The impact of a low cost wheelchair on the quality of life of the disabled in the developing world.

BACKGROUND: People with disabilities in the developing world do not have equal and adequate access to education, employment, or medical care. Their physical or mental condition, compounded by a lack of financial and technological resources, imposes a burden on both the family and the State. A wheelchair is a form of assistive technology which eases that burden for many. This study examines the impact of a simple, donated chair on the health, quality of life, and function of a subject population. MATERIAL/METHODS: Surveys were administered to 519 disabled recipients of a semi-rigid depot style wheelchair in 3 different countries at the time they received their chair and again after 12 months of use. Surveys evaluated physical and emotional health, functional independence, and lifestyle. RESULTS: On initial reports, 46.6% of subjects said they never left home, 52.3% were hospitalized one or more days/month, 70.3% reported daily pain, and 48.7% reported a negative mood state. Following 12 months of using the wheelchair, both the reported overall health rating and mood state increased by 20%; pain was significantly diminished. Although some areas in the ICF function measure improved more than others, the overall reported level of independence rose by 11%. CONCLUSIONS: A representative sample of the disabled in 3 countries of the world is socially isolated, in poor health, and with limited function. Receipt of a simple, depot style wheelchair significantly improved their quality of life, health indicators, and the ICF function measure following 12 months of use.

Use of an economical wheelchair in India and Peru: impact on health and function.

BACKGROUND: The overall impact of a wheelchair on its user must be evaluated in light of both benefit and risk. Evaluation should include not only physical function, but also overall quality of life, integration into society, and cost effectiveness. The current study examined the impact of a donated, inexpensively made wheelchair on recipients in 2 different countries. MATERIAL/METHODS: 188 recipients of the Free Wheelchair Mission (FWM) wheelchair in India and Peru were surveyed in their local setting and language by social workers. Results were entered and transferred electronically for analysis. RESULTS: At the time of the survey, the wheelchairs had been in use for an average of 18 months. 93.1% of recipients used their wheelchair more than 1 hour/day. Receipt and use of the FWM chair resulted in a significant shift toward independent function in 5 of 6 areas drawn from the International Classification of Functioning, Disability, and Health. The greatest maintenance problem was with the tires (19.7%), similar in frequency to reported U.S. users. There was an unexpected 11.7% decrease in the incidence of pressure ulcers with use of the wheelchair, most likely associated with increased mobility. Reported pain levels were not believed by participants to be related to use of the wheelchair. The impact on health and quality of life was generally viewed as positive. Monetary cost of the wheelchair is minimal. CONCLUSIONS: In summary, recipient evaluation of the Free Wheelchair Mission wheelchair in 2 different countries has shown a positive, cost-effective benefit to both health and function without unusual risk.

Evaluation of pressure and durability of a low-cost wheelchair cushion designed for developing countries.

Pressure sores are a medical problem for wheelchair users worldwide. In developing countries this problem is more critical because of lack of access to specialized technologies and medical assessment. Seat cushions to relieve pressure represent one of best ways to prevent pressure sores for people with spinal cord injury, amputation, cerebral palsy, and other disabilities that require use of wheelchairs for long periods of time. The purpose of this study was to evaluate the performance of a low cost cushion, called the Tuball, designed for low-income communities in developing countries. The Tuball is made from bicycle inner tubes and plastic balls. Its durability and pressure-relieving characteristics were compared with the ROHOTM cushion and the foam cushions now used in Brazil. A sample of 30 participants tested the three cushions: 15 persons with paraplegia and 15 matched able-bodied persons evaluated the capacity of the cushions to distribute pressure. This study also addressed the use of samples of persons without disabilities to test wheelchair cushions.The Tuball cushion provided significantly better pressure distribution than the foam cushion. A t-test was used to compare disabled persons and non-disabled persons as samples in testing cushions. No difference between pressure distribution between non-disabled and disabled participants was found in testing the ROHO cushion or the foam cushion. However, both capacities of pressure distribution and HICPR varied between non-disabled and disabled participants for the Tuball cushion. To determine the useful life of the Tuball cushion, a fatigue test was conducted to simulate sitting and transfer. Both the Tuball and ROHO cushions withstood the equivalent of at least 1 year of use, whereas the foam cushion broke down.