017, in response to the need of more wheelchair professionals and to enhance the quality-of-service delivery to wheelchair users, Dr. Sarsak developed the Wheelchair Training Program (WTP) for Rehabilitation and OT Students and integrated it into Rehabilitation Curricula/Programs in both Jordan and Saudi Arabia.  This became the first Arab training program and among the first five training courses worldwide to receive recognition from the International Society of Wheelchair Professionals (ISWP) and the Wheelchairs International Network (WIN). In 2018, Dr. Sarsak received a trainer recognition certificate from the ISWP and he has been a certified wheelchair service provider since. In 2019, Dr. Sarsak developed an OT Program and Curriculum at Batterjee Medical College in Saudi Arabia to become the first approved OT program in Saudi higher education private sector and among the first ten approved programs in the Arab world by the World Federation of Occupational Therapists (WFOT) and is currently the Head of the Program. In 2021, Dr. Sarsak authored a book entitled “Comprehensive Dictionary in Occupational Therapy” to be the first Arabic dictionary in the Occupational Therapy profession worldwide.