Purpose: This article, developed as background content for discussion during the Mobility Rehabilitation Engineering Research Center State of the Science Conference, reviews research surrounding wheeled mobility and seating (WMS) service delivery, discusses the challenges of improving clinical decision-making, and discusses research approaches used to study and improve health services in other practice areas that might be leveraged to develop the evidence base for WMS. Methods: Narrative literature review. Results and conclusions: An overview of existing research found general agreement across models of WMS service delivery but little high quality evidence to support the recommended approaches and few studies of the relationship between service delivery steps and individual patient outcomes. The definition of successful clinical decision-making is different for different stakeholders. Clinical decision-making should incorporate the best available evidence along with patient values, preferences, circumstances, and clinical expertise. To advance the evidence base for WMS service delivery, alternatives to randomized controlled trials should be considered and reliable and valid outcome measures developed. Technological advances offer tremendous opportunities for individuals with complex rehabilitation technology needs. However, with ongoing scrutiny of WMS service delivery there is an increased need for evidence to support the clinical decision-making process and to support evidence-based coverage policies for WMS services and technologies.Implications for RehabilitationAn evidence base for wheeled mobility and seating services is an important component of the clinical decision-making process.At present, there is little evidence regarding essential components of the wheeled mobility and seating evaluation or the relationship between the evaluation process and patient outcomes. Many factors can confound this relationship and present challenges to research in this area.All stakeholders (i.e. clinicians, rehabilitation technology suppliers, manufacturers, researchers, payers, policy makers, and wheelchair users) need to work together to develop and support an evidence base for wheeled mobility and seating service delivery.
|Original language||English (US)|
|Number of pages||10|
|Journal||Disability and Rehabilitation: Assistive Technology|
|State||Published - Nov 1 2013|
Bibliographical noteFunding Information:
Drs. Greer, Berliner and Sprigle have no declarations or conflicts to report. Dr. Cohen offers consultation services to insurance carriers and organizes the Clinician Task Force which advocates for improved clinical service delivery. The mobilityRERC State of the Science Conference was supported, in part, by the following sponsors: Invacare, Permobil, Pride Mobility, The Roho Group and Sunrise Medical. The mobilityRERC is funded by the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education under grant number H133E080003. The opinions contained in this article are those of the authors and do not necessarily reflect those of the U.S. Department of Education, the Department of Veterans Affairs, the Department of Health and Human Services, or the U.S. Government.
- Complex rehabilitation technology
- Narrative review
- State of the science
- Wheelchair seating