mobilityRERC State of the Science Conference: considerations for developing an evidence base for wheeled mobility and seating service delivery

Abstract

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 Rehabilitation

• An 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.

• Complex rehabilitation technology
• narrative review
• research
• state of the science
• wheelchair
• wheelchair seating

Acknowledgements

The authors and mobilityRERC thank RESNA for hosting this State of the Science Conference, and Lauren Bowers and Lisette Vonk for organization and operational support.