Article

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.
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.

Langue : ANGLAIS