TABLE 2.
Field failures of manual wheelchairs in less-resourced environments.
| Author and year | Study details | ISO testing status | Maintenance status | Field failures |
|---|---|---|---|---|
| Studies including HWC style designs | ||||
| Toro et al. (2013) | Cross-sectional survey study conducted in a rehabilitation facility in Mexico. Paediatric users of donated HWCs (n = 43) were included in the study. Wheelchair use = 20 ± 16 months. | Wheelchairs failed on ISO test. | Self-repair and modifications | Failures noted were flat tyres and reattachment of drive wheel. This study reported extended results from an earlier study (Toro et al. 2012) reported below. |
| Shore and Juillerat (2012) | Cross-sectional survey study conducted in Vietnam, Chile and India. Donated semi-rigid HWCs (n = 519) were included in the study. Wheelchair use = 12 months. | Not ISO tested | Self-maintenance | A minimal repair rate of 3.3% was reported. Repairs were required for wheels, brakes, footrests and harness. |
| Toro et al. (2012) | Cross-sectional survey study conducted in a rehabilitation facility in Mexico. Paediatric users of donated HWCs (n = 23) were included in the study. Wheelchair use = 20 ± 16 months. | Not ISO tested | Self-repair and modifications to wheelchairs | Fifteen of 23 repairs or modifications were reported. Twenty of 23 wheelchairs were in damaged condition based on clinician rating. Inoperable brakes, loose seat and back-sling upholstery, worn out castors, cracked rear wheels and damaged armrests were reported. |
| Shore (2008) | Cross-sectional survey study conducted in Peru and India. Donated rigid HWCs (n = 188) were included in the study. Wheelchair use = 6–33 months. | Not ISO tested | Self-maintenance | Problems with flat rear tyres and tyre valves were reported. Minor issues with the resin chair were seen too. Twenty-eight per cent of users reported repairs within past 18 months. |
| Mukherjee and Samanta (2005) | Cross-sectional survey study conducted in India. Donated rigid HWCs (n = 162) were included in the study. | No data available on testing of the HWCs | No maintenance | Castors, wheel bearings, axles and solid tyres were reported to be frequently damaged. Extensive repair was required with very little wheelchair use. A total of 15.17% of wheelchairs were found to be damaged beyond repair. |
| Saha et al. (1990) | Cross-sectional survey study conducted in India. Locally produced HWCs (n = 50) from two manufacturers with wheelchair usage of 3–4 years. | No data available on testing of the HWCs | No maintenance | Multiple failures reported with castor bearings, fractures with spokes, footrests, castor wheels and forks. Brakes, seat and back material were found to wear rapidly. Rusted parts were observed. |
| Studies with wheelchair models designed for LREs | ||||
| Reese and Rispin (2015) | Cross-sectional survey study conducted in Kenya with paediatric users (n = 87). Failure data collected on five wheelchair models. Wheelchair use = 12–24 months. | Four of five wheelchair designs were ISO-qualified. The non-tested model was adapted from one of ISO-qualified model (Rispin & Wee 2014). | Irregular maintenance | Brakes were found to become loose, rusty or stiff and misadjusted. High occurrence of loose, wobbly hubs, some missing hand rims or nuts, worn tread and flat tyres were noted. Castors suffered from missing bearings and tyre cracking. Bent frames with rust and paint chips were observed. Armrests often showed significant degradation, breakage or loosening. Seats and seat backs showed collapsing of the foam. Their covers were cracked and torn. Common footrest problems were rotation stiffness, broken parts and obvious repairs, excessive looseness, cracked or broken foot plates, rusting and paint chips. |
| Rispin et al. (2012) | Cross-sectional study conducted in Kenya with paediatric users (n = 30). Failure data collected on two models: one model used for two weeks and the other one for eight months. | The model evaluated after two weeks of use was adapted from one of ISO-qualified model (Rispin & Wee 2014). The other model was ISO-qualified. | No maintenance | The ISO-qualified model had stiff brakes and broken trays and footrests. Some waterproof vinyl covers and cushions needed replacement. The other model had repeated flat tyres and misaligned wheels within two weeks of use. |
| Studies with appropriate wheelchair provision of wheelchair models designed for LREs | ||||
| Toro et al. (2016) | Paediatric and adult wheelchair users (n = 142) were evaluated in Indonesia. Four wheelchair models were provided. Wheelchair use = 6 months. | Two of four wheelchair designs were ISO-qualified | Self-maintenance | Fewer self-repairs with castors, seats, armrests, footrests, push handles and frames were reported overall. |
| Rispin et al. (2013) | Paediatric users (n = 10) in Kenya were evaluated following provision of two wheelchairs models. Wheelchairs were fit to users. Wheelchair use = 3 months. | ISO-qualified wheelchairs | No maintenance | Failures were noted with one chair only. Tyres were often flat. The seat and seat back fabric was more often cracked and torn. The cushions were collapsed. Manufacturing quality control issues were found with different parts. |
| Armstrong et al. (2007) | Prospective usability study (n = 100) conducted in Afghanistan with one wheelchair model. Three follow-up visits at weeks 3 and 10 and after 4 months were conducted. Failures reported are during the visits. Wheelchair use = 4 months. | ISO-qualified wheelchair | Self-maintenance, repairs and replacements conducted during follow-up visits by practitioners | Multiple brake handle issues and failures with seat fabric and rear wheel inner tubes were reported. |
Source: Authors’ own work
ISO, International Organization for Standardization; HWC, hospital style wheelchair; LRE, less-resourced environments.