Wheelchair use in less resourced settings: a study on research quality, wheeled mobility in rural areas, and the user experience in the Lao People's Democratic Republic.

The World Health Organization estimates that nearly twice as many people in the developing world are in need of wheelchairs compared to other mobility aids (e.g., prosthetics). Wheelchairs currently being manufactured in less resourced areas are rarely designed to withstand rural conditions with poor infrastructure, which leads to increased rates of product failure and/or abandonment. Global recognition of the need for more durable and efficient wheelchairs created a movement in evaluating how patients in these settings interact with various designs. This growing body of literature focuses primarily on the impact of wheelchair models in terms of performance and perception. Performance measures are often defined by physiological and biomechanical testing, while user perception outcomes are generated through feedback assessments, surveys, and interviews. Although the results from this literature suggests a preference toward tested wheelchairs compared to locally manufactured counterparts, it is necessary to expand on methodologies that can uncover further detail on product effectiveness. For example, wheeled mobility is a new effectiveness measure that has yet to be applied in less resourced settings. Additionally, it is important to continue implementing mixed methods study designs as these approaches yield the most comprehensive information about the relationship between performance and perception. In this series of studies, I expand upon the existing literature on wheelchair use in the developing world utilizing the mixed method approach and our purpose is threefold. The first study is an objective evaluation of previous work in the field that summarizes the brief history of this research and reveals the quality level of each respective piece of literature. In the second study, wheeled mobility is used to test the effect of different wheelchair designs that each feature different propulsion systems. Finally, the third study is an investigation of perceived quality of life among wheelchair users in rural areas of the Lao PDR with the use of semi-structured interviews. The combination of outcomes from these studies highlight the importance of mixed methods approaches when evaluating patients’ interactions with wheelchairs and assistive technologies as a whole. This research also serves as a reminder of the complexities associated with working in less resourced settings, but provides a framework of strategies that can guide improvements in global wheelchair service delivery.