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Phase One Desk Review: Research Study of Wheelchair and Wheelchair Services Provision in Low-Resource Settings

Rehabilitative Medicine

Accelovate-a Partnership in Accelerated Global Health Innovation Accelovate is a global program dedicated to increasing the availability and use of lifesaving innovations for low-resource settings. Led by Jhpiego, the Accelovate program began in 2011 as a five-year, United States Agency for International Development (USAID)-funded program under the Technologies for Health (T4H) grant.

Key:

Design Challenges promote the development of innovative solutions where appropriate technology is lacking

Solution Landscapes assess what solutions exist

Value Propositions assess the benefits and drawbacks of an array of solutions for our context

Business Cases assess manufacturability and commercial potential

Market Readiness Assessments evaluate a selected technology/solution for market-level readiness factors

Briefs describe technology access and utilization challenges in a topical area and outline Accelovate’s approach

Excel Tools present raw data that implementers may develop for programming and advocacy purposes

Literature Reviews review secondary data, usually to understand a bottleneck

This report is made possible by the generous support of the American people through USAID, under the terms of the Technologies for Health award AID-OAA-A-11-00050. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.

Jhpiego is an international, nonprofit health organization affiliated with Johns Hopkins University. For more than 40 years, Jhpiego has empowered frontline health workers by designing and implementing effective, low-cost, hands-on solutions to strengthen the delivery of health care services for women and their families. By putting evidence-based health innovations into everyday practice, Jhpiego works to break down barriers to high-quality health care for the world’s most vulnerable populations.

This Literature Review covers the years 2004–2014 and does not survey later contributions to the scholarship.

Published by:JhpiegoBrown’s Wharf1615 Thames StreetBaltimore, Maryland 21231-3492, USAwww.jhpiego.org

© Jhpiego Corporation, 2015. All rights reserved.

Acknowledgments

Postpartum Hemorrhage

Pre-eclampsia & Eclampsia

RehabilitativeMedicine

Male Circumcision

page iiipage iii

Table of ContentsList of Abbreviations 4

Executive Summary 1

Phase One Scope and Standard Wheelchair Definitions 3

Phase One Methodology 5

Results and Recommendations 11

Data Limitations and Gaps 16

Next Steps 18

Appendix A. Wheelchair Distribution by Country 17

Appendix B. Established Guidelines, Assessments, and Tools 23

page iv

AT Assistive Technology Devices

DPO Disabled People’s Organization

LRS Low-Resource Settings

NGO Nongovernmental Organizations

USAID United States Agency for International Development

WC Wheelchair

WHO World Health Organization

List of Abbreviations

page v

In 2004, the World Health Organization (WHO) published its Global Burden of Disease1 report which estimated that 15% of the global population has some form of a disability from either a mobility, hearing, visual, or cognitive impairment. Many of these individuals use some form of an assistive technology (AT) device, which can be defined as, “any item, piece of equipment, or product […] that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities.”2 The wheelchair is a commonly used assistive device for individuals with mobility impairments, and an estimated 1% of the world’s population require the use of one.3 However, many of those same estimates indicate a large unmet need for manual wheelchairs among long-term wheelchair users.

To support the broad vision of ensuring personal mobility with the greatest possible independence for persons with disabilities,4 the United States Agency for International Development (USAID) has demonstrated a commitment to a number of key initiatives in the wheelchair sector that support the production, provision, and proper use of wheelchairs. This includes working with organizations to ensure that wheelchair provision programs are comprehensively and effectively designed.

This commitment has led USAID to take a closer look at the WHO published Guidelines on the Provision of Manual Wheelchairs in Less-Resourced Settings, and also the WHO Eight Steps to Wheelchair Service Delivery as outlined in the Wheelchair Service Training Package. It is thought that incorporating these eight steps in wheelchair program project design is important—based on the guiding assumption that service delivery is a critical component of wheelchair provision and distributing a wheelchair without appropriate services will demonstrate poor outcomes

1 The WHO Global Burden of Disease Report is a comprehensive assessment of the health of the world’s popula-tion that provides mortality, disability, and loss of health estimates. The report can be accessed online on the WHO website: www.who.int.2 From the first written WHO World Report on Disability, pg. 101.3 National figures on individuals with disabilities is derived from census data, population surveys, and admin-istrative data registries and varies widely in terms of definitions used, completeness of data, data collection methodologies, and timeframes used. Therefore, there is no accurate figure on the number of people that require a wheelchair although the 1% approximation is a widely accepted number.4 This broad vision is in accordance with Article 20 of the United Nations Convention on the Rights of Persons with Disabilities, as indicated in a Preliminary Report outlining Future Directions in Wheelchair Service Provision that stemmed from a USAID/WHO Future Directions in Wheelchair Service Provision Workshop held August 23–24, 2012 in Washington, DC.

Executive Summary

page vi

in comparison to distribution accompanied by a full-service structure.

With this context in mind, the Accelovate Project will complete a four-phase Research Study of Wheelchair and Wheelchair Service Provision programs, to confirm this baseline assumption.

The research study will be conducted in four phases:

nn Phase One: Initial Desk Review

nn Phase Two: Developing Interview Tools and Phase Three Planning

nn Phase Three: Field-Based Data Collection

nn Phase Four: Summary and Analysis of Research Findings

Phase One ScopeThis report outlines the findings of Phase One: Initial Desk Review.

Phase One included a desk review of current wheelchair providers and existing research studies that defined or measured the impact of receiving a wheelchair with or without appropriate service. The goal of this phase was to provide an early, objective description of the state of existing wheelchair provision and recurring themes in wheelchair service impact measurement. The desk review highlights existing research gaps and data limitations, determines future data collection needs, and proposes two recommendations for actions to be considered in Phase Two.

Standard Wheelchair DefinitionsTo begin the desk review analysis, the research team began with the following standard wheelchair definitions:5

nn Wheelchair: a device providing wheeled mobility and seating support for a person with difficulty in walking or moving around.

nn Manual Wheelchair: a wheelchair that is propelled by the user or pushed by another person.6

nn Appropriate Wheelchair: the World Health Organization’s (WHO) Wheelchair Guidelines’ definition of an appropriate wheelchair states that an appropriate wheelchair, “…meets the user’s needs and environmental conditions, provides proper fit and postural support, is safe and durable, is available in the country, and can be obtained, maintained and services sustained in the country at the most economical and affordable price.”

nn Wheelchair Provision: an overall term for wheelchair design, production, and supply; sometimes used interchangeably with wheelchair distribution.

5 From the International Society for Prosthetics and Orthotics (ISPO)-USAID-WHO Guidelines for the Provision of Manual Wheelchairs in Less-Resourced Settings.6 WHO Wheelchair Service Training Package—Basic Level.

Phase One Scope and Standard Wheelchair Definitions

nn Wheelchair Service:7 a step beyond wheelchair provision concerned with ensuring that each user receives individualized attention to ensure their use of an appropriate wheelchair.

7 The WHO has published guidelines on the Eight Steps to Wheelchair Service Delivery. These eight steps to service delivery, as per the WHO definition, include: 1) appointment and referral, 2) assessment, 3) prescription and selection, 4) funding and ordering, 5) wheelchair preparation, 6) fitting, 7) user training, and 8) maintenance repairs and follow-up. USAID partners are encouraged to incorporate these eight steps in their project design and implementation plans.

Phase One MethodologyThe Phase One Desk Review was conducted in two parts. In Part One, researchers completed an exhaustive internet search to determine a list of active wheelchair providers and develop global and country-level wheelchair distribution volume estimates. In Part Two, researchers conducted a comprehensive gray and published literature search on existing wheelchair impact and outcome measurement tools. Details on the standard definitions, scope, and methodology for each part are included below.

Part One: Wheelchair Providers and Distribution Volume EstimatesGiven this context, the research team first tried to develop a characterization of global and country level wheelchair distribution—by determining both a list of active providers of wheelchair organizations, as well as developing distribution volume estimates.

Specifically, the research team conducted a systematic survey of the following four inputs:

1. A review of available web-based disability statistics and wheelchair distribution databases to determine total reported volumes of wheelchair distribution.

2. A review of registered nongovernmental organizations (NGOs), disabled people’s organizations (DPOs), charitable foundations, and United Nations agencies currently assisting persons with disabilities.

3. A search of wheelchair NGO/DPO websites, published data, and annual reports to determine distribution data programs and volumes reported through to July 2013.

4. A review of websites developed for wheelchair associations, service professionals, users, caregivers, and charitable foundations detailing top global and country-level wheelchair service providers.

These data were compiled and then organized into a sortable database with the following columns:

nn Total wheelchair distribution—cumulative.8

nn Total wheelchair distribution—annual.

nn Total wheelchair distribution—by NGO.

nn Total wheelchair distribution—by country or region.

With this database, researchers were able to determine the most active wheelchair providers and the country, which received the largest number of wheelchairs. As a result, the researchers had a clear picture of current wheelchair distribution efforts at both the country and global levels. This database was then sorted by additional data columns to form a Country Selection Matrix, which formed the basis of Recommendation One, which outlines a potential list of countries where further analysis can be conducted in subsequent Phases (Phases Two to Four) of the larger research effort.

The additional columns that formed the Country Selection Matrix include:

nn Country Income Classification: using the World Bank Income Group classification, distribution data were sorted for low- and low-middle income countries only, excluding countries that were middle income or higher.

nn Estimation of Potential Gap: To contextualize distribution data in the context of estimated need, the Country Selection Matrix created a proxy measure of potential gap that was developed by the following ratio:

# of wheelchairs distributed in-country (cumulative)

Estimated need in-country (or 1% of the total country population9)

8 Organizations’ websites often provided estimates of wheelchair distribution that were cumulative—over the life of the organization and program—as opposed to discrete annual estimates. Where possible, our research team tried to find reported annual estimates or approximate them by determining a yearly average. However, these approximations introduce uncertainty in the annual estimate; therefore, our recommendations are derived from analyses of cumulative figures.9 This Estimated Need metric was suggested in the Needs Assessment section of the report of the ISPO-USAID- WHO Consensus Conference on Wheelchairs for Developing Countries.

nn Presence of Jhpiego Country Office: The countries on the Country Selection Matrix were further classified according to the presence of a Jhpiego country office—currently there are 41 nations where Jhpiego has an established, in-country presence.

nn In-country DPO/NGO Activity: Finally, the number of registered DPOs by country were listed, to get a country-level picture of how active wheelchair provision services are in that country.

Some additional data assumptions were used:

1. Estimated Need in-country is 1% of country-level population that requires a wheelchair.

2. All donated wheelchairs that were distributed had one recipient.

3. The wheelchairs distributed were still in use from the time they were distributed.

4. All NGOs and DPOs who catered for the physical disability population have the potential to be involved in the distribution of wheelchairs, unless their website explicitly excludes this activity.

The results of the Country Selection Matrix analysis have been included in Part One of the Results and Recommendations Section.

Part Two: Definition of Wheelchair Service Impact and Outcome Measurement ToolsThe second part of research explored existing gray and published literature to determine how previous research studies have framed or measured impact of wheelchair service provision, in both quantitative and qualitative terms.

As a first step, the research team set appropriate search terms to use during the literature search and used some basic search terms in various combinations. Those search terms were:

nn Wheelchair, wheeled mobility

nn Service provision

nn Training

nn Guidelines, assessment, tools, quality of life assessment

nn User satisfaction

nn Developing country, low-resource country, low-resource setting, Africa, sub-Saharan Africa, South East Asia, East Asia

The research then developed a list of databases to consider during the literature search, inclusive of: PubMed, Comprehensive Journal Index and Additional Resources for Nursing and Allied Health Professionals, Education Resource Information Center, Embase, Sciverse Scopus, Centers for Disease Control and Prevention Disability and Health, WHO Disabilities and Rehabilitation Database, and Center for International Rehabilitation and Research Databases.

As one example, the graphic below illustrates the PubMed search terms and results: Literature Database Search String Example: PubMed Search

1. “effective” and “wheelchair or wheelchairs” and “provision” – Six Results

2. “tool or tools” and “wheelchair service” and “provision” – Two Results

3. “tool or tools” and “wheelchair OR wheelchairs” and “Provision” – Four Results

4. “tool or tools” and “wheelchair or wheelchairs” and “developing country OR countries” – Three Results

5. “tool or tools” and “wheelchair OR wheelchairs” and “user satisfaction” – Five Results

This search strategy resulted in hundreds of published articles to sort though. To go through these articles for relevance and applicability to this four-phase research study, inclusion and exclusion criteria were also developed for the literature review. In certain cases, exceptions to these exclusion criteria were considered.

The following table provides a summary of the inclusion and exclusion criteria developed for this portion of the desk review.

Table 1: Inclusion and Exclusion Criteria for Literature Review

No Inclusion Criterion Exclusion Criteria and Exceptions

1 Less resource context: The publication has a focus in a geographical area with limited financial, human and infrastructural resources to provide wheelchairs.

Due to the differences in settings, funding, and policy issues between developed and developing world settings, developed world studies were largely excluded. However, some technical rehabilitation and health related aspects are similar and relevant in both settings, such as the need for pressure relief devices for users who lack lower body. In such cases, the research team used their judgment to determine which studies should be included.

2 Service relevance: The article is directly related to wheelchair service provision, where any of the eight WHO steps of service provision are mentioned, including assessing individual needs and providing users with appropriate wheelchairs adjusted and fitted to the user

Literature was excluded if it made no mention of service provision or the relevance of service, but only mentioned the wheelchair “product.”

3 Manual wheelchair focus: The publication has a focus on wheelchairs that are propelled by the user or pushed by another person

All literature on power or motorized wheelchairs were excluded.

4 Adult wheelchair user focus: The publication focus remained on adult wheelchair users.

Studies conducted on children were excluded unless they had a particularly compelling characterization of basic service provision.

5 Level of Wheelchair Service Provision: Publications were only considered if there was a focus on “basic” service provision, as described in the WHO Wheelchair Guidelines for Service Providers.

Studies were excluded if they mentioned “intermediate” or “advanced” service provision.

Studies were excluded if they mentioned “intermediate” or “advanced” service provision.

The selected published and gray literature were all written in the English language and were a mix of quantitative and qualitative research. Other factors for inclusion of a publication for review during the literature search phase included:

Rigorous The publication involves a well-designed and/or validated study.

Valid The publication refers to an outcome measurement tool, which has been externally tested and validated

Professional The publication has been written from a clinical professional’s perspectiveor for use by clinical professionals (occupational therapists, physical therapists, medical doctor, prosthetist or orthotist or other).

Sponsors The publication has been sponsored by either wheelchair users, DPO, local NGOs, international NGOs, academic institutions, or commercial enterprise.

Data source Data were collected from wheelchair users, carers, family members, wheelchair suppliers or professionals.

These studies were classified into a Literature Selection and Categorization Matrix with the following columns:

Table 2: Literature Selection and Categorization Matrix

Citation Code

Less Resourced

Context

Service Relevant

Manual Wheelchair

Focus

Basic, Intermediate, or Advanced Level of Service

ProvisionExample:

Article 1 Y P Y B

Legend = Y, N, P stands for Yes, No, and Partly.

Finally, to add to this literature search of existing gray and published literature, the research team also searched for established guidelines, assessments, and tools that supported effective wheelchair service delivery in order to determine what existing definitions of wheelchair service impact were commonly used. By compiling these outcome tools, the research team was able to analyze and list definitions and parameters of wheelchair service impact currently in use.

Only 5% of people who need a wheelchair receive one.

Recommendation #1: Country Selection Matrix and Study Site SelectionThe research team conducted an exhaustive internet search and was able to document a cumulative total of 2,116,715 wheelchairs distributed globally, the bulk of which were distributed since the year 2000. This represents 3% of the total estimated wheelchair need, which is consistent with figures that state that 5% of the population that is estimated to require a wheelchair actually receives one. With this figure, we can conclude that this database accounts for most of the charity and donor based wheelchair distribution that occurs around the globe.

For more country level detail, see Appendix A: Wheelchair Distribution by Country.

The wheelchair distribution database compiled by the research team was also able to determine both NGO presence by country, as well as the top providers and distributors, based on total (cumulative) volumes that were self-reported by each NGO. In order of decreasing distribution volumes, the top five NGOs were:

nn Wheelchair Foundation 935,854

nn Free Wheelchair Mission 659,801

nn Latter Day Saints Charities 300,000

nn Hope Haven Charities 100,661

nn UCP Wheels for Humanity 50,000

The next step was for the research team to analyze the Country Selection Matrix to determine which countries would be ideal for further analysis and research in Phases Two to Four. It was determined that the low-income and low- to middle-income countries with the top distribution volumes would be considered as long as the country was reasonably politically stable and Jhpiego had an in-country presence that would allow for programmatic and research support to conduct the remaining phases of this research study.

This criterion was also supplemented by the starting premise that the research study would choose two countries to work in, and those two countries would be in separate continents. Based on that

Results and Recommendations

premise, Recommendation #1 of this desk review recommends that further study occurs in one country in each of the two categories:

Country Category #1 (Africa)

Country Category #2 (South-East or East Asia)

Ghana Bangladesh

Kenya India

Tanzania Indonesia

Uganda Philippines

Zambia

Once the two countries are selected, it is further recommended that the research study choose a very specific sub-national location (region, district, or even city) to conduct this research in order to exert greater control on the research study and have a full understanding of the scope and size of adult basic wheelchair distribution and wheelchair service provision programs across organizations.

Recommendation #2: Definitions of Wheelchair Service Impact and Outcome Measurement ToolsA review of the literature, guidelines, assessments, and outcome tools used to define wheelchair service impact yielded a total of 31 potential articles that could be used to inform the Desk Review understanding of what definitions of wheelchair service impact are widely used and can be adopted for our purposes. The results of the Literature Selection and Categorization Matrix are included in Table 3 below.

Table 3: Results of the Literature Selection and Categorization Matrix

Research Study Article

Less Resourced

Service Relevant

Manual WC Focus

Basic or Intermediate

Rigorous Valid Tool Sponsor Data from?

31 articles selected

8 studies (26%) were in less resourced settings

30 studies (97%) were service relevant.

23 studies (74%) were related exclusively to manual WC.

19 studies (61%) were related to basic services.

27 studies (87%) were done with a rigorous framework.

22 studies (71%) used an externally validated tool.

2 studies were sponsored by inter-national NGOs and 18 studies by educational institutions.

17 studies had data from wheelchair users and 4 from professionals.

No study or tool in existing literature comprehensively assesses wheelchair service delivery in low-resource settings.

Some notable observations were recorded by the research team:

nn The literature review exercise did not result in a study or a tool that comprehensively assessed wheelchair service delivery. Almost all of the 31 selected articles assessed the impact of a few elements of appropriate wheelchair service but no evidence was found of assessment that measured the impact of all eight levels of comprehensive service as described in WHO guidelines. Therefore, it is difficult to determine the effects of the comprehensive service delivery against the few elements of service for which research has been conducted.

nn Internally used but not validated tools have not been considered for the desk review. Relevance of certain tools might be disputed due to the level of resources available in the context that the tools were developed for.

The reviewed literature suggests as two categories of impact definitions: quantitative and qualitative. When it comes to quantitative definitions of impact, the studies and tools measured three types:

nn Changes in the level of secondary physical complications of the wheelchair user, such as urinary tract infections, pressure sores, repetitive strain injury and further postural deformities.10

nn Changes in the level of the wheelchair users’ mobility capacity, which is measured by distance traveled, functionality and independence.

nn Some quantitative assessments of wheelchair users’ knowledge of the product and product maintenance as it correlates to the lifespan of the wheelchair, continuity and frequency of usage were found.11 In addition, the level of proficiency of wheelchair skills has been observed against safety, underutilization and abandonment.12

10 Greer et al. mentions harms such as: overuse or repetitive strain injuries, pressure sores, falls and accidents, equipment abandonment, and underutilization.11 This comes from a pilot study exploring issues in maintenance and repairs of wheelchairs completed by several authors including Shirley Fitzgerald, Diane Collins, Rory Cooper, Michelle Tolerico, Annmarie Kelleher, Peter Hunt, Stephanie Martin, Bradley Impink, and Rosemarie Cooper.12 This comes from work done on Manual Wheelchair Skills Capacity Versus Performance by Peter Inkpen, Kim Parker, and Lee Kirby.

When it comes to qualitative definitions of impact, the studies and tools measured two types:

nn Quality of Life of persons with mobility disabilities, including a brief treatment of the topics of social inclusion, financial independence, and general wellbeing. Changes in the level of self-esteem and self-confidence of the user have also been studied.

nn Although extensive examples were not found in the literature, additional qualitative definitions of impact would encompass: transformation of quality of life of the user, caregivers, and other relevant stakeholders, satisfaction with provider, satisfaction with the product, and satisfaction with overall wheelchair service.

Because less than a quarter of the literature surveyed was based in low-resource settings, the research team states as Recommendation #2 that qualitative definitions of impact would need to be explored de-novo in the countries of study, as existing tools and literature reviews are geared toward higher-resource settings, therefore, may not be as culturally appropriate and as easily adaptable. A quick review of outcome tools also suggests the same for questionnaires and tools that would be used for this study. This recommendation would mean that as planning for Phase Two and Phase Three were underway, sufficient investment would be required to conduct qualitative research via focus groups and key informant interviews, in order to determine culturally appropriate determinants of impact that resonate with wheelchair users, caretakers, wheelchair service professionals, and other important stakeholders. Although this recommendation is more complicated in terms of establishing the requisite research protocols and analyzing data, ultimately the information gleaned would be rich and a strong contribution to the wheelchair impact indicator definition space.

However, quantitative definitions of impact would be more readily adaptable to less-resource settings, and, therefore, this can be easily considered for the research study.

A mixed measurement of impact (with both qualitative and quantitative indicators) is possible but would complicate the research protocol, therefore, would not be advisable if sufficient time was not available to iterate the research tools and protocol.

For additional detail on existing outcome tools surveyed by this desk review, see Appendix B: Established Guidelines, Assessments and Tools.

Despite the efforts of the research team to be as inclusive, thorough, and systematic as possible, two major data limitations and research gaps remain.

Research Gap #1: Incomplete Data on Wheelchair Distribution on Global NGOs/DPOsIn the first part, wheelchair distribution statistics are incomplete or potentially inaccurate because of the following reasons:

1. Reported data on wheelchair distribution are not disaggregated uniformly, thereby, hindering an effective comparison between groups. Some organizations distribute wheelchairs to different age groups (adult vs. child), in different geographies (urban vs. rural), or to different genders (male vs. female).

2. Reported wheelchair distribution is also potentially under reported (due to undocumented distribution) or over reported (due to double-counting of program activities between two partners). We could not find an independent agency that verified country-level distribution.

3. We cannot conclude if the wheelchairs distributed are still in use or if each individual received only one wheelchair or many. Similarly, we do not have information on the average duration of use.

4. We could not obtain a comprehensive list of DPOs and NGOs involved in wheelchair provision with or without services in each country due to the amount of time and due to some local DPOs not having websites.

Further studies would need to be conducted to obtain accurate country-level data that can be disaggregated by additional parameters such as sex, age, and income or occupation. This would allow for analysis of subgroups of persons with disabilities. In addition, the development and implementation of standardized tools and methodology for data collection to be used for all countries are recommended for easy comparison. Those studies are beyond the scope of this research exercise but could be useful to consider in the future.

Data Limitations and Gaps

Health care needs and resources are different in low-resource settings, particularly when it comes to caring for individuals with disabilities.

Research Gap #2: Limited Studies in Low-Resource SettingsIn the second part, one of the limitations that emerged from the literature review was the lack of research studies that were conducted purely for low-resource settings. General health care needs and resources are markedly different between high- and lower-resourced settings, and this is particularly pronounced when it comes to caring for and treating individuals with disabilities. In addition, when it comes to qualitative assessments that measure satisfaction or quality of life many of the existing impact or outcome measurement tools are not tailored to demonstrate an understanding of cultural and ethical issues in working with disadvantaged populations.

Accelovate’s study of wheelchair services in Kenya and the Philippines aims to fill the evidence gap.

This report concludes the analysis conducted for Phase One of the four-phase Research Study on Wheelchair and Wheelchair Service Provision. As next steps, the following are required:

nn Confirmation of Phase Two and Phase Three site selection (two research countries selected from Category #1 and Category #2).

nn Decision on qualitative or quantitative determination of impact and subsequent research tool development and iteration.

nn Planning for hiring, field travel, and in-country meetings with stakeholders to begin work on Phase Two.

nn Revisit Phase Two and Phase Three timelines, where Phase Two is six months (September 2-13–February 2014), and Phase Three is three months (March–May 2014).

nn Discuss and plan for Research Protocol implications for Phase 2, 3, 4, inclusive of developing and submitting IRB applications.

Next Steps

Appendix A. Wheelchair Distribution by Country

Accelovate Wheelchair Distribution AssessmentsOrganization Presence by Country

These data are self-reported by organization, compiled from websites and/or annual reports. Last updated July 17, 2013.

Wheelchair Foundation

LDS Charities

Free Wheelchair

Mission

UCP Wheels for Humanity

Whirldwind Handicap International

Canadian Wheelchair Foundation


UK

Motivation International

AfghanistanAlbaniaAlgeriaAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAzerbaijanBahamasBangladeshBarbadosBelgiumBelizeBeninBoliviaBosnia and HerzegovinaBotswanaBrazilBulgariaBurundiCambodiaCanadaCape VerdeCentral African RepublicChileChinaColumbiaCosta RicaCroatiaCubaCyprusCzech RepublicDominicaDominican RepublicDRC

AfghanistanAlbaniaAlgeriaAmerican SamoaAngolaAntigua and BarbudaArgentinaArmeniaBarbadosBelarusBelizeBoliviaBosnia and HerzegovinaBotswanaBrazilBulgariaBurundiCambodiaCameroonCanadaCape VerdeChileChinaColombiaCosta RicaCote d'IvoireCroatiaCyprusCzech RepublicDemocratic Republic of the CongoDominican RepublicEcuadorEgypt

AfghanistanAlbaniaAngolaArgentinaArmeniaBangladeshBelarusBeninBoliviaBotswanaBrazilBulgariaBurundiCambodiaCameroonChileChinaColumbiaComorosCosta RicaCubaDjiboutiDominican RepublicDRCEast TimorEcuadorEgyptEl SalvadorEthiopiaFijiGabonGhanaGuatemalaGuineaGuyanaHaitiHondurasIndiaIndonesia

AfghanistanAngolaArgentinaArmeniaBelizeBoliviaBosnia and HerzegovinaBrazilBulgariaCambodiaCameroonChadChechnyaChinaColumbiaCosta RicaCubaDominican RepublicEcuadorEgyptEl SalvadorEthiopiaGazaGhanaGuatemalaHaitiHondurasIndiaIndonesiaIraqIsraelJamaicaLiberiaLibyanMaliMexicoMoldova Republic of

AfghanistanAlbaniaArgentinaArmeniaBelarusBoliviaBosnia and HerzegovinaCape VerdeChinaColombiaCote d’IvoireCzech RepublicDominican RepublicEcuadorEthiopiaFijiGeorgiaGhanaGuyanaHaitiIndiaIndonesiaIsraelJamaicaJordanKazakhstanKenyaLaosMacedoniaMadagascarMalawiMalaysiaMexicoMoldovaMongoliaMozambiqueMyanmar

AfghanistanAlbaniaAlgeriaAngolaBangladeshBosnia and HerzegovinaBrazilBurkina FasoBurundiCambodiaCape VerdeChinaColumbiaCôte d'IvoireCubaDemocratic Republic of CongoEgyptEthiopiaFranceGuinea-BissauIndiaIndonesiaKenyaLao People's Democratic RepublicLebanonLiberiaMaliMoroccoMozambiqueNepalNicaraguaNigerPhilippinesRepublic of Korea (South)

AfghanistanAmerican SamoaAntiguaArgentinaBelizeBoliviaCanadaChileChinaColombiaCosta RicaCubaDominican RepublicEcuadorEl SalvadorEthiopiaFijiHaitiIndonesiaIraqJamaicaKenyaLithuaniaMexicoNepalPanamaPeruPhilippinesPuerto RicoRussiaRwandaSierra LeoneSouth AfricaSri LankaTajikistanUSAVenezuelaVietnamZambia

BeninBulgariaEthiopiaGhanaKenyaLesothoMalawiMaliMauritaniaMozambiqueNamibiaNepalNigeriaPakistanPhilippinesPolandRomaniaSerbiaSouth AfricaSt Vincent & GrenadinesSwazilandTanzaniaTurkeyUgandaUkraineZambiaZimbabwe

Bosnia and HerzegovinaBulgariaEthiopiaHaitiIndiaKenyaLesothoLithuaniaMalawiMoldovaMozambiquePakistanRomaniaSerbiaSri LankaSouth AfricaSouth SudanTanzaniaUnited KingdomZimbabwe




LDS Charities

Free Wheelchair

Mission





UK


East TimorEcuadorEgyptEl SalvadorEritreaEstoniaEthiopiaFijiFranceFrench PolynesiaGeorgiaGhanaGreeceGrenadaGuamGuatemalaGuyanaHaitiHondurasHong KongHungaryIndiaIndonesiaIranIraq (via Kuwait)IsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribati

El SalvadorEstoniaEthiopiaFijiGeorgiaGhanaGreeceGrenadaGuamGuatemalaGuyanaHaitiHondurasHong KongHungaryIndiaIndonesiaIraqIsraelItalyJamaicaJapanJordanKazakhstanKiribatiKorea Democratic PeopleKosovoKyrgyzstanLaosLatviaLebanonLesothoLiberia

IraqJamaicaJordanKazakhstanKenyaKyrgyzstanLao People's Democratic RepublicLebanonLiberiaMadagascarMalawiMalaysiaMaliMexicoMoldova Republic ofMoroccoNepalNicaraguaNigerNigeriaPakistanPalestinePanamaPapau New GuineaPeruPhilippinesRomaniaRwandaSenegalSierra LeoneSomalia

MongoliaMyanmarNamibiaNicaraguaNigeriaNorth KoreaPakistanPalestinePanamaPeruPhilippinesPolandRomaniaRussian FederationRwandaSierra LeoneSri LankaSyrian Arab RepublicThailandTibetTrinidad and TobagoUgandaUkraineUzbekistanVenezuelaViet NamWest BankZimbabwe

NepalNew GuineaNicaraguaNigeriaPakistanParaguayPeruPhilippinesRwandaSamoaSaudi ArabiaSierra LeoneSlovakiaSouth AfricaThailandTibetTogoTrinidad and TobagoTurkeyVenezuelaVietnamUkraineUnited Arab EmiratesUruguayZambia

Russian FederationRwandaSenegalSerbiaSierra LeoneSomaliaSri LankaSudanThailandTunisiaUnited KingdomUzbekistanViet Nam




LDS Charities

Free Wheelchair

Mission





UK


Korea, Democratic People's Republic Of (South)Korea, Republic of (North)KosovoKyrgyzstanLaosLatviaLebanonLesothoLiberiaLithuaniaMacedoniaMadagascarMalawiMalaysiaMaliMaltaMarshall IslandsMauritaniaMexicoMicronesia, Federated States ofMoldova, Republic ofMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNepalNicaraguaNigerNigeria

LithuaniaMadagascarMalawiMalaysiaMarshall IslandsMexicoMoldovaMongoliaMozambiqueMyanmarNamibiaNepalNicaraguaNigeriaPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPortugalPuerto RicoRomaniaRussiaRwandaSaint LuciaSamoaSerbiaSierra LeoneSlovakiaSouth AfricaSpainSri LankaSudanSurinameSwaziland

South AfricaSri LankaSudanSwazilandTanzaniaThailandTibetTogoTongaTrinidad and TobagoUgandaUkraine




LDS Charities

Free Wheelchair

Mission





UK


Northern Mariana IslandsOmanPakistanPalestine TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoRomaniaRussian FederationRwandaSaint LuciaSaint PetersburgSaint Vincent and the GrenadinesSamoaSaudi ArabiaSenegalSerbiaSierra LeoneSolomon IslandsSomaliaSouth AfricaSpainSri Lanka

TaiwanTanzaniaThailandTongaTrinidad and TobagoUgandaUkraineUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamZimbabwe




LDS Charities

Free Wheelchair

Mission





UK


SudanSurinameSwazilandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTibetTongaTrinidad and TobagoTurkeyTurkmenistanUgandaUkraineUnited Arab EmiratesUnited States of AmericaUzbekistanVanuataVenezuelaViet NamVirgin Islands, BritishVirgin Islands, United StatesWest Bank/IsraelZambiaZimbabwe



Wheels of Hope Wheels for the World International Committee of the Red Cross (ICRC)

Friends of the Disables Latin America

BoliviaChileDominican RepublicEl SalvadorGuatemala

Haiti HondurasGhanaKenyaTanzaniaThailand

AlbaniaEthiopiaGhanaJordanKenyaNigeria

RomaniaUkraineSierra LeoneSouth Africa

AfghanistanColumbiaDemocratic Republic of CongoIraqSri Lanka

BoliviaChilePeruUruguay

UNICEF Wheelchairs for Tibet Elanor's Project Motivation RomaniaBoliviaChile

PeruUruguay

Tibet Peru Romania

UNDP Wheelchairs for Iraqi KidsKenya Iraq

ToolThe Home

Daily living functions

Primary caregiver Physical home

settingWith whom do

you live?Assessment of Quality of Life 4D Basic

Assessment of Quality of Life 6D Standard

Assessment of Quality of Life 7D


Efficiency of Assistive Technology and Services (EATS); Effectiveness measure instrument: Individually Prioritized Problem Assessment (IPPA)

EQ-5D-5L Health Questionnaire (English version for the USA)

Functional Mobility Assessment (FMA)

Functioning Everyday with a Wheelchair (FEW)

Handicap International Motivation Mobility Alliance

Psychosocial Impacts of Assistive Devices Scale (PIADS)

Quality of Life Questionnaire (15D©) Adult

Seating Identification Tool (SIT)

Tool for Assessing Wheelchair Discomfort (TAWheelchair)

Wheelchair Adapted IOI-HA

Wheelchair Skills Test

Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon-M, Version 3.0)

WHO Quality of Life

Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0)

Wheelchair Outcome Measure: (WHOM) Version 4

KWAZO (Quality of care questionnaire to assess the quality of assistive technology provision process from a client’s perspective)

Buckinghamshire Hospitals Adult Needs Assessment Checklist

Usability Scale for Assistive Technology

Life Space

Appendix B. Established Guidelines, Assessments, and Tools

Tool

Physical Health and Complications

Mobility

Pain; pressure sores; urinary tract

infections; falls/accidents; repetitive

strain

Within the house Outside the houseUsing public

transport

Assessment of Quality of Life 4D Basic
















WHO Quality of Life






Life Space

Tool

Wheelchair

Unique features

Condition when wheelchair

was received and condition

presently

Whether same wheelchair is being used presently; if not, why the

change

Abandonment

















WHO Quality of Life






Life Space

ToolEmployment, Social Participation, Well-Being (Quality of Life)

Social participation Psychological well-being (quality of life) EmploymentAssessment of Quality of Life 4D Basic
















WHO Quality of Life






Life Space

ToolSatisfcation

with wheelchair

Wheelchair Use

Why wheelchair user needs wheelchair

Screening for basic

wheelchair

Duration, frequency, and

number of hours spent in

wheelchair

Skills

















WHO Quality of Life

Quebec User Evaluation of Satifaction with Assistive Technology (QUEST 2.0)





Life Space

ToolDetails of

Organization Providing Wheelchair

Wheelchair Service

Before or on being given wheelchair

After or during the use of wheelchair; context;

additional services; frequency; maintenance

Satisfaction with Wheelchair Service Received

















WHO Quality of Life

Quebec User Evaluation of Satifaction with Assistive Technology (QUEST 2.0)





Life Space

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