World Health Organization Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings: Development of a Survey Tool

Keri DeGroot, OTDS, R. Lee Kirby, MD and Cher Smith, BSc(OT)

Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada B3H 4K4


Background: The provision of wheelchairs to people who need them is a complex process that, ideally, involves a number of steps within a service-delivery system. Recognizing the challenges that exist in the provision of wheelchairs in developing nations, the World Health Organization (WHO), in partnership with the International Society for Prosthetics and Orthotics (ISPO), has used a consensus-building process to develop a document – Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings – that is scheduled for final publication in the Spring of 2008. To assess compliance with the Guidelines, a simple survey tool (or “report card”) will be needed. However, as yet, such a tool does not exist.

Objective: The objective of this project was to develop a survey tool based on the Guidelines.

Methods: We reviewed the draft Guidelines and extracted from them what we considered to be the 41 key recommendations. In our survey tool, we posed these in the form of a questionnaire and rulebook. We then convened a focus-group of 6 people regularly involved in the manual-wheelchair-provision process at the Nova Scotia Rehabilitation Centre in Halifax. The main goals for the session were to get feedback on the organization of the tool and on individual questions. The results of this process were used to refine the wording of the questions.

Results: Using the draft survey tool in a group setting required less than one hour. The focus group was generally positive about the overall organization of the survey tool, as well as the wording and validity of individual questions. However, there were a number of suggestions for improvements in clarity. These were incorporated in a revised version.

Conclusions: A preliminary version of a survey tool based on the soon-to-be-published WHO Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings has been developed. This tool needs to be refined and assessed in a variety of settings before it can be recommended for widespread use. However, it appears to hold promise as a simple tool that could be useful in improving the wheelchair-provision process.


Wheelchairs, public policy, developing nations, service provision, international


We thank the members of the focus group for their assistance.

Author Contact Information:

R. Lee Kirby, Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, 1341 Summer Street, Halifax, NS, Canada B3H 4K4, Phone: 1 902-473-1268, E-mail: