Relationships Between Wheelchair Services Received and Wheelchair User Outcomes in Less-Resourced Settings: A Cross-Sectional Survey in Kenya and the Philippines

  • R. Lee Kirby
    Corresponding author R. Lee Kirby, MD, Nova Scotia Rehabilitation Center, 1341 Summer Street, Halifax, Nova Scotia, Canada B3H 4K4.
    Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Steve P. Doucette
    Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada

    Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Published:March 06, 2019DOI:


      • Overall, receipt of wheelchair services is associated with positive outcomes.
      • Some services are more beneficial than others.
      • The top individual service was “provider did training.”
      • This study is highly relevant to the optimization of wheelchair service delivery.



      To explore the relationships between wheelchair services received during wheelchair provision and positive outcomes for users of wheelchairs.


      Secondary analysis of cross-sectional data.


      Urban and periurban communities in Kenya and the Philippines.


      Adult basic manual wheelchair users (N=852), about half of whom reported having received some wheelchair services with the provision of their current wheelchairs.


      Not applicable.

      Main Outcome Measures

      Participants completed a survey that included questions related to demographic, clinical, and wheelchair characteristics. The survey also included questions about the past receipt of 13 wheelchair services and 4 positive outcomes for users of wheelchairs. The relationships between individual services received and positive outcomes were assessed using logistic regression analyses. In addition to assessing individual services and outcomes, we analyzed a composite service score (the total number of services received) and a composite outcome score (≥3 positive outcomes).


      The top 3 individual services from the perspective of relationships with the composite outcome score were “provider did training” (P=.0009), “provider assessed wheelchair fit while user propelled the wheelchair” (P=.002), and “peer group training received” (P=.033). The composite service score was significantly related to “daily wheelchair use” (P<.0001), “outdoor unassisted wheelchair use” (P<.0001), “high performance of activities of daily living” (P=.046) and the composite outcome score (P=.005), but not to the “absence of serious falls” (P=.73).


      The receipt of wheelchair services is associated with positive outcomes for users of wheelchairs, but such relationships do not exist for all services and outcomes. These findings are highly relevant to ongoing efforts to optimize wheelchair service delivery.


      List of abbreviations:

      CI (confidence interval), ISWP (International Society of Wheelchair Professionals), OR (odds ratio), WHO (World Health Organization)
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