Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Linda Shuster

Second Advisor

Dr. Kerri Morgan

Third Advisor

Dr. Don Hoover


Occupational therapy, policy, assistive technology, wheelchair, physical therapy


This study is a series of three studies aimed at exploring wheelchair service delivery in a department of physical and occupational therapists dedicated to wheelchair seating. The three studies utilized a retrospective analysis to investigate the clinical documentation written by the practicing clinicians between 2007 and 2017. The first study aimed to describe the wheelchair and accessory recommendations made in the 11-year period, in relationship to age and gender. The majority of recommendations in the dedicated seating department were for complex wheelchairs. The results indicated the ratio between standard and complex power mobility devices and four complexities of cushions changed, moving toward lower ratios of complex product recommendations.

The second study compared equipment recommendations made in 2017 with the actual equipment delivered by the durable medical equipment company, and examined the length of time between recommendation and delivery. The results indicated that a significant amount of recommendations were altered before delivery. Predicting differences between recommendation and delivery were more likely to occur with manual wheelchair recommendations using gender, age, funding source (public or private), and wheelchair complexity (defined in six categories). Additionally, a significant interaction was found in the length of time between complex power mobility device recommendation and public funding sources.

The third study explored how often, and for what reasons, people sought expert therapists in wheelchair seating in an attempt to understand how dedicated seating departments support people with chronic wheelchair needs. Using a mixed-methods approach, the quantitative results indicated that support needs differed between diagnoses more than age groups. The qualitative results described needs for services, session activities, and visit outcomes, but also found that a team approach and follow-up were critical. This study supported previous descriptions of best practice in wheelchair seating.

Overall, these three studies have healthcare policy and clinical implications. Wheelchair quality was utilized as a measure in all three studies, relating to currently proposed legislation to separate complex wheelchair coding categories from other durable medical equipment. Future studies that focus on wheelchair service delivery and investigate the impact wheelchair use should incorporate wheelchair complexity. This study also has clinical implications, by documenting barriers experienced by wheelchair users and service providers in the service delivery process, and exploring ways to the support of potential and active wheelchair users. The need for follow-up services, in particular, was an important theme throughout this study.

Access Setting

Dissertation-Open Access