Impact case study database

The situation for wheelchair users with complex and changing needs has been called “intolerable”, especially for children. Clinical provision and care has been enhanced as a result of impacts of this research on policy through evidence regarding the value of EPIOCs in enabling employment, education, social integration, health status and improved QoL allowing users to participate more fully in society, and enhancing personal comfort and lowering their risk of serious complications from EPIOC use.

Using this research (REF1), the NHS warned that wheelchairs poorly matched to users’ needs adversely affected activities, participation, lifestyle goals and health status, adding to cost and/or non-use or abandonment of the wheelchair (E1). Brunel research outputs underpinned the case for growing support, internationally for providing EPIOCs to encourage social and community interaction. They emphasised that driving assessment including functional and cognitive abilities and education on safety were essential for EPIOC users; a recommendation from this research into young EPIOC users. Brunel research (REF1, REF2, REF4) was used to underpin key targets for health service improvements and core service delivery standards for therapists who support people with disabilities, benefiting 1,200,000 potential chair users in the UK and an estimated 72,000 potential users in NSW Australia (E2).

Impacts on practitioners and services internationally

Professional standards, guidelines and evidence-based sources have been shaped by the research

By transforming understanding of the importance of EPIOCs for children’s development and successful transition to independence in adulthood, this evidence has broadened assessment to include provision based on the social development needs of children and young adults, not just their mobility needs. Internationally, practitioners have improved evidence-based guidelines and recommendations to enhance the quality of their professional practice.

This research has been used internationally to recommend that for children with inefficient mobility, EPIOCs enhance independence and facilitate participation in family, school, and community life. Direct use of study REF3 highlighted that to enhance EPIOC use without contributing to problematic posture and pain, supportive seating, powered seating functions and adequate suspension are important features to consider in prescription (E3, E8). Brunel research highlighted widespread debilitating suffering caused by pain (E3) and that EPIOC users related their pain to underlying medical conditions and to improperly configured wheelchairs. EPIOC users opined that wheelchair tilt functions can be used to manage pain/discomfort. This research informed influential position statements to support the application of seat functions to assist clinicians in decision-making and justifying funding (E4).

Brunel research (REF2) underpinned advice on when children should start using power mobility. The evidence was used to recommend that early utilization of EPIOCs for children with mobility limitations enhances independence, improves development in multiple areas, and enables children to grow to become productive and integrated members of society (E5, E8).

Expert international consensus now endorses the therapeutic use of wheelchairs beyond mobility assistance. Using this research (REF6), international recommendations advocate short orthoses for daytime use to prevent ankle deformity and prolong gait ability and emphasise that correctly adapted wheelchairs can prevent skin ulcers and slow scoliosis progression thereby counteracting life-threatening complications for children with muscular dystrophy (E6). Drawing directly on these findings (REF2) an international consensus group published clinical practice guidance for powered mobility in children of different ages, needs, and abilities. Recommendations based on these publications highlight the importance of EPIOCs in enhancing independence and facilitating participation in family, school and community life and that enhancing EPIOC use without contributing to problems of posture and pain, supportive seating, powered seating functions, and adequate suspension are essential features to consider in chair prescription (E7).

The research on children has been utilised by clinicians for the prescription of EPIOCs and to develop and provide hand-outs for advanced training and safety for different types of child learners and to inform and support their parents (E8). One of these hand-outs has recently been translated into Norwegian (E9) further illustrating the need internationally for evidence-based information to support child EPIOC users and their parents/carers.

Impacts on commercial companies

Material provided by companies for chair prescribers, users, payers and other purchasers has been informed by this Brunel research and used as part of the justification for costs. The research (REF5) has provided evidence-based information to prescribers and purchasers of wheelchairs, demonstrating that appropriate seating interventions, alongside competent assessment, can reduce pain and suffering, but at a financial cost which is justifiable by the enhanced wellbeing of chair users (E9). Brunel research (REF4) changed funding decisions in Canada from the provision of power tilt and recline chairs for pressure relief to the provision tilt-in-space features that give users the ability to autonomously control comfort, rest and pain reduction (E10). Brunel research has changed perceptions of the role of EPIOCS from mobility aids to enhancing the engagement of severely disabled adults and children in society. It has contributed to developing the market and international clinical guidelines impacting 1,200,000 UK, 1,700,000 USA wheelchair users and approximately 131,800,000 people needing wheelchairs worldwide.