**Background:**
Wheelchairs are among the most commonly prescribed assistive devices, with an estimated 65 million people worldwide (1% of the global population) requiring one. Successful prescription can increase participation, independence, and quality of life, while inappropriate prescription can lead to injury, dissatisfaction, and limited activity. Despite the complexity and importance of wheelchair and seating prescription, there has been a lack of consensus on which outcome-measurement tools should be used by clinicians and researchers. This systematic review aimed to determine which outcomes are being measured and which measurement tools are being used following new wheelchair prescriptions for adults.
**Methods:**
A systematic review protocol was developed a priori. Searches were conducted in MEDLINE, CINAHL, EMBASE, and PsycINFO from earliest available to March 2022 without language restrictions. Search terms included terms related to wheelchairs, wheelchair use (participation, occupation, activities of daily living), and satisfaction/quality of life. All quantitative or mixed-methods study designs were considered: RCTs, non-randomized controlled studies, before-and-after studies, interrupted time-series studies, observational studies (including cohort studies), case-control studies, and case-series studies. Participants were aged 18 years and over (or ≥75% aged 18+), living in private dwellings, group homes, or residential care, requiring a new wheelchair prescription on a likely permanent basis. Two reviewers independently screened citations and assessed full-text eligibility; a third author checked 20% of citations. Quality was assessed using the PEDro scale for RCTs and the Newcastle–Ottawa Quality Assessment Scale for non-randomized studies. Data were extracted by one author and checked by a second.
**Key Results:**
The search identified 7056 papers after duplicate removal. After screening, 155 papers underwent full-text review, and 48 articles met inclusion criteria (representing 45 studies, as 6 papers reported data from the same studies). Studies were published between 1992 and 2021. Most studies (40/45; 89%) used a cross-sectional or cohort design. Only 1 quasi-experimental trial was identified, which was considered low quality. Observational studies were of mixed quality. Participant ages varied widely (maximum age 102 years). Over half of studies (69%; 31/45) included people with a range of diagnoses; 13% (6/45) included a single primary diagnosis. Follow-up times ranged from 7 days to 3.8 years post-prescription. Regarding intervention type, 27% (12/45) included power or manual wheelchairs, 27% (12/45) included only manual wheelchairs, 40% (18/45) included power wheelchairs or scooters, 4% (2/45) did not report wheelchair type, and 1 study included only seating systems.
A total of 37 standardized outcome-measurement tools were identified. Study-specific outcome-measurement tools were used in 39 studies. Outcomes were categorized into 12 domains: caregiver assistance required, wheelchair use, cost, wheelchair skills, environmental factors, satisfaction (with wheelchair and/or service delivery), process outcomes related to service provision, impairments/health conditions, activity and activity limitations/participation and participation restrictions, goal attainment, quality of life, and major life events.
The most common domain was wheelchair use (27 studies), though only 3 standardized tools were used for this domain. User satisfaction was measured in 23 studies, with 11 using the QUEST 2.0. Activity and participation were measured in 19 studies using standardized tools, most commonly the functional independence measure. Quality of life was measured in 13 studies, using tools such as PIADS and RAND SF-36. Health status was measured in 13 studies, typically with disease-specific tools. Less commonly evaluated were goal attainment (5 studies), cost (5 studies), and major life events (2 studies). Study-specific tools were used alone in 14 studies (31%) and in combination with standardized tools in a further 25 studies (56%).
**Clinical Implications:**
The wide diversity of outcomes and measurement tools reflects the complexity inherent in wheelchair prescription, including varied clinical populations, device types, and contextual factors. The high use of study-specific tools (87% of studies used them) makes comparison across studies and settings difficult. The authors note that no single outcome measure can capture all relevant information for wheelchair and seating evaluation. They recommend developing consensus on which measures should be used to achieve greater consistency across studies and facilitate data pooling. Bringing together experts, including consumer and community members, to establish recommended measures would assist researchers and clinicians in evaluating wheelchair prescription and improve data sharing.