title: Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework.
abstract: BACKGROUND
  Wheelchairs for disabled children (≤ 18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports demonstrate the need for improved access to wheelchairs both locally and internationally. The use of health economics within this field is lacking. Provision of wheelchairs based on cost-effectiveness evidence is not currently possible. We conducted the first systematic review in this field to incorporate evidence of effectiveness, service user perspectives, policy intentions and cost-effectiveness in order to develop a conceptual framework to inform future research and service development.
  
  
  METHODS
  We used an adapted EPPI-Centre mixed-method systematic review design with narrative summary, thematic and narrative synthesis. 11 databases were searched. Studies were appraised for quality using one of seven appropriate tools. A conceptual framework was developed from synthesised evidence.
  
  
  RESULTS
  22 studies and 14 policies/guidelines were included. Powered wheelchairs appear to offer benefits in reduced need for caregiver assistance; improved communicative, personal-social and cognitive development; and improved mobility function and independent movement. From 14 months of age children can learn some degree of powered wheelchair driving competence. However, effectiveness evidence was limited and low quality. Children and parents placed emphasis on improving social skill and independence. Participation in wider society and development of meaningful relationships were key desired outcomes. Policy intentions and aspirations are in line with the perspectives of children and parents, although translation of policy recommendations into practice is lacking.
  
  
  CONCLUSIONS
  There is a distinct lack of high quality effectiveness and economic evidence in this field. Social and health needs should be seen as equally important when assessing the mobility needs of disabled children. Disabled children and parents placed highest priority on independence and psychosocial outcomes of wheelchair interventions. Translation of policy and guidelines into practice is lacking and more effective implementation strategies are required to improve services and outcomes. Future research should focus on outcome measure development, developing economic evaluation tools and incorporating these into high quality studies to address known research gaps. The novel conceptual framework maps current gaps in evidence and outlines areas for development.
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy Building, Normal Site, Bangor University, Bangor, Gwynedd LL57 2PZ, UK. n.bray@bangor.ac.uk.
authors.forename: Nathan
authors.initials: N
authors.lastname: Bray
authors.forename: Jane
authors.initials: J
authors.lastname: Noyes
authors.forename: Rhiannon T
authors.initials: RT
authors.lastname: Edwards
authors.forename: Nigel
authors.initials: N
authors.lastname: Harris
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D019988:Children with Disabilities; D019317:Evidence-Based Medicine; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D014910:Wheelchairs / Q000191:economics / Q000706:statistics & numerical data